Osteochondrosis

Spinal hernia: symptoms of common varieties and deciding on surgery or non-surgical treatments

Median (median) herniation of the intervertebral disk is usually localized in the lumbar or cervical region, less often affects the thoracic spine.

This type of hernial deformity is considered the most unfavorable for the patient, often accompanied by impaired motor function and malfunction of the internal organs. But is this pathology really dangerous and is it possible to avoid complications?

What you need to know about the disease

Hernial deformity of the intervertebral cartilage is the bulging of a part of the disk structure beyond the vertebrae. But few people think that the course of the disease is influenced not only by the size of the hernial sac, but also by its location on the spine.

The median herniated disc is localized on the back surface of the spinal column, from the back.

The most frequent manifestation is the inability to straighten the back, and patients are forced to move, bending the torso forward. The angle of inclination can vary from slight to strong (sometimes up to 90 °).

When localized in the cervical region (as a rule, it is a midline hernia of the C5-C6 disk, less often in other parts of the neck), patients are forced to keep their heads low and use a high pillow to sleep.

But, in addition to difficulties in extension, such localization carries an additional danger: nerve processes emerge from the back of the spinal column, which can be clamped by protrusion of cartilage tissue.

Constriction of the nerve causes a partial or complete loss of motor function and disorders in the work of the internal organs.

Classification of pathology

The posterior median hernia can be located strictly in the center or slightly shifted to the right or left. Depending on the location relative to the vertebra, such types are distinguished:

  • Dorsal deformation. The cartilaginous defect is located strictly in the middle of the vertebra and is considered the least severe. For example, the dorsal median hernia of the intervertebral disk L4-L5 (the most frequent localization of the lumbar pathology is the disk L4-L5) only prevents the extension of the body, but there is almost no compression of the nerve roots.
  • Left-sided mid-paramedian herniated disc. Deforming changes are located slightly to the left of the center of the vertebra, and when the nerve is clamped, motor or tactile disorders on the left side of the body, as well as improper functioning of the organs, are noted on the left. With the localization of the hernial bulge in the cervical or thoracic regions, such patients may experience pseudoheart pain and impaired respiratory function.
  • Right-sided mid-paramedian hernia violates the functions of the right side in humans.

In addition to the location relative to the vertebra, the course of the disease is also influenced by the direction of protrusion. It may be:

  • Outwards The deformed cartilage with a part of the pulpous nucleus extends beyond the outer limits of the spinal column. The disease has a favorable course and, subject to medical recommendations, has only a minor impact on the quality of human life. In most cases, patients can stop the progression of the disease and avoid complications.
  • Inside. The protrusion occurs inside the spinal canal, and even with minor sizes of cartilage bulging, there is compression of the spinal cord and impaired function of the internal organs, loss of sensitivity or weakening of motor activity. This type of pathology is considered the most dangerous. With it, more often than other types of cartilage deformations, surgical intervention is used to eliminate the compression of the spinal cord.

In the early stages, the medial disc bulges successfully respond to conservative treatment, and the diseased can continue to lead a full-fledged lifestyle, only slightly limiting locomotor activity and following a diet.

Launched forms of pathological cartilage bulging are almost always accompanied by complications, and the use of conservative therapy does not always have the necessary therapeutic effect.

Reason to suspect spinal disease

In what cases it is possible to suspect that a back midline herniation of the intervertebral disk has arisen?

There are no specific symptoms for this condition, the symptoms are similar to other vertebral diseases, but the reason to check the state of the spinal column should be the following:

  • Difficulty extensor movements. Early pains may not yet be present, but patients will notice that it is difficult for them to throw their heads back (if the cervical region is affected) or to make a back arch in the lower back.
  • Localized pain syndrome. Palpation of the spine pain is felt where there is disc deformity. Irradiation of pain in the limb or nearby back areas is possible.
  • Impaired sensitivity. Numbness, tingling, itching or burning sensation on certain areas of the skin.
  • The weakening of the muscles of the limbs. Muscle weakness can range from minor to severe, causing serious impairment of motor function.
  • Failure of the internal organs. Pain in the heart, indigestion, and even impotence, which arise for no apparent reason, require suspecting the posterior median hernia.

Even if one of the listed symptoms is noted, you should not postpone the visit to the doctor, because timely started treatment will allow you to avoid complications.

Median hernial deformities more often than other types provoke compression of nerve roots and cause various complications.

But with timely treatment for medical help in most cases, the progression of the disease can be slowed down, and these patients do not lose the opportunity to lead a full life.

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Denial of responsibility

The information in the articles is intended solely for general information and should not be used for self-diagnosis of health problems or for medical purposes. This article is not a substitute for medical advice from a doctor (neurologist, therapist). Please consult your doctor first to know exactly the cause of your health problem.

The essence of pathology

The human spine consists of vertebrae and intervertebral discs. It is these discs that serve as shock absorbers, which take all the jolts during the movement and provide the flexibility of the ridge.

