Dorsal hernia l5-s1 and l4-l5

If 5 lumbar vertebra and 1 sacral are affected, an intervertebral hernia of the L5-S1 disk is diagnosed. In this section of the spine, pathology occurs most often, because it is on the lower back that the maximum load appears when walking, running and other movements. If the disease is treated untimely, the consequences can be unpredictable, up to disabling the patient. Therefore, it is important not to ignore the symptoms and consult a doctor immediately for help.

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Causes of development

The main factor provoking the development of a hernia of the lumbar spine L5-C1 is progressive osteochondrosis of the spine, in which the intervertebral discs (MTD) become thinner, collapse and change their normal location. With pathology, the lumbar vertebrae also suffer - they gradually wear off, as a result of which the functioning of the spine is impaired.

Other common causes that cause L5-S1 intervertebral disc herniation are:

  • congenital and genetic pathologies that adversely affect the development and functioning of the musculoskeletal system,
  • injuries, bruises, dislocations and fractures of the lumbar region,
  • the progression of diseases of a degenerative-dystrophic nature,
  • increased physical activity,
  • sedentary lifestyle,
  • malnutrition,
  • insufficient daily fluid intake,
  • deficiency of calcium and phosphorus in the body.

With progressive osteochondrosis, the cervical (vertebra C5 — C6) and lumbar (L4 — L5 and L5 — S1) departments are most often affected.


The pulpous nucleus can protrude in different directions. Depending on where exactly the center of the disc fell, there are such types of lumbosacral hernia:

  • Paramedial disc herniation. In this case, the disk core occupies a position to the right or left of the spinal cord.
  • Dorsal. With the development of such a pathology, the nucleus falls into the canal where the nerve plexuses pass, therefore, with a dorsal hernia of the patient, acute symptoms are worried.
  • Median disc herniation L5 — S1. The bulging contents of the intervertebral disc is located in the middle of the spinal canal.
  • Paramedian-foraminal hernia. The disk core falls into the area of ​​the spinal roots.
  • Bilateral median-paramedian disc herniation L5 – S1. In this situation, the pulpous nucleus is directed to the central and lateral parts, however, pain symptoms spread on both sides.

Considering which side the nerve fibers are pinched and inflamed, a hernia happens:

Characteristic symptoms

Rear hernia of the intervertebral disc provokes acute pain in the lumbar region. In advanced cases, mobility of the lower extremities is impaired, internal organs located in the small pelvis suffer, a person loses libido. If the protrusion is in the cavity where the vertebral nerves pass, the pain spreads to the gluteal and femoral region. The innervation of the foot and fingers is disturbed, numbness of the skin or tingling is felt, as if goosebumps are running on the legs. The median or median hernia in advanced cases provokes paresis, since as the protrusion increases, the spinal canal is damaged.

Although the location of hernias may have different localization, general symptoms can be distinguished, among which the most common are:

  • sharp and sharp backache in the lumbar region,
  • exacerbation of pain after physical exertion, prolonged stay in one position,
  • numbness and impaired functionality of the lower extremities,
  • involuntary urination and defecation,
  • “cough push” syndrome, when soreness intensifies when trying to cough or sneeze.

Diagnosis of herniated disc L5-S1

In order for L5-S1 hernia treatment to be effective, it is important to find out how badly the spinal column is affected, and also to identify the location of the protrusion. Therefore, after the initial examination, palpation and history taking, the doctor will give a referral to a CT scan or an MRI scan. Using these diagnostic measures, it will be possible to establish the exact dimensions of the hernia. To determine the location and degree of damage to the vertebrae, an additional radiography is performed. After confirming the diagnosis, the doctor selects an individual therapy regimen.


If the lumbosacral hernial protrusion does not exceed 6 mm, it will be possible to do without surgery and get rid of the problem in a conservative way. Certain groups of drugs presented in the table will help get rid of inflammation, swelling and pain syndrome:

There may be several reasons for the formation of a dorsal hernia of the lumbar spine:

Dysplasia of the lumbosacral spine. This condition is a congenital anomaly of development in the structure of the lumbar. At the same time, the structure and shape of the vertebrae changes, the ligaments are broken, the cartilage tissue, blood vessels and nerves are destroyed. As a result, a dorsal protrusion is formed.

Osteochondrosis of the spine, leading to the destruction of the intervertebral discs and the appearance of protrusion.

Diseases of the spinal column associated with impaired posture - kyphosis, scoliosis and lordosis.

