As a rule, conservative therapy is the first line of treatment for degenerative diseases of the lumbar spine.
But non-surgical treatment of lumbar disc herniation is not always successful, and in the presence of sequestration or persistent neurological symptoms, it is possible to use surgical techniques to remove the disc herniation. Surgical treatment is performed under general anesthesia. Operations can be either minimally invasive using endoscopic techniques or open type with fixation and the use of instrumentation. Long-term results after surgical treatment depend both on the quality of the operation and the presence of full rehabilitation in the postoperative period.
Treatment methods for spinal hernia without surgery: which one to choose?
Intervertebral hernia is one of the most common diseases of the spine.
Every hundredth inhabitant of the earth suffers from it, including children. Therefore, it is understandable that many people are interested in how a hernia is treated? Are there methods for treating spinal hernia without surgery? Which ones are most effective?
Conservative methods in most cases provide excellent results in the treatment of hernia. Only in 10% of cases is there a need for surgical intervention.
Before starting therapy, the patient is referred for diagnostics. Usually an X-ray or magnetic resonance imaging is performed. Only based on the results obtained, the doctor will be able to choose the optimal method of therapy.
Treatment of intervertebral hernia
At the European Center for Orthopedics and Pain Therapy, they try to use conservative methods of treating hernias, resorting to radical intervention in extreme cases. For effective treatment, early consultation with a doctor is important. Don't self-medicate! Elimination of pain does not mean that the hernia is cured!
Treatment of intervertebral hernia comes down to the following steps:
Gentle mode. First of all, it is necessary to unload the spine. To do this, you need to remember basic things:
- sleep on a high-quality bed frame and orthopedic mattress;
- do not curl up during sleep in a corkscrew fashion (when the lower part of the body is on the stomach and the upper part is on the side);
- use individual insoles and comfortable shoes;
- be sure to get rid of excess weight;
- distribute the load on both hands;
- when lifting weights, do not ignore the aids (bag on wheels, belts for carrying weights, etc.);
- stretch and stretch your back muscles;
- avoid sudden swinging movements;
- at the first signs of fatigue - rest, if possible, rest lying down;
- according to doctor's indications, use an orthopedic bandage to relieve the spine (especially during physical activity)
Drug therapy
Medicines are prescribed to relieve acute inflammation and reduce pain; muscle relaxants are used to relieve spasms and relax muscles. In the initial stages of the disease, the doctor may prescribe chondroprotectors.
Physiotherapy
For hernia, even in the acute period, physiotherapeutic procedures may be indicated. But under no circumstances should you warm up the hernia yourself! Only a doctor, after examining the patient and analyzing examination data, can prescribe a course:
- UHF
- ultraphonophoresis;
- electrophoresis;
- laser;
- magnetic therapy
All types of physical therapy should only be performed under the supervision of a physician. After the sessions, metabolic processes are restored, muscle spasms disappear, and pain decreases.
Manual therapy
Manual therapy is very popular in the treatment of hernia. Thanks to massage, deep muscles are developed and the vertebrae return to their physiological position. The qualifications and experience of the doctor are important; contraindications and concomitant diseases must be taken into account. Otherwise, a course of manual therapy may provoke complications and worsening of the condition.
Special gymnastics
High-quality and correct therapeutic exercises can strengthen the muscular frame, achieve spinal traction and improve blood supply to the tissues surrounding the disc. Exercise therapy goes well with swimming. The exercise plan is selected individually, the emphasis is on performing physical exercises aimed at developing flexibility and mobility of the joints without putting stress on the spine. Only the doctor must select an individual set of exercises suitable for the patient, taking into account the location of the hernia and its stage.