The disk consists of a fibrous ring that holds the pulpal nucleus in place. But for some reason, the kernel bulges and the disk moves. Thus, hernia of vertebrates develops.

Hernias form in 2 stages:

  1. Protrusion. Disk offset by more than 4 mm. The inner fibers of the ring are damaged, and its shell is still intact. Pulpous nucleus is shifted, but is located within the annulus.
  2. Entrusion. Due to the damage to the fibers of the fibrous ring, the core falls out of its limits. It is at this stage that a hernia occurs.

This pathology refers to degenerative diseases.

Osteochondrosis is considered to be the main cause of hernia formation on the spine. As a result of degenerative-dystrophic processes, the intervertebral disc loses its elasticity and it is easily injured.

Provocative factors for the development of a hernia are:

  • heavy work associated with lifting weights,
  • sedentary oboz life, sedentary work,
  • poor posture, creating an excessive load on any part of the spine,
  • overweight,
  • malformations of the spine,
  • injuries.

Common causes of development of pathology can be weightlifting. Training with the burden without compliance with safety (correct selection of the weight of the tool, the use of a safety belt) increase the vertical load on the spinal column, which leads to rapid wear of the intervertebral discs.

Characteristic features of "popular" hernia of the spine

Quite a lot are interested in the question whether osteochondrosis and vertebral hernia are related?

Yes, the hernia formed in the spine is the last stage of progression of osteochondrosis, which is a degenerative-pathological changes in the tissue of the fibrous ring of the intervertebral disk. The occurrence of cracks and ruptures in it leads to the prolapse of the disk beyond the anatomically determined limits.

You should know that the protrusion of the disc to 1-3 mm is the norm, the swelling of the ring to 5-6 mm is not a hernia, but its harbinger - protrusion. "Classical" vertebral hernia - 6 mm. At the same time, a more significant size of protrusion, for example, 15 mm, is always a vertebral hernia with a ruptured ring.

On a note! In people over 60 years old, vertebral hernia and spinal instability are quite rare phenomena, and cases of spontaneous regression, and even the complete disappearance of the pathological protrusion of intervertebral discs, are often found in young people under 30 years of age.

If the diagnosis of osteochondrosis or protrusion of the intervertebral disc has already been made, then you should pay attention to the following violations with hernia of the spine.

Lumbosacral hernia L5: S1

Vertebra hernia L5 C1 is the most common herniated intervertebral disk among all spinal hernias. Letters and numbers indicate its location between the last lumbar and first sacral vertebrae.

The superiority of lumbosacral hernia is due to the fact that it is this place that has the largest loads, and the joint itself is quite mobile.

Herniation L5: S1 is characterized by the following set of manifestations:

  • constant burning pain syndrome, localized at the level of these vertebrae, aggravated after hypothermia, physical exertion or a long stay in a static position,
  • painful radiation to the buttock, to the back of the foot, pain in the knee, numbness of the foot,
  • change or lack of sensitivity of the skin in painful places, as well as on the ankle and sole,
  • the occurrence of acute pain in the leg when sneezing and coughing is a “cough push”,
  • after a long sitting over the entire surface of the foot, the "pricking goosebumps" start running and the thumb is numb,
  • the muscles of the buttock located on the side of the hernia protrusion gradually weaken, it becomes difficult to bend the big toe,
  • the symptom of Lasega - if, while lying on the back, to raise a straight leg, there is a sharp sharp pain under the knee and in the lower back, and if you bend the knee, then the pain syndrome subsides,
  • in advanced cases - a violation of erection, difficulty with the retention of urine and feces.

Vertebral hernia 5 6 cervical vertebra

Behind this diagnosis is No. 2 in the ranking of all intervertebral hernias — the back (middle) or right-sided hernia of the cervical region, located between vertebrae C5 and C6. The rupture of the fibrous ring in this place leads to the constant infringement of the 6th nerve root.

For clinical practice, vertebral dorsal hernia C5: C6 is important, which causes narrowing of the intervertebral canals and spinal stenosis. In many cases, it is accompanied by protrusions and uncovertebral arthrosis in the segment above - C4: C5, and in the segment below - C6: C7.

Cervical hernia C5: C6 can be recognized by the following features:

  • neck mobility is limited, which leads to cervical rectum,
  • numb and sore shoulder blade, neck, outer shoulder and forearm, hand, thumb and index fingers,
  • pain in the head has a constant, breaking or aching nature and is localized in the upper part of the neck and occipital region.
  • decreases the severity of the biceps reflex of the shoulder,
  • it is possible - the hand is poorly obeyed when it is withdrawn to the side and turned inward, and the brush is also hard to bend.

Lumbar hernia vertebra l4 l5

Dorsal vertebra hernia l5 or diffuse vertebral hernia l4 - 7 mm, occupies the third position in terms of prevalence among vertebral hernias (see Lumbar hernia: pathology formation and treatment methods). The lumbar vertebrae can be denoted by different letters - l, L, l or L. The same applies to the designation of vertebrae of other departments.

