Index
¿WHATÉ IT IS A HERNIATED DISC L5-S1?
As we have already discussed on some occasionón, Things you may not know about the spine 5 vélumbar vertebrae, and laterés the column containsúto with the sacrum. The L5-S1 segment isá constituted by the vértebra L5, intervertebral disc, facet joints, m ligamentsúsculi and first sacral vertebra.
A disc herniation occurs when the contents of the L5-S1 intervertebral disc leak out of the disc and into the lumbar canal., sometimes the disc material can compress and affect the nerve structures. when we have an L5-S1 hernia, the ra can be affectedíz L5 as it exits through the hole formed between the two vévertebrae, y la raíz S1 before it leaves the column. If the hernia is too bigén the sacral roots can be affected and produce a sícauda equina syndrome.
SÍNTOMAS
When a hernia occurs, it can happen that one or more of the nerve structures that are at this level are compressed.. He símain symptom that we are going to have is a ciática.
One thereáTica is radiating pain that travels down the back of the thigh and down the leg to the foot.. Usually associated with weakness and sensory disturbances. At the level of the L5-S1 segment we can have affected the raíz L5 daysíz S1 and the dural sac, pudéndose affect meás of one nervous structure at a time themselvesún the sizeñor hernia or narrowing of the lumbar canal.
LEFT L5-S1 DISC HERNIA VS RIGHT L5-S1 DISC HERNIA
The síSymptoms of a left L5-S1 herniated disc are the same as those of the left herniated disc, it úonly thing to changeía is the leg through which the pain radiates. In the case of very large central hernias, the 2 legs
Síntomas L5: Suníz L5 at the level of L5-S1 can be affected by lateral hernias, they don't have toé be very large since many times we have associated a narrowness of the foramen of conjunctionón (remember that the raíz L5 leaves the column through the hole formed by the vértebras L5 y S1). Suníz L5 también can be affected by central hernias más voluminous. the clíonly caused by compressionón de la raíz L5 due to a herniated disc L5-S1 is a ciática that runs along the buttock and down the posterolateral aspect of the thigh, lateral aspect of the leg and dorsum of the foot. Many times they have associated weakness to get on heels.
Síntomas S1: In this case we will have a pain radiating through the buttock, posterior aspect of the thigh running down the lateral aspect of the leg and foot. UsesíWe love weakness to curl our toes and stand on our toes and the áarea with altered sensitivityíto the outer face of the leg and foot. Suníz S1 is responsible for the reflex hereíI read that I will have itíamos diminished.
Síntomas por compresióno of dural sac: Very large hernias can cause compressionón of the dural sac and give a set of sísymptoms known as Sícauda equina syndrome consisting of saddle anesthesia, tenderíthus less sensitivity on the inner side of the thigh genitals and floor pélvic and péloss of control of sphyíinterest and impotence. The Sícauda equina syndrome is an emergencyéit says it requires a decompressionón urgent.
DIAGNÓSTICO
magn resonanceética. It is the best test to diagnose the pathologyía discal and in which we see with más clarity the neural structures. Although it is necessary to put the imáresonance genes with the sísymptoms since on many occasions findings appear that have no repercussionsón clíunique and we run the risk of being attributed some sísymptoms that do not correspond to them, of AHí The importance of going to a specialist in pathologyía of the column that knows how to properly interpret your sísymptoms and give them a correspondence in the imprintsámagn resonance genesética.
Electomyografía. It is a test that will indicate that raíz o raíthis isánot affected. Remember that a raíz can be affected at different levels, dayífrom L5 travelíto be affected at level L4-L5 o L5-S1. At the electromyographía consists of placing electrodes on the leg throughés of which we are going to pass some currents, We will measure the time it takes for theímule theéctrical in reaching the foot and if intensity of signal is lostñalong the route. In the event that the time it takesñal-eléctrica is greater or it arrives más débill to end electrode, we can say that raíz isá affected.
TREATMENT OF L5-S1 DISC HERNIA
In principle the ciáTica caused by a herniated L5-S1 disc is a benign process that resolves itself.ówhat in 8-12 weeks. However, in some cases we will need to perform a decompressionón and remove the herniated disc. In cases of severe pain that we cannot control in any way, pésignificant loss of mobility orícauda equina syndrome, Eastá indicated to perform a surgeryíthe urgent or preferred.
PHARMACOL TREATMENTÓGICO
In the early stages of pain we will use analgesicéyes we can use paracetamol or NSAIDs (anti-inflammatory), spasm can be reduced by muscle relaxants. In the case of not being able to control the pain, we can include opioids in the treatment and fádrugs that lower the pain threshold such as pregabalin and gabapentin.
PHYSIOTHERAPY TREATMENT
During the acute period, manual treatments should be focused on reducing inflammation.ón and get relaxationón muscle and increase mobility by reducing stiffness. Treatments such as manual therapy, electromodulación, punch itón dry can be úuseful in these moments. Any kind of manipulation should be avoided.ón vertebral or tracesón if you have a herniated disc L5-S1 and you are in an acute phase.
TÉTECHNICAL PAIN UNIT
In cases where pain is not controlled with conservative treatment, the next step is to perform an infiltration.ón foraminal o una infiltrationón epidural, what we do is insert a needle either into the space surrounding the dural sac or into the hole through which the raíz nervous to deposit a medication in this placeóno anti-inflammatory (usually a corticosteroid and anestheticéphysical local) that diffuses through the tissues and reduces pain. In case of painás localized and affecting a raíz specifically, it will be possibleíto perform a pulsed radio frequency, this tétechnique consists of introducing a catébe close to the raínerve z that emits radiofrequency (heat), that will alter the transmissionóno pain, decreasing the intensity of the señto the pain that the brain will receive. Spaghettién will lower the pain threshold, that is to say, it is neededá one isípainful mule más powerful to feel pain. It is a tétechnique that is performed with local anesthesia and sedationón and is ambulatory.
TREATMENT OF DISC HERNIATION WITH LÁBE THE RADIOFREQUENCY.
Treatment of herniated disc with lábe or radiofrequency can be considered as the step prior to surgeryía. It's about youéhit the cnicasálines that are performed with local anesthesia and sedationón and that they are ambulatory. BáThey physically consist of introducing a needle into the intervertebral disc that emits heat, the goal is to evaporate the water contained in the intervertebral disc and reduce its volume. By reducing the volume of the intervertebral disc, the pressure is reduced.ón that the disc exerts on the nervous structures and in this way decreases the pain. The biggest drawback of these técnic is that it is notán indicated for all types of hernias, should be used on fairly healthy discs and can only be used on contained bulges or hernias.
SUR TREATMENTÚRGICO, LA MICRODISCECTOMÍA
It's the téit is a cnicaándar and the máis currently used. An incision is madeón on the backáyou are the least smallñto from 2-5 cm and through systems that magnify visionón (a microscope, some magnifying glasses) we open the L5-S1 space and remove the herniated disc, for this we have to dissect the musculature and sometimes it givesñar the jointsón facet and remove the yellow ligament.
SUR TREATMENTÚRGICO, SPINE ENDOSCOPY.
The spine endoscopy it's a ténovel technique consistent with introducing a cámara throughés of the orifice through which the nerves exit, in this way we can access the interior of the spine and treat herniated discs. The good thing about thisétechnique is that when using an access “natural” no da is neededñar the muscles or joints to access the interior of the spine and therefore the bleeding, postoperative pain is less and recoveryón más ráask. Click on the link to know what a column endoscopy consists of.
