* Successful results are obtained with the PRP method in the treatment of low back pain. It can be used in our patients with pain that affects the agonizing quality of life and patients who are not suitable for surgical treatment. And they are applications that should be tried.
Lumbar hernia is a very common discomfort in our society that can be very painful and has severe consequences. The condition called lumbar hernia is a clinical condition that occurs as a result of the cushions that are located between the back vertebrae and the purpose of which is to absorb the load on the body and provide flexibility to the spine, that is, the discs into or out of the canal through which the spinal cord passes due to deterioration in time. · The causes of its occurrence are generally very influential. In other words, many factors such as traumas, irregular posture positions, inappropriate movements, age-related and so on can be counted. Generally, it is more common between the ages of 30-50, but it can be seen at the age of 20 and over the age of 50. When hernia occurs, it shows its clinic with pain. This pain is pain that spreads to the hips, thighs, legs. Before the pain begins, numbness and tingling in the buttocks and thighs may occur. The first sign that can be called the preliminary symptom of the hernia can be a change in the pattern and habit of urinating. Having low back pain should not always be considered in favor of a herniated disc. Because it should not be forgotten that only 1% of lumbar pains are found to have lumbar hernia. The most important feature of the pain caused by lumbar hernia is the spread of the hips to the legs. These pains can cause the person to gain a psychologically nervous and sensitive structure, which affects the social life of the person. ·When the lumbar hernia extends into the canal, it puts the spinal cord under pressure. This pressure manifests itself as pain, and this pressure causes a decrease in strength and loss of function in the muscles of the nerve it affects and in the areas it stimulates, depending on the damage it causes in the nerve. · Lumbar hernias are usually L4 in the lumbar region. And it occurs between the L5 vertebrae or between the L5-S1 vertebrae. However, hernias can occur in other regions, and even hernias can occur in more than one region. There may be many reasons for low back pain. There are not only pillows in the waist area, which we call disc. There are structures such as muscles, bones and ligaments surrounding that area, and it should not be forgotten that a significant part of low back pain is pain called mechanical low back pain. It is the fear of lumbar hernia and the desire and desire to confirm this with visual methods and expensive methods such as MRI. Considering that 1% of low back pain is a herniated disc, it can be seen that the rate of lumbar hernia is low. In addition, examination is very important in determining the hernia and it is the most important diagnostic tool in distinguishing the hernia. · When low back pain occurs, lumbar hernia should not be suspected in cases where there is no pain, numbness and tingling that spreads to the legs and there is no loss of strength. In addition, the lumbar hernia gives symptoms as a result of the pressure exerted on the spinal cord. Examination is the most important diagnostic tool in the diagnosis of lumbar hernias. Visual methods such as computerized tomography, MRI, medicated lumbar film are used in order to determine the effects of the size of the hernia in case of necessity of the findings obtained as a result of the examination. ·Medicated waist film is an interventional method to detect the nerve that is under pressure as a result of drug administration into the canal of the spinal cord. Although the arrival of MRI reduces the usability of this method, it is sometimes necessary. The physician decides whether this is necessary. If a hernia compressing the spinal cord is detected during the examination and as a result of the methods taken or performed to support the results of the examination, the treatment to be applied depends on the person, the examination findings, the size of the hernia, and the condition of the hernia in the canal. Drug treatment and physical therapy may be used in patients who have pain complaints but do not affect their social life, where the localization and location of the hernia are appropriate and who have not developed strength loss. But this should not be forgotten. Depending on the progression of the hernia over time, it is likely that the clinic will suddenly deteriorate and the loss of strength and sensation in the foot and leg may occur, and this situation may lead to the emergence of a condition called caudo-equina syndrome in medicine. Surgery is an inevitable treatment method in patients whose social life is affected and who have loss of senses, strength and reflexes, because no medical treatment or method causes the recovery of this hernia. · Unfortunately, one of the methods used by patients with low back pain in our country is to undergo a back pulling procedure by people who are not medically inclined. The feeling of seeking remedy generally underlies this effort. The feeling of seeking remedies is the product of an under-informed society. Unfortunately, unwanted and more complicated events may occur in the face of waist pulling events. When seeking a remedy, it is important to act within the knowledge and recommendations of your doctor. Surgical procedure is really a scary situation. However, it