It is interesting. Hernia l7 vertebra is a pathology that is impossible in humans. The letter l denotes the lumbar vertebra, and the number 7 its serial number. If you have heard such terminology in a conversation, it means that veterinarians or dog and cat lovers communicate with each other, since a person has only 5 lumbar vertebrae.

The common symptoms for lumbar hernia l4-l5 are:

  • constant, aching and burning pains in the area of ​​the affected segment,
  • the increase in pain occurs when emptying or movements, sometimes during a meal, and the pain subsides in a standing position,
  • swelling of the ankles,
  • Lasegue symptom (see above symptoms L5: S1)

Specific signs of foraminal hernia L4: L5 (with a forward fibrous ring rupture):

  • pain syndrome is localized only in the segment,
  • during laughter, coughing, sneezing, other strains of the abdominal muscles, tingling and goosebumps begin to run down the skin of the abdomen.

The symptoms peculiar to paramedic hernia L4-L5 with lateral impairment of the nerve root, which some people mistakenly call as pyramidal hernia in the spine, manifest as follows:

  • the pain radiates to the buttock and spreads through the back of the thigh to the lower leg,
  • leg often goes numb.

The most dangerous, dorsal hernia L4-L5 with a rupture or separation of the ring in the direction of the spinal cord additionally manifests itself with the following symptoms:

  • the sensitivity of both legs is disturbed, in severe cases the knee jerks are disturbed and paraparesis of the legs is possible,
  • there are difficulties with the retention of urine and feces,
  • in men, erectile dysfunction is possible,
  • during an acute period, pain may be aggravated by a slight cough or a deep, sharp breath.

But Schmorl's medial hernia l4-l5, during which changes occur inside the vertebral body, is discovered by chance, because it proceeds without serious consequences and without other additional manifestations.

Important! Note that the above sets of symptoms relate to the standard course of the disease. Individual characteristics of the body can change the sensations and their "classic set".

Diagnostics

Refining the diagnosis of intervertebral hernia includes:

  • checking the sensitivity of the skin and neuromuscular reflexes,
  • determination of the level of muscle strength - electromyography (EMG) and transcranial magnetic stimulation (TMS),
  • assessment of peripheral nerves - electroneurography (NCS)
  • x-ray, myelogram,
  • computed tomography (CT),
  • magnetic resonance imaging (MRI).

It is worth noting that spinal X-ray with a hernia - a normal image, myelogram and CT scan, do not represent a special diagnostic value. These examinations do not allow to see the true picture of changes in the discs and nerve roots.

However, during the initial diagnosis, it is necessary to make them, because using x-ray examinations, it is possible to detect bone lesions, for example, “spurs”.In addition, myelogram + CT scan allows to exclude the presence of benign or malignant tumors, because the spinal tumor and vertebral hernia have similar symptoms.

Council Despite the fact that the price of an MRI examination is higher than radiographic methods, follow the development of a hernia, 1 time in 3 months, it is preferable to use it in a safe way for health, unless of course the patient has no contraindications - the presence of metal implants or a pacemaker.

Decision-making

After a diagnosis, a vertebral hernia should not immediately panic when hearing about its large size. For example, a 5 mm foraminal hernia of the cervical spine is much more dangerous than a 7 mm paramedial lumbar hernia, and ventral hernias discovered by chance do not require treatment at all.

In what cases do not pay attention to the doctor's proposals for surgical removal of the hernia, and when you need to immediately agree, and not lose valuable time? Hernia can be treated without surgery if its size is 2.5-6 mm, as well as if an MRI examination is not done.

Surgical intervention is necessary in the presence of:

  • horsetail syndrome in lumbar and lumbosacral hernias - difficult acute pains along the sciatic and femoral nerves, numbness of the perineum, weakening of erection, spontaneous twitching of the muscles of the legs, difficulty holding or incontinence of urine and feces,
  • persistent or increasing symptoms after 6-12 weeks of conservative treatment,
  • deterioration after continuous 2-year complex therapy.

Movalis and vertebral hernia

This drug today belongs to the first echelon of NSAIDs. In comparison with other nonsteroidal anti-inflammatory drugs, its use is not limited to 2 months, since its action is milder, and it rarely causes side effects. You can replace movalis with rhewmoxicam.

On a note. Excellent results are given by the combination of oral movalis and its formopuncture introduction on acupuncture points. However, many experts do not see the feasibility in the simultaneous introduction of vitamins of group B.

Mydocalm and vertebral hernia

Mydocalm belongs to the group of muscle relaxants - drugs that relieve spasm or excessive tension (hyper tone) of the skeletal muscles, as well as partially improve blood circulation. However, it should be used with caution, because it relaxes all muscles, including the "protective" tension of muscle fibers, which can lead to increased pain. You can replace mydocalm with Sirdalud medicine.

