Intervertebral hernia treatment period of exacerbation what to do. Exacerbation of a hernia of the lumbar - what to do, how to treat? Muscle relaxants and auxiliary drugs

Intervertebral hernia is a serious disease that occurs with alternating periods of remissions and exacerbations. Conservative treatment is effective, but it does not solve the problem of the protrusion itself. , but a relapse is also possible - the re-formation of an intervertebral hernia. How to be treated in such a situation?

During exacerbation, the same methods of therapy are used as at the initial stage of hernia formation. The classical treatment regimen is medicines, physiotherapy exercises (exercise therapy), hirudotherapy, the use of some folk remedies is allowed.

Traditional Therapy

With a hernia of small sizes of the lumbar and other parts of the spine, it is prescribed. The course of treatment takes place in 2 stages:

Etiotropic therapy - elimination of the cause of exacerbation.
Pathogenetic therapy is the elimination of elements of the pathogenic process.
Symptomatic therapy is the elimination of symptoms.

Additionally, a course of exercise therapy and hirudotherapy can be prescribed.

Etiotropic therapy

This stage of treatment includes only surgical intervention. There is no other way to get rid of the protrusion.

The hernial protrusion is removed with the help of microdiscectomy, a minimally invasive procedure, after which only a small scar remains on the patient's skin. The rehabilitation period in the clinic is only 1 day. During the intervention, the surgeon does not touch either the muscles or the ligaments (partial removal of the yellow ligament can be performed), or the bones. Pain after surgery is very weak and quickly regresses. Therefore, for the patient, this method of treatment is the most effective and gentle.

Pathogenetic therapy

It is aimed at eliminating pathological processes and includes chondroprotectors and, homeopathy, vasodilators.

Chondroprotectors and preparations based on hyaluronic acid. Their task is to improve the nutrition of the intervertebral discs and supply them with the necessary elements for proper functioning (Teraflex capsules, Plus and Rumalon injections).

Homeopathic remedies. Used prophylactically or in conjunction with other drugs. At the beginning of their intake, an exacerbation of chronic diseases occurs, thereby forcing the immune system to fight pathological processes.

Vasodilators. Their goal is to improve blood circulation at the location of the intervertebral hernia. This group of drugs includes Trental and Pentoxifylline. Let's admit an independent reception, however, the drugs have contraindications and side effects. It is better if they are prescribed by a doctor.

Symptomatic therapy

Allows you to reduce the manifestation of symptoms of a hernia of the lumbar and other parts of the spine. This includes the removal of pain (NSAIDs, steroids), muscle spasms (muscle relaxants), irritability and insomnia.

Non-steroidal anti-inflammatory drugs

They have analgesic, anti-inflammatory and antipyretic properties. This group includes Diclofenac ointments (gels), as well as tablets, capsules and powders (Nise, Nimesil, Ibuprofen). Oral agents have many contraindications. It is undesirable to use them without consulting a doctor and in the presence of acute processes in the gastrointestinal tract.

Steroid anti-inflammatory drugs

They are prescribed in case of severe inflammation and pain syndrome during exacerbation of a hernia of any part of the spine, including the lumbar. Steroid drugs include Diprosan,. They are injected directly into the periarticular sac. For such a procedure, the high qualification of the doctor is important.

Muscle relaxants and auxiliary drugs

The former are used to relieve muscle tension (capsules or injections). Muscle relaxants are prohibited for self-use. They must be prescribed by the attending physician.

During the use of NSAIDs, the walls of the stomach suffer. Therefore, such agents as Gastal, Almagel, Phosphalugel are prescribed in parallel, which create a protective film for the mucosa.

Against the background of the pain syndrome, there is often a sleep disturbance, irritability, nervousness increase. To improve the psycho-emotional state, the doctor may prescribe antidepressants, for example, Sertraline or Insidon, or limit himself to something easier - Zelenin drops, peony tincture.

Most drugs for the treatment of a hernia of any part of the spine are available by prescription. For first aid, you can buy Nise, Ibuprofen without a prescription, supplement the tablets with an ointment or gel with NSAIDs in the composition.

After the relief of acute pain, it is urgent to consult a doctor who will prescribe a course of treatment. The most ideal option is to call for help at home, because delay in a situation with an exacerbation of an intervertebral hernia is “like death.”

Therapeutic exercise (LFK)

During the period of exacerbation of the intervertebral hernia, bed rest is recommended. Its observance allows you to unload the spine as much as possible. In most cases, a hernia of the lumbar spine is exacerbated. With severe pain, the following postures of unloading muscles help:

Using a stand, lying on your back, raise your legs so that the thighs and shins form a right angle between them.
Lie face down and place a pillow or small cushion under your stomach.

