O que é uma hérnia discal lombar?

É uma condição em que o material interno de um disco intervertebral na região lombar se desloca, comprimindo raízes nervosas e causando dor lombar e ciática.

Quais são os sintomas mais comuns?

Dor lombar que pode irradiar para as pernas, sensação de formigamento ou dormência nas pernas e fraqueza muscular.

Quais são as causas principais?

Desgaste gradual dos discos devido ao envelhecimento, musculatura fraca, excesso de peso, má postura e movimentos bruscos ou repetitivos.

Como é feito o diagnóstico?

Através da avaliação dos sintomas, exame clínico e exames de imagem como ressonância magnética ou tomografia computadorizada.

Quais são as opções de tratamento?

Incluem medicamentos analgésicos, fisioterapia, exercícios específicos e, em casos mais graves, cirurgia.

A cirurgia é sempre necessária?

Não. A maioria dos casos melhora com tratamentos conservadores. A cirurgia é considerada quando há falha nos tratamentos não invasivos ou em casos de sintomas graves.

Quanto tempo dura uma crise de hérnia discal?

Os sintomas podem melhorar em 6 a 9 meses, independentemente do tratamento, pois muitas hérnias são reabsorvidas naturalmente.

A hérnia discal pode desaparecer sozinha?

Sim. Muitas vezes, o corpo reabsorve a hérnia ao longo do tempo, levando à melhora dos sintomas.

Quais atividades devem ser evitadas?

Levantamento de pesos, movimentos bruscos, posturas inadequadas e atividades que aumentem a pressão na região lombar devem ser evitadas.

Como prevenir a hérnia discal lombar?

Manter uma postura correta, praticar exercícios regularmente, fortalecer a musculatura das costas e abdominais, evitar o tabagismo e controlar o peso corporal.

Understanding Lumbar Disc Herniation

Lumbar Disc Herniation

Lumbar disc herniation is a common condition affecting the spine, causing pain and discomfort. It’s important to recognise the symptoms and seek appropriate treatment to improve quality of life.

What is Lumbar Disc Herniation?

A disc herniation is when a fragment of the intervertebral disc is expelled from the disc. This expulsion occurs through one or more fissures in the disc and cannot happen in perfectly healthy discs. A disc herniation is different from a disc protrusion, which corresponds to a progressive bulging of the disc as it collapses. Fissures, herniations, and disc protrusions are all consequences of discopathy or degenerative disc disease, a very common condition in the population, which explains the high number of people with disc herniations.

Evolution of Lumbar Disc Herniation

Having a disc herniation is not necessarily serious or painful. Often, disc herniations are discovered in people who have no back pain complaints. A disc herniation becomes painful when it compresses a nerve root located just behind the disc in the spine. The evolution can lead to a decrease in symptoms, even if the herniation itself does not disappear. On the other hand, there may be a worsening of pain and, in more severe cases, paralysis. For many patients, the evolution is cyclical, alternating between periods of pain and remission.

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SYMPTOMS

Most of the time, symptoms start after a mundane effort, with intense pain in the lumbar region, followed, after minutes or days, by the onset of pain in one of the legs. This leg pain is related to the compression of a nerve root by the herniation, following a precise path. It is called sciatica when the compressed roots are located at the back of the leg and cruralgia when they are in the front part of the thigh. The pain may extend to the feet or be limited to areas such as the buttocks, thighs, or calves. Besides pain, tingling, numbness, loss of sensation, or even paralysis may occur, indicating severe nerve root injuries, which may become permanent if left untreated.

Tests

Disc herniations are accurately diagnosed by computed tomography (CT scan) or magnetic resonance imaging (MRI). Performing one of these exams is essential before considering a surgical intervention.

Treatment Options

Treatment Options for Lumbar Disc Herniation

In the absence of paralysis or urinary problems, surgery for disc herniation is never an emergency. Medical treatment consists of rest, analgesic and anti-inflammatory medications, and, in some cases, massages or infiltrations. The goal is to reduce inflammation around the compressed nerve root and wait for a possible spontaneous resolution of symptoms. After a few weeks, doctor and patient evaluate the effectiveness of the treatment and the likelihood of natural recovery.

Principles of Surgical Treatment

Criteria for Lumbar Disc Herniation Surgery

If the evolution is not favourable, the surgeon will decide on the need for surgery based on the severity of symptoms, the duration of the condition, and the morphology of the herniation. In many cases, a simple removal of the expelled disc fragment by microsurgery is sufficient. In cases of recurrence or when the herniation occurs in a very degenerated disc, the entire disc must be removed and replaced by an implant.

Surgical Procedure

Endoscopy: Disc Herniation Removal

The endoscopic removal of a disc herniation is a minimally invasive procedure that allows the surgeon to precisely access and remove the herniation. Using a high-definition camera and specialised instruments, the surgeon can visualise and treat the affected area without causing significant damage to surrounding tissues. This method reduces recovery time and minimises the risk of complications, providing immediate pain relief and restoring nerve function.

Find Out More About the Procedure

POST-OPERATIVE CARE

The patient is encouraged to get up a few hours after the surgery. A physiotherapist teaches the appropriate movements for daily life, such as getting up, lying down, picking up objects, and performing personal hygiene. Hospital discharge may occur on the same day as the surgery (outpatient) or the following morning. The patient receives guidance on dressings, analgesic medication, and rest until the follow-up appointment.

CONVALESCENCE

At home, it is recommended to alternate rest in a comfortable position (semi-reclined, with legs slightly bent) with light walks on flat surfaces. Initially, walks should last 10 to 15 minutes, and can be gradually increased. Everyday activities, such as cleaning or driving, should only be resumed progressively from the 2nd or 3rd week, respecting the limits imposed by pain.

Physiotherapy begins after the 3rd week, with massages on the scar and painful areas, followed by exercises to stretch the body and strengthen the spine and limbs. Full recovery varies, but often allows a return to work or sports activities in the 4th week, except in cases of persistent pain.

In the long term, there are no contraindications for a normal active and sports life.

Frequently Asked Questions

What is a lumbar disc herniation?

It is a condition in which the internal material of an intervertebral disc in the lumbar region is displaced, compressing nerve roots and causing lower back pain and sciatica.

What are the most common symptoms?

Lower back pain that may radiate to the legs, a tingling or numbness sensation in the legs, and muscle weakness.

What are the main causes?

Gradual wear and tear of the discs due to ageing, weak musculature, excess weight, poor posture, and sudden or repetitive movements.

How is the diagnosis made?

Through symptom assessment, clinical examination, and imaging tests such as magnetic resonance imaging or computed tomography.

What are the treatment options?

They include analgesic medication, physiotherapy, specific exercises, and, in more severe cases, surgery.

Is surgery always necessary?

No. Most cases improve with conservative treatments. Surgery is considered when non-invasive treatments fail or in cases of severe symptoms.

How long does a disc herniation episode last?

Symptoms may improve within 6 to 9 months, regardless of treatment, as many herniations are naturally reabsorbed.

Can a disc herniation disappear on its own?

Yes. Often, the body reabsorbs the herniation over time, leading to an improvement in symptoms.

What activities should be avoided?

Lifting weights, sudden movements, inadequate postures, and activities that increase pressure on the lower back should be avoided.

How to prevent lumbar disc herniation?

Maintain correct posture, exercise regularly, strengthen back and abdominal muscles, avoid smoking, and control body weight.