This tool does not treat the pathology itself, but is used to relieve swelling. After it is taken, the soft tissues squeeze the nerve root less and this leads to a partial reduction in pain and an improvement in the blood supply to the intervertebral disc.

Blockages and hormonal drugs

Instruction: 3-4 epidural injections are placed in the region of the affected segment, which are performed no more than once a week. It is not recommended to make more than 4 blockades, without a 3-month break between courses.

In some cases, a positive effect is achieved with the help of anesthetics, for example, novocaine or lidocaine. In severe conditions, corticosteroid drugs are added to the anesthetic. In some patients, such combined injections can relieve pain for up to 3-4 weeks.

Important! The technique of intralaminar or transforaminal epidural medical blockades is quite complex, so you should be especially careful when choosing a specialist who will perform such anesthesia.

Collagen and vertebral hernia

The pulp-fibrous ring of the intervertebral disc consists of collagen fibers, therefore, in case of its primary violation - osteochondrosis or protrusion, long-term use of chondroprotectors is advisable.

With hernias - strong protrusions and ruptures of the disk ring, collagen will not help restore the integrity of the intervertebral disc or reduce the size of its protrusion. Reception chondroprotectors "need" to maintain the disks that are in the vertebral segments located above and below the affected.

Physical therapy and massage

Despite the fact that excessive physical exertion during vertebral hernia and weight lifting is categorically contraindicated, daily exercise therapy and course massage therapy sessions are not just necessary, but mandatory.

Nevertheless, the photo and video in this article gymnastics with herniated vertebrae is not placed. In contrast to exercise therapy in osteochondrosis and even exercise therapy in protrusions of discs, the complex of exercises for intervertebral hernia must be compiled by an exercise therapy instructor or sports doctor (see Therapeutic gymnastics for hernia of the lumbar spine - general rules and an approximate set of exercises).

A graduate will first analyze the localization of the process, the size of the hernia, the severity of manifestations, general health and the presence of other diseases. Only after that an individual complex will be compiled, in which the alternation of static, dynamic and post-isometric exercises will be determined, the initial number of repetitions and the scheme of increasing loads.

The only way to treat vertebral hernia that does not require medical approval is to visit the pool. It is necessary to swim for 40-45 minutes, 2-3 times a week, dispensing the load on well-being. The only thing you should know is that with spinal hernias you shouldn’t swim with the Brass or Butterfly style.

Manual therapy

Attention! The use of manual treatment for hernias with progressive neurological deficit is prohibited by the WHO protocol

In domestic practice, manual therapy is permissible, but not only with a chiropractor, but with a manual therapist with a higher medical education. At the same time, the manipulations performed by the doctor should be extremely delicate, the number of sessions should be no more than 2-5, and the reduction of the intervertebral joints displacements must alternate with post-isometric relaxation!

And in conclusion, it is necessary to add - the treatment of a hernia, without surgery or after it, should take place against the background of adherence to a healthy lifestyle, optimal drinking regimen, a balanced diet and keeping body weight in the normal range.

Features of the operation in the thoracic spine

The thoracic spine is anatomically a rigid structure consisting of the vertebrae, sternum and ribs. It is immobile, because protrusions and herniated intervertebral discs are formed in it extremely rarely, and are mainly the consequences of traumatic injuries.

Despite the improvement of surgical methods, medical equipment and equipment, a variety of accesses to the pathological site, during operations on the thoracic region it is almost impossible to avoid traction of the spinal cord and nerve roots, as well as significant resection of bone structures. For example, the remote articular processes, the bases of the arches or the heads of the ribs further require the mandatory installation of stabilizing systems or implants.

The articular processes of the thoracic segment are located medially (closer to the middle), and the intervertebral joints are posteriorly relative to the dural sac. Thus, in order to reach the lateral (lateral) edge of the sac and spinal roots, resection of the articular process or most of it is necessary. But, even with the complete removal of the appendix to visualize a hernia or sequestration, it is necessary to move the roots strongly, and, consequently, the dural sac and spinal cord.

Modern methods of operating the thoracic section offer a number of minimally invasive interventions with minimal resection of bone tissue, which practically do not violate the biomechanics of the spinal column and accelerate the period of rehabilitation of the patient.

The most promising today are: lateral transpedicular (posterolateral) access and posterolateral transfacial (pediculosa), which excludes resection of the root or base of the vertebral arch. They allow you to bypass the dural sac from the lateral or ventral (peritoneal) side, exclude traction of the spinal cord and removal of the articular processes.

Given the poor visualization of the pathological site during the operation of the vertebral hernia of the thoracic region, lateral, ventral or minor posterior lateral accesses are more preferable. In this segment, the intervertebral holes, which are bounded above and below by the bases of the arms, open laterally. Accordingly, with lateral surgical access and the same direction of the holes, it is possible to qualitatively examine not only the lateral side of the intervertebral disk, but also its entire posterior surface.