It is prescribed by a doctor after the relief of pain. The main objectives of the exercises: improving blood circulation in the affected area, strengthening the muscles of the press and back. To avoid the appearance of pain and discomfort, you need to practice at a slow pace. The complex should be divided into several parts and alternate them during the day.

In addition to exercise therapy exercises, you can do some. To avoid injury, classes must be conducted by an instructor.

Hirudotherapy

Treatment with leeches is prescribed both for exacerbation and for the emerging hernia of the spine. Leeches contain the active substance hirudin, which is able to restore damaged disc tissues and improve metabolism in a short period of time. aimed to:

Improvement of blood circulation.
Immunity boost.
Saturation of the body with useful substances.
Removal of spasms.
Prevention of blood clots
Relief of inflammatory processes.

The first result of treatment appears after two sessions, for a complete recovery it is necessary to do courses 2 times a year for 10-12 procedures. Leeches are grown on special farms under sterile conditions and disposed of after use. Like other methods of treatment, hirudotherapy has contraindications:

Poor blood clotting.
Low level of red blood cells.
Oncology
Diseases of the cardiovascular system

Folk methods

Along with traditional treatment, various home-made rubbing, ointments, lotions, compresses, bee stings, and the use of decoctions / infusions of medicinal herbs are popular with patients. But they can only be considered as adjuvants that relieve pain. Self-medication with the help of these methods is impractical.

Phytotherapy

In the treatment of medicinal herbs and fruits, fortifying agents containing a large amount of vitamins and microelements are used. Before eating it is recommended to use:

Fruits of viburnum, ginseng.
Rosehip infusion.
Salad of dried apricots, raisins and walnuts, seasoned with lemon juice.
Bran with honey.

For compresses and rubbing, you can make a decoction of chamomile with rose hips and (or) an infusion of lilac flowers.

aromatherapy

To relieve the pain syndrome, oil infusions have proven themselves well: from fir oil with honey, from the leaves of St. John's wort, birch and comfrey roots. Oils can be taken orally, after filtering from the sediment. You can do massage with them, using them as a relaxation and pain reliever.

Of the essential oils for the treatment of hernia, basil, coriander, rosemary, and mint oils are suitable. Clary sage essential oil relieves pain and reduces inflammation. Such funds are used for taking a warm bath and hot compresses.

Apitherapy

With an exacerbation of the intervertebral hernia, treatment with bee venom can quickly relieve pain, as well as improve blood circulation and metabolic processes at the site of the bite. After completing the full course, you can achieve a long-term remission. Apitherapy must be done by a qualified health worker. In addition to experience with bees, he must also know the points to which the sting must be directed.

Before using herbs and bee products, be sure to consult a doctor and make sure there are no allergies.

Such methods of treatment as massage and manual therapy are carried out only at the initial stage of the disease. When exacerbated, they can further worsen the patient's condition.

To avoid re-exacerbation of a hernia of the lumbar and other parts of the spine, you should regularly (1-2 times a year) be examined by your doctor, lead a healthy lifestyle, eat right, get rid of bad habits and regularly do a complex of exercise therapy.

The exacerbation of hernias of the spine proceeds very rapidly, with a pronounced pain syndrome, stiffness in movements and, in some cases, fever.

Treatment of an attack of an intervertebral hernia should begin as early as possible. Various anti-inflammatory and analgesic drugs are used for this. If the back still hurts, injections of powerful pain medications are prescribed.

The most severe is the exacerbation of the vertebral hernia of the lumbar spine. The cervical region suffers somewhat weaker, but in the thoracic region, the exacerbation of the hernia proceeds moderately.

1 What is an exacerbation of the intervertebral hernia?

What is it and how to survive the exacerbation of the intervertebral hernia? During conditional remission (when the disease practically does not manifest itself in any way, or manifests itself minimally), the spinal column more or less stabilizes.

Compensatory mechanisms are turned on, which are designed to reduce the consequences of the presence of a hernia on the entire musculoskeletal system. The back muscles are connected to work (to reduce the load from the spinal column).

During an exacerbation (it rarely happens on its own - there is usually a provoking factor) all this "stabilization" is violated. Often there is a displacement of the vertebra, and it can be so serious that there will be compression (infringement) of the vertebral nerves.