should be kept in mind that the use of alternative treatment methods to avoid this is a situation that has severe consequences and consequently complicates the surgical procedure and may reduce the rate of benefit as a result of the surgical procedure. ·The aim of physical therapy programs is to strengthen the waist and abdominal muscles and increase the flexibility of the nerves that are tense. But it should not be forgotten that it should be done on time and on the spot. The most important problem of patients with low-grade hernia is the emergence of disturbing pain in various positions and movements, and the possibility of having a larger hernia in the future is ultimately included in the group of candidates for surgical treatment. Physical therapy programs can be applied to relieve the pain of the patients in this group and to stop the progression of the hernia. Physical therapy programs are also used for patients with loss of strength before the operation to return to their former powers after surgery. There are various methods applied when a herniated disc is detected. These are the removal of the disc with laser, removal of the disc with endoscopic methods, and open surgery.Although the first two groups are advantageous methods in terms of both returning to active life after the procedure and reducing the wound infection complications that may occur after the procedure, an important problem is to prevent recurrent hernia events after these procedures. can be seen frequently and this group of patients who can be treated are selected patients.In other words, these methods cannot be applied to all patients with herniated disc. The patient's age, clinic, weight, current condition of the spine, and the location of the hernia should be suitable for this hernia. Open surgical procedure, on the other hand, is a superior method with low recurrence rates as it enables the hernia to be seen directly and evacuated almost completely. Likewise, the biggest fear of patients with herniated disc is the fear of suffering the same pain and this is a situation that disrupts their psychology. After the surgical procedure, patients are mobilized on the first day. It is a fact that there are some prejudices about surgical procedure among the public. Are these the definitive solutions? Is there a risk of paralysis? And what if my hernia recurs. Thanks to the technological developments it has taken behind the developing brain and nerve surgery, it has managed to minimize the problems that may arise in its operations. Considering that there are 5 hernia areas in the lumbar region, there is always the possibility of hernia coming out in other disc areas that have not been operated on. It should be known that the surgery to be performed is performed only on the existing hernia area and does not prevent other hernias. There may be complications after all operations, as well as complications after lumbar hernia surgeries. One of these, paralysis, is a concept that can be considered theoretically, but it is a complication that can be quite rare in practical terms. However, the fact that it is rare does not mean that it will not happen. The status of the benefit obtained from lumbar hernia surgeries is compatible with the patient's clinic.The rate of benefiting from surgery is quite high in patients whose strength loss is not severe. However, it is necessary to accept the almost total strength loss that occurs in patients who have lost strength for a long time, but it is difficult to recover. This loss of strength is not the result of the failure of the operation, but the result of the patient not performing the necessary procedure at the required time. · One of the mistakes made in our society is to put forward the failures of the procedures, not the success rates, but when talking about these, the patient's structure is not taken into account. It should not be forgotten that the purpose of medicine is to use science to improve people's quality of life and to save lives. Doctors are people who present and use this information. Numbness and tingling may remain in the hips and legs after the surgical procedure. Such complaints usually disappear 6-12 months after the operation. Sometimes a recurrence of pain occurs a few months after the surgery. This recurrence is due to the adhesions that occur during the needling of the operation area rather than the recurrence of the hernia. These adhesions are tried to be opened through physical therapy programs. The purpose is to increase the flexibility of the adhesions in that area. However, if the complaints do not decrease despite all efforts, a second operation may be required.However, it has been recently determined that some substances used during surgery reduce the formation of these adhesions and have been used. After the hernia surgery, hernia may recur in the previously operated area, although very rarely, the reason for this may be a hernia that was not evacuated sufficiently before. · A situation that should not be forgotten is that lumbar hernia cases are greatly relieved after surgery. Patients who have undergone lumbar surgery have to protect themselves. And they have to strengthen their abdominal and waist muscles with various exercises and not gain weight. · It should not be forgotten that if there is weight in patients whose lumbar hernia is not at the level of surgery but who suffer from pain, it can provide nearly 50% relief in their complaints when they reach a weight suitable for their height.
OP DR GÖKALP KARAARSLAN