Types of operations

Classical laminectomy is widely known, quite popular in the past, but rejected by specialists because of the high percentage of adverse outcomes. It does not allow direct access to the anterior surface of the dural sac and visualization of the posterior surface of the intervertebral disk. Therefore, the removal of small, soft-tissue lateral hernias by a laminectomy is relatively justified, but the elimination of bulky, ossified formations is not complete without deformation of the spinal cord.

Despite all the disadvantages of laminectomy, some neurosurgeons prefer to use it, since with an error in determining the localization of pathology, it is possible to expand the trepanning window to the overlying and underlying vertebral motor segment.

Transthoracic (intercostal) anterior surgery is performed from the side opposite to the location of the protrusion. A surgical incision is usually made 2 ribs above the intended affected area. This access provides a good visualization of the affected disk and is effective in central and lateral placement of education, and is also applicable to operating multiple and multi-level lesions. With central localization of the hernia, anterolateral thoractomy is more suitable, and for lateral hernia, lateral or posterolateral thoracic.

Further, after the formation of the trepanation window, an additional radiological control of the affected level is carried out. Then the vena cava and aorta are displaced, the segmental vessels are ligated, the disc is gradually removed, the posterior longitudinal ligament, the hernia itself, and, if necessary, osteophytes. The epidural space is examined, sequestration is excluded. Finally, a stabilizing system is installed (interbody body with 1 or 2 cages approximately 20 mm long and 12 to 14 mm in diameter).

The lateral extracavitary approach is performed from the side of the herniated disc. It involves resection of the posterior part of the rib, its head of the transverse process, the base of the arch and the articular process. The pleura peels off and is removed, but the pleural cavity is not opened. Access allows you to cut lateral and central hernia, volumetric in size and ossified (calcined, solid). In some cases, ossified hernias are tightly fused with the lining of the spinal cord. This requires the excision of the dura mater together with the formation and its plastic.

The transfacial pediculo-preserving approach is rightly considered the most minimally invasive. It is characterized by one-sided skeletization of the spinous arches and articular processes. Then, the lower part of the overlying arch and the upper part of the underlying arc of the level of interest, the medial or total resection of the facet (facetomy) are removed. Next, the spinal root and dural sac are visualized, where the hernia is located. The method is optimal for removing soft lateral hernias.

Lateral transpedicular access allows you to qualitatively examine the posterior surface of the vertebrae, is less traumatic for muscular-ligamentous and bone structures, does not require moving the spinal cord or roots back, and does not affect the arteries. During the operation, the patient is located on the abdomen, the skin incision is made transversely to the spine or in a semicircle, if access to several vertebrae is necessary. Next, the transverse process and the head of the rib are resected, the neurovascular bundle is displaced slightly and the hernia is removed.

Concept and types

Intervertebral hernia - the process of displacement of the pulpous nucleus in the region of the intervertebral disc, accompanied by the breakthrough of the fibrous ring. The bulging out contents can put pressure on the nerve roots and on the spinal cord, which is fraught with the development of paralysis. Therefore, intervertebral hernia requires treatment to begin urgently.

Doctors distinguish 4 stages of disease progression:

  • the presence of degeneration in the fibrous ring,
  • appearance of protrusion,
  • extrusion or breakthrough fibrous ring,
  • development of sequestered damage.

Depending on the area of ​​the ridge in which the damage is located, they distinguish the following types:

  • cervical disease,
  • thoracic ailment (less common than other types),
  • affecting the lumbosacral region (the most common type).

Depending on the severity, in addition to the usual and uncomplicated damage to the spine, physicians distinguish such varieties:

  1. Sequestered intervertebral hernia.
    It is a disease accompanied by rupture of the fibrous ring, with the complete loss of pulp content. The presence of sequestered intervertebral hernia - an indication for surgery.
  2. Wandering sequestrated pathology.
    This is the process of complete separation of the pulpal component with its migration beyond the affected disk. This pathology requires an urgent operation in an institution that has the appropriate equipment. It is important to pre-do not only MRI, but also CT. So, during the operation, the surgeon will not have unpleasant surprises for which he is not ready in material terms.
  3. Calcified intervertebral hernia.
    This is the presence of bone components that require removal. Usually such a problem also requires surgery.
  4. Pathology of Shmorlya.
    This is a hereditary pathology, in which the bone component does not keep up with the muscular frame, in connection with which voids form in the vertebral bodies. Modern treatment of this pathology is reduced to the observation of its dynamics.