Injuries to the lumbar spine. This also includes transferred surgical interventions, falls, sharp turns.

Infections, such as bone tuberculosis.

Excessive exercise with weight lifting. Often, dorsal hernias occur in athletes. In addition, people who experience constant vibration, such as drivers, are at risk.

Violation of metabolic processes in the body, leading to malnutrition of cartilage. In addition, a failure in metabolic processes leads to an increase in body weight. Particularly dangerous in terms of the development of the dorsal hernia are fat deposits in the abdomen. They have a significant effect on the lower zone of the spine.

Regular intake of nicotine into the body significantly increases the risk of hernia formation.

Hypodynamia. In terms of the formation of the dorsal hernia, the sedentary lifestyle is the danger. In the high-risk zone are sellers, accountants, drivers, people of those professions who are forced to spend most of their time sitting.

The fact of a hereditary predisposition to the formation of a hernia cannot be ruled out.

Age-related changes that cause the natural wear of discs.

Disorders of the diet, which leads to insufficient intake of nutrients. In this case, all organ systems, including the spine, are affected. Since it is the lumbar region that experiences the maximum load, its vertebrae are destroyed before the rest.

Symptoms of the dorsal hernia l5-s1 and l4-l5

Pain Syndrome Until the hernia has reached medium size, the pain syndrome will manifest itself weakly. As it grows, there is an increase in pressure on the spinal nerves. As a result, any movement: raising the legs, changing the position of the body - all this will be accompanied by excruciating acute pain. In advanced cases, patients are not even able to cough, without experiencing pain. She, as a rule, gives to the buttocks and thighs.

Impaired sensitivity. In patients, the sensitivity of the legs and toes of the foot decreases, which is also associated with damage to the spinal nerves. Numbness of the tailbone and gluteal muscles may appear. In addition, the lower extremities often swell.

Vertebral Syndrome. This is a complex of symptoms, the appearance of which is associated with pain. Intuitively, a person tries to unload the lumbar and sacral parts, begins to stoop, lean forward. As a result, incorrect posture is developed. In addition, a sense of balance suffers and the gait changes. Curvature of the spine leads to the development of problems in the work of internal organs.

Radicular syndrome. In process of atrophy of muscle tissue, there is a violation of the sensitivity of the limbs, their weakness appears. The skin becomes dry, or, on the contrary, sweating may increase, which is associated with a malfunction of the sebaceous glands. As the hernia increases, the risk of lower body paralysis increases.

The more damaged the spinal cord, the higher the risk of developing life-threatening conditions for the patient:

Failures in the reproductive system.

Disorders of the functioning of the pelvic organs, which is expressed in constipation or diarrhea, urinary incontinence, etc.

Laseg's syndrome. The neuropathologist determines the presence of this syndrome. A patient with a dorsal hernia has a complete or partial disappearance of physiological reflexes, in particular, of the knee and Achilles. But at the same time, new pathological reflexes are formed.

Physiotherapy and massage

Massage manipulations restore normal blood supply and nutrition to diseased areas. Physiotherapeutic measures, which are prescribed as adjunctive therapy and for prevention, will help speed up the restoration of damaged disks and normalize the functioning of the lumbosacral spine. The following procedures are useful:

When can’t you do without an operation?

If the hernia formation has reached a large size (from 12 mm), and conservative methods no longer work, surgical treatment is performed, during which the hernia and other damaged structures are removed through a micro-incision using an endoscope. This type of surgery is called microdisectomy. Laser removal may also be used. The procedure involves the evaporation of the pathological contents of the intervertebral disc using a laser beam. The type of operation is determined only by the doctor individually.

Negative consequences and their prevention

Ignoring the symptoms and postponing a visit to the doctor provokes dangerous complications:

  • violation of the functioning of organs located in the pelvis,
  • problems with the work of the lower extremities,
  • severe pain
  • complete destruction of the intervertebral discs and disability.

But if treatment is carried out in the early stages, such consequences can be avoided. This means that the disease must be treated in a timely manner. As a prophylaxis, it is recommended to do exercises every day, dose the load on the lower back, do not overcool, lead a healthy lifestyle, treat pathologies of a degenerative-dystrophic nature.


A hernia is a protrusion of the inner part of the intervertebral cartilage through a defect in its outer shell. The intervertebral disc is a fairly large formation that can be damaged in any department.

There are a large number of different options for protruding the disc, however, from a practical point of view, not all classifications are important.

