introduction

The spinal disc protrusion ( disc protrusion ) is a degenerative, ie wear-related, disease of the spine. Here it comes, as the name already says, to the protrusion of an intervertebral disc into the spinal canal. This can lead to compression of nerve fibers or even parts of the spinal cord, which usually results in severe pain or even neurological symptoms.

Disc protrusion is often referred to as an incomplete herniated disc. In contrast to the complete herniated disc ( prolapse ), however, there is no tearing of the shaping fiber ring of the disc. A therapy of this disease is tedious, but leads in most cases to the freedom from symptoms. An operation is rarely performed.

symptoms

In many ways, disc protrusion may be considered a precursor or a mitigated form of prolapse . So their symptoms are similar to those of a mild disc prolapse. However, it should also be noted that many cases of disc protrusion are completely symptom-free or only associated with mild discomfort. They are then ( if at all ) often only discovered as incidental findings in the context of the investigation of another disease.

If a disc protrusion is conspicuous, this usually happens with quite severe pain. Depending on the height of the spine, the protrusion may damage different nerve fibers, so that the pain in characteristic body regions. As on other spinal sections, this can be back pain on the one hand. Especially for the lumbar spine ( lumbar spine ), however, pain in the buttocks, legs and feet, but especially in the anterior and lateral thigh, and the dorsum, typical.

In addition, neurological symptoms can occur in the aforementioned body regions. Non-painful paresthesia and numbness are among the classic symptoms of disc protrusion. These sensations can be presented in very different ways. Frequently a tingling, " running ants " or itching is described.
In the case of a more serious manifestation of the diseases, motor disorders can eventually lead to a feeling of weakness and fatigue of the leg muscles.

All of these symptoms may increase or decrease depending on the current posture. Frequently described is an amplification of complaints in stooped posture.

Pain

Frequently, a disc protrusion of the lumbar spine is completely painless. Even with sudden onset of pain there is often a painless disc protrusion for many years. If the protrusion develops very quickly, it can be accompanied by severe pain. In particular, when the disc protrudes in the direction of the spinal canal and presses on the nerve fibers, this can lead to severe discomfort.

The pain itself is described as dull pain in the hollow back of the lower back. He sits low and can flare up with a slight movement and be piercing. Unfortunately, there are often symptoms along the lumbar spine along the exiting nerves. Pain from the spine, over the buttocks, to the legs, feet and toes can result.

For the therapy, it is of enormous importance to reduce this dull pain in the lumbar spine with painkillers. Only through movement and targeted muscle strengthening can the disc protrusion of the lumbar spine be controlled in the long term. By the time this point is reached painkillers will need to allow a painless movement of the spine.

causes

Although disc protrusions can in principle occur at any level of the spine, the lumbar spine is still the most commonly affected by far. Most of the protrusion is at the level of the disc between the lumbar vertebrae 4 and 5, just below the iliac crests. This has the simple reason that the largest body weight rests on this spinal column section and the strongest leverage forces, such as when heavy loads are used, work. Another factor that promotes the development of prolapse is normal age-related signs of wear and tear.

However, other factors are considered to be the main cause of the occurrence of disc protrusions. These include genetic weaknesses of the intervertebral disc structures, one-sided strains on the spine or a weak back muscles. This view is confirmed by the rapidly increasing number of disc protrusions and incidents in our time of lack of exercise and office work.
At the same time, studies have shown that obesity from a BMI of 27.5 or higher has the potential to reduce the risk of disc disease. In addition, an accident or injury-related cause of disc disease is often discussed. However, this has not been confirmed to date.

diagnosis

An initial suspected diagnosis is usually made on the basis of clinical symptoms in combination with positive clinical tests, such as attenuated lower extremity reflexes. The final diagnosis of spinal disc protrusion of the lumbar spine is then made by magnetic resonance imaging of the spine ( MRI ). Even in a CT a herniated disc is usually well visible.

What to do?

If a diagnosis of disc protrusion has been made, therapy should be started as soon as possible to prevent disease progression. For this purpose, a treatment plan should be worked out with the attending physician and the next treatment steps discussed.

Despite the need for bed rest and physical protection, it is still important to maintain some physical activity, provided that no neurological symptoms ( abnormal sensation, muscle weakness ) occur. Otherwise, there is a danger of being trapped in a vicious cycle of inactivity, muscle breakdown and symptom intensification.
In order to allow a painless movement, it should not be dispensed with the use of painkillers. Particularly suitable for long-term use are especially painkillers from the group of the so-called NSAIDs, which include, for example, ibuprofen, diclofenac and naproxen ( Dolormin® ).

Although exercise is conducive to the treatment of spinal disc protrusion of the lumbar spine, heavy exercise should still be avoided. It is equally important to pay attention to a healthy posture in everyday life.

