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Herniated disc in the lumbar spine

In Germany, statistically approximately 27-40% of people have back pain. About 70% have pain at least once a year and about 80% complain about back pain at least once in their life. From all sections of the spine, the lumbar spine (LS) is most frequently affected. After infections of the respiratory tract, the second leading cause of doctor visits is back pain. For men, the most common cause for a loss of working hours is back pain with 14%, and for women, with 11% it is the second most common cause. The most commonly, back pain appears in the age group of 50 - to 70-year-olds.

In connection with back pain, disc herniation is of importance; other labels are disc prolapse, herniation, nucleus pulposus-prolapse. Most commonly, herniated discs occur in the lumbar spine between the 4th and 5th lumbar vertebrae and the 5th lumbar vertebrae and the sacrum (S1), where the disc pressure is the highest. Under this continuous exposure of the fiber ring it will brittle (it dries out and loses its elasticity) and it comes to small cracks. These are mainly located in the rear section of the fiber ring, because there are small scars left behind by former vascular supply of the intervertebral disc and weaken the fiber ring. While in most cases, a self-healing occurs, with further progress of such lacerations, it comes to a pushing of the nucleus pulposus tissue (under pressure) into these fissures, and thus to a bulging of the disc, which is called a disc protrusion. The passing of nucleus pulposus tissue (soft core) through the fiber ring or from the fiber ring out, is the actual disc herniation. The functional significance of the herniated disc consists of an irritation or compression injury of spinal nerve roots (the so-called root compression syndrome).

Leading symptom of a herniated disc are radiating pains outgoing from the back into leg or foot. Typical names for this are lumbago or sciatica. Numbness and paralysis may also occur, when the pressure of the herniated disc on the nerve root is very strong. For the individual nerve roots, there are characteristic muscles, such as L5-syndrome with weak dorsiflexion or the S1-syndrome with weak plantarflexion. Emotional disturbances related to the skin areas supplied by the nerve (dermatome). For the L5 root, it is the tibia and the big toe, for the S1 root, the outer foot and the heel.

Treatment measures are primarily dependent on the type of pain, the neurological deficits and visual-morphological findings although basically distinguished between conservative, minimally invasive and surgical treatment (microsurgical or endoscopic surgery). The therapy would involve a step diagram. If a therapy does not show the desired result within a time window of 3-4 weeks, then the next step must be "scaled". At long adherence to a treatment without improvement may lead to chronicity of the complaints with the emergence of pain memory, and to fixation of poor posture because the muscle attachments are reduced, the joint capsules are shrinking and herniated discs are being calcified. In late stages of it, various forms of spinal instability and deformation result. This is why the motto that surgery should be delayed as much as possible is not always true, because in a very advanced stage of degeneration or wear certain therapies are not possible (such as the artificial disc), more elaborated reconstruction and stabilization operations must be performed.