The most frequent localization of pathology in the lumbar:

A more complex classification is division with respect to the axial plane of the body. There are anterior (ventral) and posterior (dorsal). In turn, the latter are divided into:

  • Lateral protrusion (foraminal). This process is localized in the region of the lateral cartilage and does not affect the spinal canal, but involves the nerve root. It can be left-handed and right-handed.
  • Median formation - with this option, the pathology is formed along the median line in front or behind.
  • Paramedian - an option in which part of the formation penetrates the spinal canal. Very often causes compression of the nerve structures.

This localization is of most interest to neurosurgeons who are facing surgery to remove hernial protrusions of the discs.

Ventral disc herniation

Anterior protrusions are quite common, but have the least clinical manifestations. In the anterior half of the intervertebral cartilage there are no spinal roots and there is no connection with the spinal cord.

This anatomical location favorably affects the course of the process:

  • Ventral formations may not have clinical manifestations at all.
  • Discovered as random finds during magnetic resonance imaging.
  • Most often, they do not require active treatment with conservative and operative methods.

Surgical treatment of the disease in some cases is more dangerous than the prevention of its complications by conservative methods. However, this is true only for formations that do not cause clinical manifestations.

Dorsal disc herniation

Dorsal disc herniation: what is it? Imagine the dial of a watch, which is directed 12 hours forward and 6 hours back. Divide it into the front and back half. All protrusions that are between 3 and 9 hours behind the dial are dorsal.

Dorsal hernia most often causes unpleasant symptoms:

  1. Reflex.
  2. Compression.
  3. Spinal cord lesions.

This type of protrusion is subdivided into several options listed above. The posterior median hernia is located at 6 hours, the paramedian at 5 and 7 hours, and the remaining options can be attributed to lateral. For example, a dorsal hernia of the L5-S1 disc may be any of the following.

Separately, it is worth mentioning such a pathology as a dorsal diffuse hernia. With this option, there is no habitual hernial sac, the inner contents of the cartilage from all sides presses on the rear sections of the fibrous capsule. The size of the disk increases and once a dorsal diffuse hernia of the disk can break through in any direction. The most dangerous option is when a diffuse disc herniation L5-S1 damages the spinal cord.

It is necessary to understand each individual version of the dorsal formations.

Lateral (foraminal)

Right-sided and left-sided lateral hernias occupy a rather large share of our conditional dial, so for a long time they also may not cause clinical symptoms.

If the process damages the right or left spinal roots, the following symptoms occur:

Such manifestations usually force a person to see a doctor, who, according to the results of examination and MRI, can make a diagnosis.

The median or median hernia is directed strictly along the median line of the body. It can be localized in the ventral or dorsal region. Of course, the dorsal medial hernia of the disc is more dangerous, since it prolapses into the spinal canal.

L5-S1 median hernia of the disc causes the above symptoms of sciatic nerve damage, to which a violation of the function of the pelvic organs can be added:

  • Feeling of incomplete emptying of the bladder and rectum.
  • Frequent urination and bowel movements.
  • Spontaneous excretion of urine and feces.

The listed symptoms are also caused by the median hernia of the L4-L5 disc, but the pathology of the Achilles tendon and a decrease in reflexes are also added to them. In some cases, this protrusion leads to paralysis of the lower extremities.

Unfortunately, these manifestations may remain even after removal of the hernia, since nerve cells recover with great difficulty. However, in some cases, the medial hernia of the L5-S1 disk does not cause irreversible disorders, therefore, timely diagnosis and treatment is required.

It should be understood that the higher the spinal cord is damaged, the more severe the clinical manifestations. Lumbar protrusions cause only pelvic dysfunction.A herniated disc C5-C6 in the cervical region can cause complete paralysis.


A paramedian disc herniation also affects the spinal canal, as it is very close to the median line at the back. Manifestations of education do not differ from median localization. So, the paramedian herniation of the L4-L5 disc causes the same clinic as the medial in this floor.

This variant of protrusions can be to the right and to the left of the midline. A left-sided paramedian hernia of the disc is capable of disrupting the function of the left lower limb, and a right-sided paramedial hernia of the disc L4-L5 leads to paralysis of the right leg.

L5-S1 paramedial disc herniation often has combined options. For example, there are:

  • Paramedian-foraminal hernia - in this case, part of the hernial sac is located in the region of the spinal canal, and the second half is in the region of the lateral surface of the disc.
  • Median-paramedian disc herniation L5-S1 - in this case, the protrusion is located on the median line in both directions directed from it - bilateral location.
  • Sequestered paramedian disc herniation L5-S1– part of the formation separates from the sac and enters the lumen of the spinal canal.