With this complication, a pronounced pain syndrome develops. The pain may be so severe that the patient cannot even sleep. The larger the size of the hernia and the more serious the factor provoking it (for example, trauma or sprain of the back), the more painful the exacerbation will be.

How long an exacerbation of an intervertebral hernia lasts is an individual question. For some patients, it may take several hours. For others, the pathology stretches for several days, which already requires a visit to the doctor (or calling him at home).

On average, an exacerbation lasts two days, during which the patient cannot eat, sleep, or walk normally.

1.1 Causes of exacerbation: when and why does it appear?

What causes exacerbations of intervertebral hernias? What triggering factors exist? In fact, any inaccurate movement of the body can cause an aggravation, but there are several most common causes.

Causes of exacerbation of the intervertebral hernia:

Household injuries. An inaccurate sharp movement of the body is enough - even this is quite enough for the onset of pathology. But in general, minor injuries and inaccurate movements are not so often the main cause.
Severe injuries often lead to exacerbation of the hernia. For example, a blow in the back, or a fall even from a small height.
Excessive physical activity. Workers in many labor professions are forced to continue to engage in it even in the presence of a hernia. As a result, the progress of the disease and frequent exacerbations.
Stretching of the spinal column. It is enough to perform prohibited exercises with rotational or axial loads on the spine - and the disease will manifest itself again.
Relatively rare, but still there are exacerbations due to hypothermia. Both local (only in the area of the pathological process) and systemic (for example, walking down the street in winter weather).
Weight lifting. And it can even be small (TV, empty bedside table, a bag of groceries).

1.2 How does an exacerbation of a hernia manifest itself?

What cannot be confused is the exacerbation of an intervertebral hernia, especially if it is localized in the lumbar spine. Symptoms grow rapidly, proceed so strongly that the patient may fall out of life for several days.

Symptoms of exacerbation of the intervertebral hernia:

severe, excruciating pain in the area of the pathological focus with irradiation (radiation) to the lower or upper limbs, less often to the peritoneum or chest (temporary intercostal neuralgia may develop);
fever may occur in response to increasing inflammatory processes in the tissues of the spine and individual vertebrae (the temperature can rise up to 38 degrees);
stiffness in the movements of the back, rigidity of the muscular corset (the spasm is especially pronounced in the cervical region);
when trying to tilt or turn the body, severe pain occurs or existing ones intensify - to the point that the patient may lose consciousness;
development of nausea and even vomiting is possible, but usually such symptoms occur with severely leaking large hernias;
when localized in the cervical region, dizziness and severe headaches can develop, radiating to the bridge of the nose (because of which the patient cannot look at the light), photopsy may also occur (visual artifacts in the form of flashes, lightning).

1.3 Exercises for strangulated disc herniation (video)

1.4 Why is it dangerous?

An exacerbation of an intervertebral hernia cannot lead to any fatal consequences. The exceptions are isolated cases in which the patient has congenital anomalies and defects in the structure of the vertebral arteries and the spinal column itself.

But health problems can arise a lot. First, the pain itself can interfere with normal functioning. Patients can live normally only under powerful painkillers, and usually do not get enough sleep due to constant awakening against a background of inflammation and pain.

Secondly, the inflammatory process in the tissues of the spinal column acts as a pain catalyst. He strengthens and supports her. And inflammation itself leads to some complications: nausea, vomiting, swelling, fever.

Thirdly, even after a decrease in pain and inflammation (3-4 days after the exacerbation), some symptoms may remain. For example, stiffness in body movements and spasm of the spinal muscles.

Prolonged course of the intervertebral hernia and frequent complications are fraught with damage to the nerve nodes and the spinal canal. And this can already lead to the patient's disability (for example, to partial or complete paralysis of the lower extremities).

Therefore, the treatment of the disease should be carried out in a timely manner. In the early stages, it is usually limited to conservative (non-surgical) therapy.

2 What to do with exacerbation of the intervertebral hernia?

What to do with an exacerbated intervertebral hernia? It is important here not to try to engage in any physical exercises (even therapeutic exercise therapy is prohibited!) Or try to “align” your back. This will not lead to anything good, on the contrary, the symptoms will intensify and the exacerbation will take longer.

It is important to provide maximum comfort to your body. We need bed rest with the most optimal posture for the patient himself (so that he is comfortable and the pain is felt as weakly as possible).