There is also a classification of such diseases of the spine, depending on the location relative to the longitudinal ligament:

  1. Front.
    This is one of the most simple pathologies, the treatment of which is usually conservative. The symptoms of the disease are often absent and usually the problem is discovered by chance.
  2. Back.
    Loss is carried out from behind, into the lumen of the spinal canal. This is the most common location of the lesion. Treatment may be conservative. However, if the result is absent within 1 - 2 months, the appointment of the operation is recommended.
  3. Median.
    The disease is localized in the lumbosacral region and is located, in particular, on the transitional vertebra (L5 / S1). Treatment is usually radical. The operation is prescribed in the presence of a large protrusion.
  4. Paramedian.
    This is the most painful type of disease. The symptoms are extremely intense, since the protrusion of the pulpal content occurs in the region of the cuff of the nerve root and is accompanied by squeezing of the dural sac. With this arrangement, the spinal lesions recommended surgery.
  5. Lateral.
    Symptoms of the disease are expressed by radiating pain.Most often, the pathology is located in the lumbosacral region. Unpleasant sensations can not be completely eliminated with analgesics. Such pronounced symptoms are a consequence of the loss of the pulpal contents into the lateral pocket. The treatment of this pathology is an operation.
  6. Foraminal.
    Localization may be in the region of the cervical, thoracic and lumbosacral spine. At the same time, the hernia is small and bulges into a narrow foral foramen.
  7. Extraforaminal.
    This damage to the spine is extremely difficult to diagnose, it is rare. The treatment of this spinal pathology is surgical.

The most common lesions of the lumbosacral region of the ridge (up to 96% of cases). The second place in terms of prevalence is a hernia of the cervical region (up to 5% of cases), and the most rare are the lesions of the thoracic spine (up to 2% of cases). The most rare is the thoracic pathology of intervertebral discs.

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What is herniated disc

There are discs between the vertebrae. These formations consist of cartilage tissue and collagen fibers that form the basis of the annulus. In the center is the gelatinous (pulposal) core, which acts as a shock absorber. Under the influence of unfavorable factors, this nucleus begins to swell into the intervertebral canal, but is retained by the fibrous ring. Protrusion appears. As soon as the rupture of the ring occurred, a hernial protrusion is formed.

Factors contributing to the appearance of a hernia:

  • age changes
  • features of the musculoskeletal system: scoliosis, weakness of the back muscles,
  • excessive loads: heavy lifting, sudden movements, uncomfortable postures during work,
  • diseases of the spine: osteochondrosis, infections, injuries.

How manifest

For a hernia of the thoracic spine are characterized by complaints of pain on the front, side of the chest and in the interscapular region. Pain can be shingles. Any movement: turning, bending, sneezing, deep breathing - causes suffering. By the nature of the pain can be burning, aching, stabbing and in the form of lumbago.

But this is not limited to this. Since the hernia goes beyond the limits of the intervertebral disk, a compression of the nearby structures occurs: nerve roots or spinal cord. Clinical manifestations depend on where the hernial protrusion goes.

  1. Anterolateral hernia for a long time asymptomatic, but when exposed to the anterior longitudinal ligament contribute to the development of pain.
  2. Lateral (lateral hernia) can squeeze the roots, which is manifested by pain in the abdomen and chest.
  3. The posterior (median) hernia is the most dangerous: as it grows, signs of compression of the spinal cord are observed. Dysfunction of organs located in the small pelvis and lower extremities is added to the intense pain.

How to establish the diagnosis

If you have pain in the thoracic spine and precordial area, you should immediately consult a doctor. This is necessary in order to exclude heart disease, which can simulate intervertebral hernia.

The diagnosis is made on the basis of complaints, examination and data of special methods of research. The most informative are:

  • radiography of a specific spinal column,
  • computed tomography (CT),
  • magnetic resonance imaging (MRI) allows you to set the location, the size of the hernia and the condition of other structures of the spine and soft tissues,
  • Myelography is an x-ray study using a contrast agent that allows you to assess the state of the spinal cord.

Timely diagnosis of the disease allows you to avoid serious consequences.

Medicines

  1. Used drugs that reduce pain and have anti-inflammatory effect: Nimesulide, Meloxicam, Ksefokam, Arkoksia.
  2. Topically applied ointments, creams or gels in the affected area. These are such means as Nise gel, Aertal cream, Indomethacin ointment, Fastum gel. Drugs that have a warming effect should be avoided.
  3. Muscle relaxants are drugs that reduce muscle spasm, which accompanies pain syndrome and itself contributes to the appearance of painful sensations. May occur reflexively. These include: Sirdalud, Mydocalm and Baklosan.
  4. Improve the condition of the nervous system B vitamins, which are used in the form of injections or pills. These are Milgamma, Kombilipen, Kompligam V.
  5. If the pain is unbearable, then blockade with Novocain or Lidocaine can alleviate the condition.
  6. Chronic pain syndrome requires antidepressants.

Do not self-medicate. All medications taken only after consulting a doctor.

Non-drug effects

  • Sleep on a hard surface.
  • Do certain exercises that form the muscular system and help keep the spine in the correct position. These are tasks of physical therapy.
  • Massage and manual therapy.
  • Physiotherapy with DDT and electrophoresis.
  • Acupressure and acupuncture.
  • Non-surgical treatment of hernia with the use of special devices.

If conservative methods do not give a positive result (pain persists for several months, it becomes more intense, complications in the form of paralysis appear), then surgical treatment is resorted to. The disc located between the vertebrae can be removed completely or partially (microdiscectomy). Perhaps the laser effect, which evaporates the gelatinous core. As a result of this procedure, the disk is reduced in size.