All of these options are determined during magnetic resonance imaging. Other diagnostic methods are not accurate enough for such a detailed assessment of the localization of pathology.

Most lumbar protrusions require one or another treatment. There are quite a lot of options for influencing the pathological protrusion of the intervertebral cartilage, however, the localization and extent of the lesion determine one or another medical tactic.

Complications of the dorsal hernia l5-s1 and l4-l5

Sequestration of a hernia with a violation of the integrity of the disc and the release of the pulpous nucleus into the lumen of the spinal canal. A person suffers from severe pain, which is explained by compression of the spinal nerves and spinal cord. As a result, the patient loses the ability to self-care, as he becomes unable to move.

As the hernia grows, a complete or partial paralysis of the patient may form with the assignment of a disability group.

The formation of an autoimmune inflammatory process. The reason for its manifestation is the protein content of cartilage and fibrin fibers, which trigger an autoimmune reaction.

Squeezing a bundle of roots of the spinal nerves. In medicine, this complication is called a ponytail symptom.

Violations of the act of urination and the process of defecation due to a malfunction of the pelvic organs.

Atrophy of tissues of the lower extremities associated with loss of sensation.

So, the dorsal hernia, located at l4-l5 level, can lead to paralysis of the legs and a complete loss of sensitivity of the feet with all the consequences arising from this condition.

Dorsal hernia, located at l5-s1, can provoke serious disruption in the functioning of the internal organs of the pelvis. Therefore, if the first symptoms of the disease appear, you should immediately seek medical help.

Diagnosis of the dorsal hernia l5-s1 and l4-l5

If a dorsal hernia is suspected in the lumbar spine, instrumental diagnostic methods are necessary. The most informative method in this case will be MRI. The direction of protrusion, its size, degree of compression of the spinal canal will be visible in the image.

If it is not possible to have an MRI, then the patient can be sent for CT. However, according to its results, it will be possible to establish only the fact of the presence of hernial protrusion. An X-ray examination in this case is uninformative, it will only allow us to conclude that there are no other sources of pain - curvature of the spine, its injuries or tumors.

Do you still think that it is impossible to cure the joints?

Judging by the fact that you are reading these lines now, a victory in the fight against inflammation of the cartilage tissue is not yet on your side.

And have you already thought about hospital treatment? It is understandable, because joint pain is a very dangerous symptom, which with untimely treatment can result in limited mobility. Suspicious crunch, stiffness after a night's rest, the skin around the problem area is tense, swelling in a sore spot. All these symptoms are familiar to you firsthand.

But perhaps it is more correct to treat not the effect, but the cause? We recommend reading an article about modern methods of treating joints. Read the article >>

Surgical treatment of dorsal hernia l5-s1 and l4-l5

As a rule, surgery is prescribed in no more than 20% of cases. An indication for the operation is the development of complications, the lack of effect of conservative therapy, a significant hernia size, severe pain. In addition, surgical intervention can be carried out with paralysis of the patient, as well as with violations of the internal organs.

Modern methods of getting rid of bulging are as follows:

Microdisectomy, in which part of the hernia is removed and, if necessary, part of the vertebra. The procedure is performed under the microscope. After 5 days, the patient can perform non-physical work, and after 3 weeks his ability to work is fully restored.

Endoscopy is performed using a special device - an endoscope. Thanks to him, a puncture on the skin that will be made to remove the hernia will not exceed 20 mm. The duration of the procedure does not exceed 45 minutes; it will require the introduction of local anesthesia. The hernia itself can be removed using a laser or cold plasma.

Laminectomy is rarely used by modern surgeons. It is performed if the hernia is large. During the operation, the patient is removed part of the vertebra, as well as a fragment of the disk.

However, no matter what method of removal of the hernia is chosen, there is always a risk of relapse.

Education: Moscow State University of Medicine and Dentistry (1996). In 2003, he received a diploma from the educational and scientific medical center for managing the affairs of the President of the Russian Federation.

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How does hernia form?

The mechanism of hernia formation is due to the device of the intervertebral disc. It consists of a pulpous nucleus (jelly-like substance) and a rigid multilayer fibrous membrane (fibrous ring). The protrusion of the contents (nucleus) through the weak point of the fibrous capsule leads to the formation of hernias.

Kernel Failing Stages:

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