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知らないと危ない!腰痛とヘルニアの治療方法の違いについて

のび

慢性化した腰の痛み、ぎっくり腰の激痛、皆さんも経験した方は多いでしょう。しかし、良く聞く「ヘルニア」とは何かご存知でしょうか。腰痛とヘルニアは、似ているようで実は全然違います。簡単に言えば、腰痛は治りますが、ヘルニアは治療が難しい病気です。今回は腰痛とヘルニアの違いについて調べてみましょう。

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椎間板とヘルニア

腰

背骨と背骨のあいだには、椎間板という潤滑剤があります。
椎間板があるので骨どうしが摩擦したりきしんだりすることなく背骨を曲げることがきでます。この椎間板は20歳を過ぎると減る傾向にあります。実際、50歳を過ぎた人のレントゲンは髄核と呼ばれる椎間板の中心は黒く写ります。若々しい骨では白く写ります。

なにかを食べたから、なにか運動をしたからと言って増えることはありません。老化は遅らせることができるので、椎間板の減りを遅らせることはできても、椎間板を増やすことはできないのです。椎間板のなかの髄核が飛び出して神経を圧迫して痛みが走る、これが椎間板ヘルニアです。

椎間板ヘルニアの原因

椎間板ヘルニアは加齢や背骨にかかる負荷によって起こります。加齢も不可も意識して避けることはほぼ不可能です。
唯一、椎間板ヘルニアの原因で意識的に回避できることとして「急な動作」が挙げられます。ぎっくり腰も急な動作によって発症しますが、ぎっくり腰と椎間板ヘルニアは併発しやすいのです。朝起きて、すぐに起きるとか、重たいものを腰を下ろさないで持ちあげる、高いところから飛び降りるなどの動作は20歳をすぎると控えたいものです。

腰痛とヘルニアの違い

椎間板ヘルニアはぎっくり腰のように腰への激痛が走ります。よって、ぎっくり腰と椎間板ヘルニアは区別がつきづらいのですが、しびれなど神経の異常があるかないかで見分けます。

ぎっくり腰は髄核が飛び出さないので、神経への異常はないものですが、椎間板ヘルニアは髄核が飛び出しているので、神経を刺激して腰からお尻のあたりがピリピリと傷みます。

ぎっくり腰の場合は1~2週間程度で痛みが治まりますが、椎間板ヘルニアの場合はいつまでもしびれたような痛みが残ります。神経が圧迫されているので、安静に寝ていると治るというものではありません。できるだけ速やかにお医者さんに診てもらいましょう。

ぎっくり腰と椎間板ヘルニアを併発した場合は、先にぎっくり腰の対策をします。
つまり絶対安静で腰を冷やします。ぎっくり腰の症状が緩和してから、椎間板ヘルニアの対処をしても遅くはありません。

■腰椎椎間板ヘルニアチェック表

  • *腰痛だけではなく、図のような範囲にしびれや痛みが走る(お尻・太ももの裏側・太ももの外側・ふくらはぎ・足の裏・足の指)
  • *お尻の痛みやしびれが頻繁に感じられる
  • *歩行に支障がある
  • *おじぎをしたり、椅子にすわったりと屈む姿勢で症状が悪化する
  • *太ももやふくらはぎ、足に重だるさや冷感がある
  • *立っていることがつらい、または不可能
  • *パンツや靴下を履くことが困難
  • *足首が思うように動かなくなる
  • *下肢の筋肉が痩せてきている(左右差がみられる)

ヘルニアの治療

■安静
ヘルニアの症状は、突然の疼痛と、その後の著明な疼痛の軽減ないし完全な消失が特徴。あわてて治療を進めるのではなく、我慢できる範囲の疼痛などであれば安静にして経過をみるのも一つの選択。通常6~8週間で、半分以上の方が軽快します。

■鎮痛薬
ボルタレン、ロキソニンなど非ステロイド消炎鎮痛薬( NSAIDと省略されます )。

・ボルタレン……1錠15.3円で1日3回食後に服用。副作用は胃部不快感、浮腫、発疹、ショック、消化管潰瘍、再生不良性貧血、皮膚粘膜眼症候群、急性腎不 全、ネフローゼ、重症喘息発作(アスピリン喘息)、間質性肺炎、うっ血性心不全、心筋梗塞、無菌性髄膜炎、肝障害、ライ症候群など重症な脳障害、横紋筋融 解症、脳血管障害、胃炎。

・ロキソニン……1錠 22.3円で1日3回食後に服用、副作用はボルタレンと同様。

どちらの薬でも胃潰瘍を合併することがありますので、胃薬、抗潰瘍薬などと一緒に処方されます。5年間、10年間の長期服用で腎機能低下などの副作用があ りますので、注意が必要。稀に血液透析が必要となる場合もあるので、漫然と長期投与を受けることはできる限り避けて下さい。

鎮痛薬の問題点は数ヶ月以上の服薬で胃腸症状、腎機能低下が高率に発生しますので、急性期を過ぎたら主治医と相談し、減量ないし休薬を考えましょう。

■除圧椎弓切除術
神経に対する圧迫を除去するために、骨成分である脊椎の椎弓と呼ばれる部位を切除する手術です。人体の後方からアプローチします。

健康教室  「腰痛について」
オンリー・ユー出版 (2014-05-10)

まとめ

腰痛とヘルニアは似ているようで全く違います。腰痛は10日ほどで完治しますが、ヘルニアは椎間板を増やす事はできないので、完治が難しく、投薬や手術という方法がとられます。腰痛になった時にヘルニアかも知れないと不安な場合は、ヘルニアチェック表でよく確かめておくと良いでしょう。

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