The spine consists of bones, which we call 'vertebra', arranged on top of each other. In the middle of each vertebral body is the spinal cord, which is a continuation of the brain.

Sensations returning to the brain from various parts of the body or orders distributed from the brain to the body travel within the spinal cord. Nerves originating from the level of each vertebral body in the lumbar region spread to the hips and legs, providing sensation and movement to these areas. These bones, called vertebrae, are connected to each other by flexible structures that we call 'discs'. Over time, these flexible structures, namely the discs, wear out and lose their elastic properties. As such, this disc protrudes backwards due to trauma or loads. In other words, this disease occurs as a result of the gelatin-like inner part of the discs tearing the outer part, which consists of a stronger connective tissue, and putting pressure on the spinal cord and nerves. A herniated disc is a pathological process that occurs as a result of the herniation (hernia) of the intervertebral disc(s) in the lumbar region. Depending on the movement and loading of the vertebra, approximately 95% of hernias are seen at the L4-L5 level of the spine; The second most common occurrence is at the L3-L4 level, and its incidence continues to decrease towards the proximal (3). The most obvious symptom of a herniated disc is waist and leg pain. The pain that occurs in the form of sciatica may be severe enough to prevent movements such as walking, standing and sitting. A herniated disc can also turn into a condition in which serious symptoms such as paravertebral muscle spasm, lower extremity hypoesthesia and strength deficits are observed. The incidence of herniated disc increases between the ages of 30-50; The incidence decreases after the age of 60, and it is rarely seen in childhood. The fact that lumbar disc herniation is characterized by frequent and serious symptoms, especially in the middle-aged and working population, brings about social and economic problems.

What are the symptoms of a herniated disc?

The most obvious symptom of a herniated disc is lower back pain. Patients express a dull pain localized especially in the lumbar region. This pain; It is usually not very disturbing and increases with long periods of standing and movement, and decreases with rest. Depending on the anatomical distribution of the affected nerve root and the excess pressure, pain may radiate to the leg, and sometimes this pain is severe enough to prevent movement. Sudden worsening of the condition may be due to a trauma, sudden movement or heavy lifting, or it may begin suddenly without any cause. It may cause locking and stiffness in the waist and legs.

What are the Risk Factors of Lumbar Herniation?

The main factors that cause a herniated disc are; They can be listed as age, gender, obesity, smoking, sedentary lifestyle, heavy physical activity, traumatic accidents, work and occupational factors. The incidence of lumbar disc herniation is high between the ages of 30 and 50, which is generally considered the productive age. Although there is information in the literature stating that male gender is considered a risk factor and that the frequency of surgery due to herniated disc is twice as high in men compared to women, gender is generally not considered as a risk factor. It is stated in the literature that obesity is an important risk factor for the formation of a herniated disc due to its effect on increasing the load on the spine. Smoking negatively affects the oxygen carrying capacity of hemoglobin and the resulting oxygenation problem in the discs are among the factors that cause herniated discs. Sedentary life, exposure to repetitive vibrational effects, working in jobs that require standing or sitting for long periods of time, weekly working days, daily working hours, and physically intense work are reported as factors associated with lumbar disc herniation. Applied in Lumbar Herniation

What are the treatment methods?

Physiotherapy, together with medical treatment, constitutes the first step of conservative treatment. In cases of extreme pain, bed rest for 3-4 days may be recommended. Strengthening and stretching exercises can be planned for walking, abdominal muscles, gluteal region and leg muscles. Patients need to be educated and especially taught to avoid movements that will increase intervertebral disc pressure. Since medical treatment will increase physiotherapy tolerance and patient comfort, it is recommended to use it simultaneously. First of all, nonsteroidal anti-inflammatory drugs (NSAIDs) can be used because they reduce inflammation and edema. Opoid analgesics can provide symptomatic relief from myorelaxants. Surgical Treatment: Progressive motor deficits and cauda equina syndrome are considered indications for emergency surgery. Apart from this, the presence of persistent pain that does not improve despite 4-6 weeks of conservative treatment and the detection of progressive neurological deficits during follow-up are indications for surgery. If the neurological deficit involves motor losses, the necessity of surgery becomes inevitable.

Depending on the pathological condition of the disc, different methods such as laminectomy, discectomy, foraminotomy and spinal fusion are preferred. Open standard surgery can be performed in the surgery of herniated disc and in parallel with technological developments; Less invasive techniques such as microdiscectomy and endoscopic microdiscectomy are also used. In procedures performed with invasive methods, the operating time is shorter, tissue trauma and blood loss are less, and recovery and discharge occur earlier. Due to such advantages, invasive methods are considered the gold standard in the surgical treatment of herniated disc.