Treatment is carried out using the following methods:

Non-steroidal anti-inflammatory and pain medications are prescribed. With a moderate pain syndrome, ordinary Paracetamol helps (it also relieves inflammation), with serious ones - and its analogues.
Warming up the affected area (risk, but often helps). You can use warming ointments and gels, or special products. For example, or.
High fluid intake and increased food intake. What for? To restore the body's resources and give it "strength" to fight inflammatory processes.
As soon as the symptoms subside by half, you can do general gymnastics, but in a very gentle mode. Rotational and axial loads are prohibited, as are heavy lifting/jumping/running, and sharp and deep torso bending.

A hernia for a long time may not bother its owner and does not manifest itself in any way. But periods of exacerbations can cause severe discomfort. Therefore, it is important to recognize the beginning of this period and start treatment of exacerbation of the lumbar intervertebral hernia in a timely manner.

Collapse

What it is?

A hernia of the spine in the lumbar region is a chronic disease that occurs with alternating periods of exacerbations and remissions. Remission is the period when it does not cause inconvenience and is not felt in any way. An exacerbation is a period when the symptoms of the disease become bright, cause discomfort and interfere with the patient's normal daily activities.

There is no regularity in the ratio of the duration of these periods. In the early stages, with a responsible attitude to one's health, the stages of remissions are usually long, and exacerbations are short and not intense. In the later stages of an exacerbation, they become longer and occur more frequently. But this may differ for each individual patient.

Symptoms and signs

The onset of exacerbation can be determined by the following signs:

Pain in the lumbar region that increases over time;
Feeling of stiffness in the lower back, which gradually increases;
Tingling in the legs;
Slight short-term numbness of the legs;
The appearance of discomfort and even pain when performing standard exercises from the complex of physiotherapy exercises.

Symptoms may develop faster or slower, but treatment should be started as soon as they are detected.

How long is the exacerbation period?

It depends on many factors. The presence or absence of treatment, the timeliness of its initiation, and more play an important role. At the beginning of treatment with the first symptoms, an exacerbation can last only 2-3 days. But with a late start of therapy, it can be delayed for two weeks. Although the degree of development of the pathology also plays an important role, the causes that cause it, and the factors that provoked a new exacerbation.

Causes

There are a lot of reasons why an exacerbation of an intervertebral hernia can occur. Among them:

Excessive physical activity;
Hypodynamia;
Prolonged stay in an uncomfortable position;
Colds;
Diseases of the spine;
malnutrition;
Metabolic disease;
Weight lifting;
Weight gain;
Skipping sessions of therapeutic massage, neglect of exercise therapy;
hypothermia;
Work in a room with strong vibration.

There are many other reasons, up to driving in a shaking vehicle. Therefore, avoiding all factors that can cause an exacerbation does not exist. But following preventive measures can significantly reduce the likelihood of an exacerbation.

What to do?

The first thing the patient should do in this case is to consult a doctor who will prescribe the appropriate treatment. If you have time to do this at the initial stages of the development of the pathology, then the treatment will help relieve the exacerbation very quickly.

The doctor prescribes non-steroidal anti-inflammatory drugs in individual dosages. The first 3-5 days they are recommended to be used in injections for intramuscular injection. Diclofenac is most suitable for this purpose. But then you need to switch to tablets - it can be the same Diclofenac, Ibuprofen, Nurofen, Ortofen. They are taken one 2-3 times a day for up to two weeks.

At the same time, a non-steroidal anti-inflammatory ointment is prescribed for topical application - Voltaren, Diclofenac, Ketonal or another. It is applied 3-4 times a day, 1-2 mg directly on the affected area and around it.

Ointments for etymological treatment are also prescribed, such as chondroprotectors such as Chondroxyld. They are applied 2-3 times a day and stimulate the restoration of cartilage, stopping the progression of the process. Warming ointments are prescribed to improve blood circulation and tissue nutrition, relieve spasm and muscle hypertonicity, which can lead to compression of blood vessels and nervous tissue, which also increases pain.

Acute pain with a hernia of the lumbar spine is removed by novocaine blockade. In a medical institution, the patient is injected with novocaine directly into the spinal canal. The procedure gives a pronounced and long-lasting analgesic effect.

During this period, it is necessary to cancel physical activity, including physiotherapy exercises, as well as massage and reflexology. Cancellation of physiotherapy is at the discretion of the doctor. Also, at his discretion, the appointment of wearing a corset is carried out. But it is still impossible to wear such a corset for more than 4-5 days, since the muscles weaken and cannot bear the load themselves, but in the most acute period, the corset helps to remove it.