To achieve a long-term effect of therapeutic measures, it is necessary to identify and eliminate all possible causes that could contribute to the development of the disease. Otherwise, a similar problem may appear elsewhere.

How to prevent hernia

The main prevention is to follow simple rules:

  • avoid heavy physical exertion, uncomfortable postures and awkward movements,
  • do sports on a regular basis,
  • timely treat spinal diseases,
  • adhere to a healthy lifestyle.

Despite the fact that hernias between the thoracic vertebrae are less common than in the lumbar region or neck, they cause no less problems. Symptoms of the disease are detected mainly in people of young and mature age, who are still full of strength and lead an active lifestyle. If you do not take care of your health in time, then you can later become disabled.

Choice of surgical access

Determining the approach for removing a hernia of intervertebral discs depends on:

  • localization of protrusion (medial, paramedial, lateral),
  • the size of the hernia and the degree of compression of the spinal cord,
  • quality (consistency) of education (magcotta or ossified).

Thus, in-depth qualitative examination allows not only to make the correct diagnosis, but also to plan a surgical intervention. After an MRI examination, it is advisable to undergo a CT scan, which will help determine whether or not the hernia is ossified, and myelography with a contrast agent can more accurately determine the level affected.

The transthoracic or lateral extracavitary approach is more justified for the median placement of hernias. Massive, median, ossified formations that require extensive decompression by the method of corporation require transthoracic access. After it it is possible to install fixing systems.

Median, soft, and in some cases volumetric protrusions it is more logical to remove the posterolateral approach with the maximum necessary angle of inclination (lateral extracavitary method). Ossified (solid) placed laterally, hernias optimally curetis in the lateral transpedicular way. Lateral, soft-woven and smaller in size are better removed using the transfaceous pedicuser-preserving method.

All of the above operations require the use of a surgical microscope with a magnification of 8 to 10 times and microsurgical instruments, and in some cases, an endoscope with video monitoring.

Classification of hernia

  1. Circular hernias (they appear uniform, around the circumference of the annulus, protrusion of the gelatinous body of the nucleus).
  2. Schmorl's hernias. Otherwise they are also called “hernia of vertebral bodies”. This is a special manifestation of periosteum degeneration. Through the micropores formed in it, the gelatinous substance of the nucleus permeates the spongy bone tissue that makes up the vertebral body. Such a total change in all parts of the spine is possible with hereditary anomalies (Scheuermann-Mau disease). A single lesion of this type is possible with spinal injury or osteochondrosis.
  3. Anterolateral (they are located beyond the edge of the anterior semicircle of the contour of the vertebral body with possible damage to the anterior longitudinal ligament).
  4. Posterior lateral (beyond the contour of the posterior semicircle). Among them are also distinguished subspecies:
  • medial (median line),
  • paramedial (near),
  • lateral (lateral).

As a rule, the size of the hernia does not exceed more than 4 mm.

Symptoms of intervertebral hernia

There are three main obvious symptoms:

  • pain (especially after exercise)
  • weakness in the leg
  • numbness of the lower limbs.

But if we consider the manifestations in more detail, the symptoms can be divided into two types, and each type is characterized by a certain stage of the disease.

Stage 1 herniation development:
The appearance of a degenerative-dystrophic process in a certain part of the spine, which, in turn, leads to a decrease in the strength of the intervertebral disk, cracks are formed.
Symptoms of Stage 1:

  • circulatory disorders
  • the formation of edema.

Stage 2 hernia development

  • changing the nature of pain,
  • acute pain
  • muscle weakness
  • loss of sensitivity of the zone for which the affected nerve root is responsible,
  • dry skin at the site of hernia,
  • violation of sweating.

Also, depending on the location of the hernia, the symptoms of the disease appear differently:

1. Cervical

  • numbness of fingers,
  • shoulder pain
  • arm pain
  • dizziness,
  • combination of dizziness and headaches,
  • pressure surges.

2. Thoracic department

  • constant pain in the thoracic region,
  • combination of pain in the thoracic spine with scoliosis and kyphoscoliosis.

3. The lumbar region

  • numbness of toes,
  • isolated pain in the lower leg or foot
  • numbness in the groin area
  • regular pain (3 months and more) in the lumbar region,
  • pain in the leg, which is less common on the front, often on the side and back of the thigh.

In what cases are the methods of interference therapy used?

In our rehabilitation center “New Step”, this method is used in the acute post-traumatic period, in the postoperative period to relieve swelling, pain, and also to accelerate the regeneration processes.

Neurostimulating - stimulates the conductivity of nerve endings

Analgesic - anesthetic. Relieves pain

Trophic - improves the nutritional function of the muscles

Smazmolitichesky - removes spasms, spastic reductions

Vasodilator - restores the tone of blood vessels. Improves tissue blood supply

Indications for the application of the method of interference therapy

Contraindications to the use of the method of interference therapy

Diseases and injuries of the musculoskeletal system

What is a sequestered spinal hernia?