Conservative therapy of disc protrusion of the lumbar spine

The treatment of an intervertebral disc protrusion is in almost all cases conservative, ie non-operative. If used consistently, almost all patients will enjoy a comfortable life without serious limitations in everyday life. In addition to the basic behavioral strategy described above as a result of the diagnosis of disc protrusion, especially physiotherapy and back exercises play an important role, since the spine can be relieved by a strong back muscles significantly.
Additionally, in some cases massage, heat treatment or acupuncture may be helpful for further pain and relaxation therapy.

If the protrusion is severe, wearing a supportive corset may be necessary. Similarly, if other pain therapies are not sufficient, injecting local anesthetics or cortisol may improve the symptoms.

Exercises for the disc protrusion of the lumbar spine

Exercises in the disc protrusion should primarily aim to strengthen the trunk muscles

Even though analgesics can relieve the symptoms of disc protrusion, they still do not fight their cause. An important component in the therapy of spinal disc protrusions is therefore the training of the trunk muscles, but in particular the so-called autochthonous back muscles, which is particularly important for the stability of the spine. A whole series of exercises and sports are suitable for this.
For example, the so-called " bridge " is very classic for training the back muscles of the lumbar spine. In this case, the buttocks is raised repeatedly in a supine position, but the back maintains a straight posture.

When training the core muscles, it is important not to neglect any muscle group. So should also be trained in the context of exercises for the back muscles and the abdominal muscles. It is best to talk to your doctor or physiotherapist about how to perform and select specific exercises.

When is an OP necessary?

Surgery is a very rare and often unpopular therapeutic alternative to disc protrusion. Lumbar spine protrusion can be treated successfully in most cases with conservative therapy that is targeted and disciplined to strengthen the back. But even with the approximately 10% sufferers who do not benefit from a conservative therapy, surgery is often not useful.

Since the disc protrusion, in contrast to the herniated disc is not a rupture of the disc, the possibilities in an operation are severely limited. Modern surgical procedures allow the intervertebral disc tissue to be pushed back and removed with only a small cannula. It turns out, however, that the ratio between the risk of surgery and the benefit for the intervertebral disc is very small. An OP is thus almost never necessary for the disc protrusion of the lumbar spine.

OP of the disc protrusion of the lumbar spine

Disc protrusions are rarely treated surgically. In more than 9 out of 10 patients the conservative treatment described above leads to an improvement of the symptoms, often even to a freedom from symptoms. An operation is usually considered only if neurological deficits such as paralysis appear, so there is a risk of serious nerve damage.
The benefit-risk factor of an operation should be well estimated. Above all, it should be considered that surgical intervention always entails various risks. For example, it can lead to complications in anesthesia or wound healing. In some cases even a worsening of the symptoms after surgery may occur.

Sport with a disc protrusion of the lumbar spine

After the diagnosis of spinal disc protrusion, the question arises for many patients as to whether and to what extent further sport may or should be continued. It can be clearly stated that sport is indeed an important part of the treatment of disc protrusions. Sport is therefore urgently recommended for the treatment of disc protrusion, as the disease often arises as a result of inactivity, obesity and muscle weakness. The ultimate goal of physical exercises should be to strengthen the back muscles, but without overloading the back. It is also important that there is no pain when practicing sports, as this in turn can lead to bad stress. With initially severe pain should be started slowly with the sports structure.

On the one hand, this can be done through specific strength and movement exercises, such as in a gym.

The sports also play a role in the disc protrusion of the lumbar spine. To strengthen the back and not unnecessarily burden some sports should be preferred to others.

Highly recommended are sports that train the core muscles, improve posture and coordination and are gentle on the joints. These include, above all, endurance sports such as swimming ( but especially backstroke and crawling ), hiking and table tennis. Strength training is another gentle and encouraging activity dar. Sports that are associated with jumping, must be handled with care at first. These include, above all, skiing or basketball. However, since the limitations of the disc protrusion are very individual, even sports such as dancing, cycling or ball sports can be perceived as pleasant and helpful.

Forecast and duration

The duration depends on the extent of the disc protrusion, the implementation of a disciplined therapy, the personal risk factors and the accompanying pain. With immediate control of the risk factors, targeted muscle growth and a slight spinal disc protrusion, the disease can be quickly managed. Only a few weeks can lead here to alleviate the symptoms. The control of the disease and the prevention of other disc diseases but lifelong.

The duration is different for more severe cases of disc protrusion. If there is already a lot of pressure on the nerves, the fibrous ring of the intervertebral disc is already damaged and inactivity and overweight come to it, the duration can be delayed. The symptoms can be chronic for a few months in such cases. A subsequent herniated disc is not uncommon.

Duration of treatment of disc protrusion of the lumbar spine

The treatment of disc protrusion is a lengthy affair and is influenced by a number of factors. Depending on the severity and exact location of the disease, the discomfort may be of very different duration. In addition to the degree of protrusion, the main influence here is how disciplined the treatment and training plan is on the part of the patient.
Despite proper treatment, disc protrusion of the lumbar spine may nevertheless develop into a lumbar disc herniation. However, this is rarely the case.


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