The main rules for performing gymnastics for intervertebral hernia:
- the patient must perform the exercises carefully and carefully, avoiding spinal torsion and heavy lifting;
- all movements are performed slowly, taking any position, it is held for 10-20-30 seconds;
- all actions should be aimed at gentle traction of the spine;
- exercise should not cause discomfort
As a result, metabolic processes in the muscles are activated, and the initial contraction turns into relaxation. The joints become mobile and the muscles elastic. For some patients, the doctor recommends special traction, which requires medical equipment. In this case, sessions are carried out in an equipped office under the supervision of a qualified orthopedist.
Radical intervention
If all of the above methods do not help and the pain persists for 1.5 months, then surgical treatment is resorted to. Despite the fact that operations to remove a hernia are considered minimally invasive, they are used quite rarely - in cases of severe neurological pathology or changes in the functioning of internal organs.
Surgical methods can be traditional and minimally invasive.
If the purpose of the operation is to expand the spinal canal, then laminectomy is used, that is, the vertebral arch that limits the spinal column at the back is removed. Sometimes it is necessary to remove the arches of several vertebrae.
If the purpose of the intervention is to directly remove the hernia, then an open or endoscopic discectomy is performed. The most common and effective method today is microdiscectomy. Removal of the hernia takes place without traumatizing the surrounding tissues using special miniature instruments under the control of optical equipment. This operation is accompanied by a minimal number of complications and a quick recovery period. The next day the patient returns home.
If during the operation the disc is completely removed, then a B-Twin implant is installed in the lumbar region to stabilize the spine or the vertebrae are fixed with special structures to strengthen the spine.
Innovative technologies of surgical treatment are:
- laser puncture vaporization - used for small hernias without canal stenosis and disc destruction (a needle is inserted through a puncture in the disc, through which a laser LED passes, a directed laser beam eliminates the pinching, the pressure inside the disc decreases, signs of a hernia disappear).
- intradiscal electrothermal therapy – for severe pain, but in the absence of degenerative changes in the disc (coagulation of nerve endings occurs due to “welding” of fibers when a special heating electrode is inserted into the disc)
Minimally invasive methods are easily tolerated, the hernia is eliminated in a short period, and the possibility of relapse is minimal.
Rehabilitation period
The rehabilitation period is usually quick and painless. Literally on the 2-3rd day the patient is discharged from the hospital. In the postoperative period, the most important thing is to gradually increase the physical load with anatomically correct execution of all movements. The goal of rehabilitation is to develop joints, strengthen the muscular frame, restore (improve) limb mobility, and eliminate neurological complications
Important rehabilitation tips:
- Exercise therapy exercises should be performed carefully - their goal is to strengthen the back muscles and develop the flexibility of the ligaments that support the spine;
- if you have extra pounds, you need to get rid of them by switching to a diet with a predominant content of fruits and vegetables and limiting starchy and sweet foods;
- to consolidate the effect, it is recommended to wear a special corset;
- you can sit down only after the doctor’s permission - if you sit down ahead of time, the stitches may come apart;
- You need to get up carefully for a month with a straight wall, carefully listen to your feelings;
- the mattress must be orthopedic;
- It is necessary to avoid swinging movements and sharp turns of the body;
- mandatory monitoring by a rehabilitation specialist
If you strictly follow the doctor’s recommendations, postoperative recovery will consolidate the effect and prevent the development of complications.
Hernia is a rather dangerous and unpredictable disease. Now there are many ways to treat it, only a doctor can choose the best option. Remember, it is important to immediately begin treatment for a hernia as soon as it is identified!
Therapeutic methods
Methods for treating a herniated disc without surgery include:
- maintaining bed rest and limiting exercise;
- drug therapy;
- manual therapy and massage;
- physical therapy;
- traction – stretching of the spine;
- physiotherapy;
- reflexology;
- kinesiotherapy;
- laser therapy;
- cryotherapy;
- hirudotherapy;
- folk recipes;
- auxiliary techniques.
The optimal result will be achieved by a combination of several methods.
