Foraminal disc hernia l4-l5, l5-s1, l3-l4

Foraminal hernia of intervertebral discs is fraught with rapid progression of the disease and strong pain, affecting the quality of human life. 4-10 cases out of a hundred people with a diagnosis of disc herniation violation of the integrity of the fibrous ring occurs in the foraminal openings. The spinal cord is located along the spine, and securely covered with the dural sheath, from which depart two spinal nerve with sensitive flexible spine.

Bony foraminal is a hole, in which lie the roots of the spinal nerves. It is formed in the lateral parts of the spine and is located between the articular processes of the vertebrae. The channel has a length of 1.5 inches. In the protrusion of the fibrous ring, which creates pressure on him, there is a compression of endings, resulting in sharp brain receives a signal about the formation of pathology.

Foraminal hernia can occur in several places, and therefore there are four types of protrusions:

• Interforaminal or dorsal location within the bore;
• Foraminal medial – at the entrance between the vertebrae;
• Lateral directly from the output;
• Extratraining lateral protrusion is located outside the intervertebral foramen, or at the root of the vertebral arcs.

Gryzenia pathology accepted to qualify for the left and right side. They are also divided into cervical, thoracic and lumbar, depending on the localization.

Causes

A complex system structure of the musculoskeletal system sometimes faltering. Certain segments of the spine experience increased stress, resulting begin to work to wear. This can cause cracks, which begins to irritate and injure the roots.

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Among the major reasons of herniation of the foraminal region of the hole, leading to deformation of the annulus, should provide the following:

• Uneven load distribution on the skeleton of the back during physical work or sports;
• Injuries of the spine;
• A regular finding in one position while a sedentary lifestyle;
• Wrong food, bad habits (Smoking, abuse of alcoholic drinks) and insufficient water intake;
• Genetic predisposition due to mutation of the collagen fibers forming the fibrous ring, reducing its strength;
• Age-related changes with the deterioration of blood circulation and the appearance of protrusions;
• Extra weight creates additional stress on the vertebrae;
• Wearing uncomfortable shoes or flat feet.

See also: diffuse disc protrusion l4-l5.

Characteristic symptoms

Foraminal herniated disc is different from other similar pathologies the fact that the development of the disease the person experiences sharp and very acute pain because the affected nerve endings directly connected with the spinal cord

Dre the damage of the nerve roots in the neck

Cervical foraminal hernias occur less often. They are formed in the discs C5, C6 and C7. Appear headaches of varying intensity, dizziness, decrease in hearing and vision (floaters before the eyes), muscle weakness, numbness of fingers and also discomfort in the affected area. Rarely observed speech disorders and changes in gait. Damage to the neck that can cause these pathologies may be consequence of the result of a direct blow (for example, trauma from automobile accidents or during sudden immersion into the water upside down).

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Dre the nerves in the lumbosacral

Most common are bulging in the lumbar and sacral-lumbar the spine, since this area is created for the maximum load. Experts refer to these areas of the skeleton backabbreviations l5-s1. Depending on which vertebrae of the disruption of the integrity region of the annulus, the disease is accompanied by a digital designation. For example, a herniated l3-l4 is characterized by the presence of pathology in the lumbar spine between the third and fourth vertebrae.

Among the symptoms patients report:

• Sudden intense pain in the affected area, which can be removed only by a strong analgesic drug, in some cases, even a narcotic drug. The change of position doesn't bring relief;
• A sharp decline in the sensitivity of the feet. During protrusion the patient can not be on the toe or heel. With the release of the ring outside the disk may complete immobilization of the lower extremities;
• The decrease in activity as a result of loss or weakening of tendon reflexes.

It should be noted that foraminal herniated disc has an acute onset and is poorly amenable to analgesic therapy. The pain did not stop for a long period. Conservative treatment methods are ineffective. Herniated l5-s1, l3-l4 and l4-l5 are eliminated exclusively by surgery.

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Diagnostic methods

To visually detect the presence of disease can only highly skilled after a thorough examination and patient questioning. For confirmation of the diagnosis can be assigned to the following diagnostic methods:

• Ultrasound and x-ray. These methods allow to exclude the presence of concomitant diseases of the spine. To determine the size of the protrusion cannot thus;
• MRI and CT scan. CT and magnetic resonance imaging allow you to see the damage in 3D with an accurate assessment of the location, size of the hernia SAC and the condition of nerve endings.

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The gold standard for diagnosis is considered to be an MRI because the patient is not exposed to x-ray radiation, but the technician can get complete information about the destruction of cartilage tissue, localized swelling, condition of the nerve roots, resulting in further treatment is assigned is the prediction about the possible development and course of the disease.

Treatment

With such a diagnosis, there are two versions of events. For minor injuries the patient may help the treatment of conservative methods. If such techniques had not produced the expected effect, will be appointed surgery.

Conservative therapy

In the first stages the patient will be offered conservative therapy including analgesics and non-steroidal anti-inflammatory drugs. All medicines will reduce the tension of the muscular system, relieve pain and swelling, and improve the nutrition of tissues in the damaged area. As adjuvant therapy, the specialist will prescribe massage, acupuncture, advice from a chiropractor and physical therapy.

All activities will focus on stretching the spine to release the nerve endings and reduce pain threshold. Helps to wear a special brace. It is desirable to sleep on a hard surface. If possible, it is better to purchase a pillow top mattress.

To reduce the size of tumors, used electrophoresis with injection of drugs.

Surgery

Surgical intervention is shown in the case, if a hundred days of traditional treatments have not brought significant relief, and the pain became chronic. The operation is also assigned if the tumor is in size more than 10 mm and there is paralysis of the limbs.

Procedure carried out by neurosurgeons at the clinic. There are four methods of intervention:

• Microdiscectomy. The removal of the intervertebral disc with the elimination of pressure on the nerve endings;
• Laminectomy. Eliminated sections of the intervertebral disc and part of the bone in the area of the damaged area;
• Interspinal spacers. The method consists in installing implants that reduce pressure on the backs of the disadvantaged;
• Transformingly endoscopy. Is carried out by puncture with the needle insertion and subsequent removal of a small part of the disk and sequestration. This allows you to restore the shock-absorbing feature of the vertebra with pain relief.

Rehabilitation

After the procedure or surgical intervention, the patient will need to undergo a course of rehabilitation aimed at restoration of physical activity, strengthening of a muscular corset and to minimise the risk of relapse. It is recommended to do physical therapy, use of the pool under the coach's supervision, to reduce the working time at the computer, to eliminate the physicalload and being behind the wheel for the first two months. To delay trip to the doctor is not necessary, since delayed treatment can lead to negative consequences including paralysis of the limbs.