Prevention

In order for exacerbations to occur as rarely as possible, it is necessary to follow several recommendations:

Observe the regime of work and rest;
Do not subject the spine to excessive loads;
Avoid hypodynamia and long stay in one position;
Avoid excessive sports activities;
Do not lift weights;
Sleep on orthopedic pillows and a mattress, sit only in comfortable chairs, etc.;
Eat properly and balanced, monitor the vitamin and mineral balance;
Avoid gaining excess weight;
Perform physiotherapy exercises and massage (if assigned);
Timely treat diseases of the spine.

Conclusion

The timely start of competent treatment is the key to a short-term and non-intensive exacerbation. If it is enough to start it, then it can deprive the patient of working capacity for quite a long time.

I am 29 years old, height 160, weight 67kg, I work in medicine. The back ached periodically for 2 years, since February the pains returned, for the first time with a return on the left thigh, treatment with diclofenac, massage, physio, helped temporarily. Since March, periodically numbness on the lateral surface of the thigh, the pain intensified, skewed.
MRI dated March 15, 2010:
Lordosis is smoothed out. The height of the L4-L5 disk and the signals from it are reduced, from the rest of the disks they are preserved.
Dorsal, against the background of posterior marginal growths of the body L4 disc median
disc herniation L4-L5, 0.7-0.75 in size, narrowing the radicular canals, more on the left and forming adjacent parts of the gift sac.
The lumen of the spinal canal is narrowed at the level of the hernia to 1.3 cm in the anterior-posterior direction, the signal from the structures of the spinal cord is not changed.
Schmorl's hernia of the caudal endplate of the L4 body.
Moderate marginal bone sharpening of the vertebral bodies and marginal bone growths in the lower-posterior parts of the L4 vertebral body. The shape and size of the vertebrae are normal, signs of moderate lipodystrophic changes in the bodies of L4, L5 vertebrae.
Dorsal median protusion of the L5-S1 disc up to 0.15 cm, moderately deforming the adjacent parts of the dural sac.
Treatment:
Analgin
Diphenhydramine
novocaine
Calcium chloride
Eufillin IV drip No. 10, every other day Lasix No. 5
In the hospital: TRENTAL drip, anavenol, mydocalm, milgamma, Alflutop, Actovegin, General magnetotherapy, electrophoresis with novocaine and aminofillin, ozone therapy, PIR.
Scoliosis persists, numbness along the stripe in the left leg when walking, decreased sensitivity, reflexes are slightly reduced.
Then treatment in a rehabilitation center for 2 months:
again complex droppers 5, mydocalm No. 10 intramuscularly, Actovegin, exercise therapy, Laser, Ph/phoresis with hydrocartisone, IRT Massage.
Then neuromultivit, teraflex, massage, IRT, Interdin, el/phoresis with lidase.
Ds: Neurodystrophic lumboischialgia on the left. Radiculopathy L5 on the left. Osteochondrosis of the lumbar region with the phenomenon of mechanical compression L4-L5-S1. The stage of prolonged exacerbation. Moderate clinical manifestations.
Passed a course of leeches. The pain decreased, the leg practically did not bother.
She continued exercise therapy, swimming, teraflex.
And here again the aggravation: heaviness in the back, pain in the leg below the knee, numbness with pain.
Treatment was prescribed as in the first exacerbation.
Did another MRI:
On MR myelograms, a decrease in the MR signal and height at the L4-L5 disc is determined, the dural space is significantly narrowed at the level of the disc. canal up to 7 mm, the posterior longitudinal is thickened at the level of the disk up to 2 mm, drawn back. On the axial cut, the radius of the bulging of the disc fragment is up to 6 mm, medially located with the largest lateral. to the left, the spine on the left is pressed against the left arch, the signal is not homogeneous, the contours are not clear, the MR signal from the anterior sections of the stupid space (more on the left) is heterogeneous. The dural sac (its anterior sections, more on the left) is deformed and displaced posteriorly. The facet joints L4-L5 are thickened on both sides; the lumen of the intervertebral foramina is narrowed on both sides.
Cone of the spinal cord with a clear contour, without changes in the structure and intensity of the MR signal.
Changes in the structure and MR signal from the contents of the caudal sections of the dural sac are not determined.
Conclusion: a picture of osteochondrosis and a medial with the greatest lateralization to the left of the disc herniation L4-L5 (according to the MR picture, it may correspond to its prolapse without rupture of the posterior longitudinal ligament), affecting the dural sac, on the lion. root - causing it to swell.
The pain is not constant, the sensitivity is preserved, the leg goes numb below the knee to the foot with pain, the Achilles reflex is slightly reduced.
What to do next, tell me!!!
Dr. Stupin would like your opinion!!!