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What causes disc herniation in the lumbar region?
Lumbar disc herniation is closely related to the structure of the disc. The intervertebral disc consists of two parts - a dense circular ring that contains a thick gel-like core. The intravertebral discs are essential and important structures functioning as shock absorbers (provide cushioning between the vertebrae), they are integral for maintaining posture and permitting a wide degree of movement, they also provide support to the adjacent vertebrae of the spine
A disc hernia forms when the outer ring of the intervertebral disc ruptures and the core inside the disk ring protrudes through the rupture site outside the ring. Symptoms of intervertebral disc herniation present themselves when the nucleus of the disk protrudes in the vicinity of, or directly into an adjacent nerve. Complaints are therefore tied to the innervation region of the affected nerve (in the case of the lumbar spine - all nerves descend and innervate the legs. Sometimes the herniation happens in a direction that does not come in contact with any nerves, in such a case lumbar disc herniation can be completely asymptomatic.
Disc protrusion is an often finding on radiological examinations. Unlike in the case of a disc hernia, in the case of disc protrusion the structural integrity of the disc itself is preserved, it is instead deformed or dislocated. Small/insignificant disc protrusions are seen in almost every examination (magnetic resonance imaging or computed tomography), but they seldom cause symptoms. It is, however, possible for a disc protrusion to be large enough to depress an adjacent nerve and trigger the corresponding nerve impingement symptoms.
What are the factors that increase the risk of developing a disc herniation?
Intervertebral disc herniation is a common disease. It mainly affects individuals between the ages of 25 and 50. Men get this disease about two times more often than women. Heavy physical labor increases the risk of both the illness and its recurrence. Not only does increased body weight significantly increase the risk of developing a disk hernia, it also increases the risk of disk hernia recurrence, and furthermore, increases the risk of redeveloping a disc hernia by approximately 12 times in patients who have undergone a microdiscectomy operation.
Smoking (nicotine) reduces the blood supply to the intervertebral disc, which in turn contributes to the degeneration of the disc (worsening and aging of cellular functions) and delays its healing.
Of course, disk herniation can occur in anyone and at any age, and for no known reason.
Symptoms of disc herniation tend to occur for no discernible reason, but sometimes it is associated with lifting weights, clumsy turning, pushing, or pulling. As the pressure and load on the spine increases, especially in people with weak and poorly developed postural muscles, the disc may puncture, burst, or rupture, which in turn may have an effect on the adjacent nerve root that directs impulses to the foot. The result is severe shooting pain in the buttocks and leg.
What could be the symptoms of lumbar disc herniation?
Leg pain (radicular leg pain aka sciatica) This pain is usually much more severe than back pain. The pain may be sharp, shooting, persisting.
Back pain. May be encountered in the early stages of the disease.. If the pain is experienced, it is usually much less expressed than leg pain.
Tingling and/or numbness in the leg, observed less commonly in both legs.
The localization of pain and numbness depends on the level at which the disc herniation is located (between which vertebrae). Symptoms may manifest themselves in the buttocks; front or back of thigh; lower leg; front, back or side of the leg; at the foot. Symptoms are commonly present in only one leg.
Pain is provoked by movement. Patients will complain of pain exacerbation after lengthy sitting, standing or walking a short distance. Sneezing, coughing and laughing can oftentimes cause severe pain.
Muscle weakness. Dangerous symptoms showing a very strong nerve compression.
Urinary disorders (urinary incontinence, painless or painful urinary retention) and defecation disorders, saddle anesthesia (?) and weakness in both legs are rare (1% to 2% of disc herniated operations) but very dangerous symptoms. Medically it is called equine (many nerves of the lumbar and sacral region) compression (impingement) syndrome. In the case of major disc herniation and equine compression syndrome there is a very high risk, about 45%, that even after a successfully performed decompression surgery some dysfunction of urinary and/or bowel continence and sexual function can persist.
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