Manual therapy
Manipulations performed by a chiropractor often help reduce symptoms of a herniated disc in the lumbar spine. Before performing the procedure, the chiropractor must review the patient's medical history, imaging data, and conduct orthopedic and neurological tests.
For each specific patient, the chiropractor selects an individual program of manipulations and other chiropractic methods.
Manual therapy procedures with pain relief
Manual therapy under light anesthesia, which lasts only a few minutes, is used to treat some spinal conditions. The procedure is performed in an outpatient center or hospital and the duration of sleep and session is short, about 6 minutes. While the patient is under anesthesia, the chiropractor stretches and manipulates the affected area while the patient's body is in a relaxed state. This procedure is usually performed 1-3 times, with intervals of 2-4 weeks between them.
Drug treatment
Medicines will stop inflammation and relieve pain.
Drug therapy includes:
- analgesics (diclofenac, ketorol, ibuprofen) – eliminate pain;
- anti-inflammatory non-steroidal drugs (rheumoxicam, meloxicam) - stop inflammation and reduce pain;
- steroids (only in rare cases, no more than three times a year);
- muscle relaxants – relieve muscle spasms;
- chondroprotectors – activate regeneration processes and promote cartilage restoration;
- vitamin complexes, which necessarily contain B vitamins, improve the trophism of damaged cartilage and nerve fibers.
Medicines can be used both in tablet form and in the form of injections. For severe pain, novocaine blockades are performed. They relieve inflammation, swelling, spasms, and relieve pain. Blockades are combined with vitamins and calcium to strengthen ligaments and bones and activate regeneration processes.
Spinal traction
Traction has an effective effect. It stretches the spine, increasing the distance between the vertebrae. As a result, the nerve structures are relieved of compression, which relieves pain, the discs are aligned, inflammatory processes are reduced, and blood circulation is normalized.
Daily traction (it can be done at home) will completely get rid of problems with the spine. The exercise can be performed on the Evminov board (if it is not available, a regular board will do) or a horizontal bar.
Relevance
Currently approved drugs for the treatment of back pain provide low or moderate pain control, which necessitates the search for new therapeutic approaches.
In particular, researchers are trying to identify groups of patients who may benefit from antibiotics. A new study assessed the effectiveness of a 3-month course of antibiotic therapy in patients with chronic back pain, previous herniated disc and Modic endplate changes.
Physiotherapy
You can begin physical therapy only after pain has been relieved. It is best if a physiotherapist selects a set of exercises. You need to repeat the exercises 3-5 times a day. They normalize blood circulation, improve the nutrition of cartilage, and restore the elasticity and mobility of the spine.
You should pay attention to the fact that jumping, sudden movements, and twisting exercises are contraindicated in case of a hernia. The load and number of approaches are increased gradually. You cannot do it through force: if some exercise causes pain, then it should be excluded from the complex for a while.
Traditional methods
As additional measures, you can use folk remedies: compresses, ointments, decoctions, infusions and tinctures, which can be used both externally and internally. They will stop inflammation, improve blood circulation and relieve pain.
But folk remedies are mainly used for lumbar hernia. For cervical and thoracic hernia, they are ineffective.
The most effective measures include warming compresses:
- The spine area is rubbed with camphor oil and covered with a cloth soaked in heated milk. Wrap up well for several hours. Then the back is again rubbed with camphor oil and wrapped until the morning.
- Grind mummy tablets (5 pieces), mix them with water (20 milliliters) and honey (100 grams). The spine area is rubbed with fir oil, and then the resulting mixture is applied.
- Larkspur root (50 grams) is crushed and mixed with honey (20 grams). The resulting cake is applied to the area of the hernia, insulated and left overnight. It is recommended to drink a diaphoretic beforehand.
- Red clay is soaked, heated to 37°C, placed on gauze and applied to the damaged area.
- Horse fat is smeared on cellophane and applied to the affected area.
For compresses to have the desired effect, the procedures must be repeated for at least a week.