The spinal column is the main component of the entire skeletal system of the human body and carries with it the main supporting load. Due to its anatomical structure, it has a large margin of safety.

The spine consists of three dozen separate bones - vertebrae, fastened together by strong intervertebral discs. The disk consists of two main parts. Around the vertebra is a strong connective tissue formation - the fibrous ring. Inside is the gelatinous consistency of the pulpous nucleus.

In the aggregate, the intervertebral disk is a very solid structure capable of absorbing sufficiently strong impacts.

Sequestered spinal hernia is a medical term for the pathological process in the intervertebral disc, leading to the exit of its structures beyond the spinal column with subsequent degenerative changes.

Causes and factors of development

The intervertebral disk has a large margin of safety; therefore, hernia sequestration develops gradually. The first stage is the thinning and rupture of the fibrous ring. The pulpous nucleus, under pressure from the overlying mass of the vertebrae, forms a protrusion - protrusion. Depending on the location of the defect of the fibrous ring, protrusion occurs in the direction of the spinal canal and the spinal cord or in the opposite.

The second stage in the formation of a sequestered hernia is a breakthrough by the pulpous nucleus of the meninges. With this pathological process, the spinal cord and nerve roots are inevitably affected, which leads to impaired motor and sensory function.

The third stage is the actual sequestration of the hernia - the exit of the pulpal nucleus beyond the spinal column, which is usually accompanied by severe pain.

The sequestered herniation of the intervertebral disk goes through three stages in its development.

The factors contributing to damage to the intervertebral disc and rupture of the annulus include:

  • congenital anatomical anomalies of the structure of the vertebrae and their joints,
  • loss of elasticity of intervertebral disc tissue due to various reasons
  • chronic disruption of carbohydrate metabolism in the body
    (diabetes),
  • decrease in hormone production in the thyroid gland (hypothyroidism),
  • previous spinal injuries (bruises, fractures, including compression),
  • pathological changes in the configuration of the physiological curves of the spine (scoliosis),
  • lifting weights
  • sedentary inactive type of labor activity
  • lack of a developed muscular corset,

Clinical picture

Not in all cases the sequestration of the hernia of the spine is accompanied by rapid clinical manifestations. Sometimes this process is detected by chance with small sizes of the pathological focus.

The clinical picture of spinal hernia sequestration includes the following symptoms:

  • severe pain, localized depending on the location of the intervertebral disc in the neck, chest, lower back, The main cause of pain syndrome is compression of the hernial protrusion of the nerve root.
  • decrease in the intensity of pain in a relaxed supine position,
  • restriction of mobility in the affected spinal column,
  • forced pathological tilt of the neck or trunk due to the formation of increased muscle tone,
  • the appearance of painful swelling at the site of sequestered hernia,
  • impaired motor and sensory function
  • dysuria and bowel movements,

Diagnostic methods

The following measures are taken to establish the diagnosis:

  • examination by a neurologist in order to identify all the details of the disease,
  • palpation of the lumbar region allows you to identify pain in the localized sequestered hernia and along the nerve trunks,
  • checking the mobility of the spinal joints reveals pain when flexing, unbending the back and turning the body,
  • X-ray examination of the spine in the direct and lateral positions is carried out in order to identify the localization of the sequestered hernia, Spinal X-ray - the main method used to diagnose the disease
  • magnetic resonance imaging allows not only to identify a defect in the intervertebral disc, but also helps to determine the associated damage to the vertebral bodies and nerve roots of the spinal cord. The size of a sequestered hernia can vary from a few millimeters to a few centimeters, Magnetic resonance imaging - a method for accurate and detailed diagnosis of sequestered spinal hernia
  • electroneuromyography allows you to visually see the passage of an electrical signal along the nerve and muscle fibers,

Sequestered hernia is differentiated with the following diseases:

  • spinal cord tumor
  • anatomical anomaly of the vertebral body,
  • nerve root inflammation (sciatica),
  • inflammatory process of the nerve (neuritis),
  • inflammation of the membranes of the spinal cord (epiduritis, meningitis),

Treatment options

Treatment of sequestered hernia of the spine is carried out under the supervision of a neurologist and includes a set of medical, physiotherapeutic measures, if necessary, of an operational nature. In uncomplicated cases, therapy is carried out on an outpatient basis. The development of complications may require hospitalization in the specialized department of the hospital.

Drug therapy

Drug therapy is used in the acute period of the disease and is aimed at eliminating pain. Preparations are selected individually by a doctor. For the treatment of used drugs from the group of nonsteroidal anti-inflammatory drugs: Ketorol, Diclofenac, Meloxicam.

These drugs have a powerful analgesic, anti-edema and anti-inflammatory effect. Forms of release of drugs differ in a variety that allows the doctor to choose the most suitable method of drug delivery to the pathological focus depending on the intensity of the pain syndrome. These forms include: injection, pills, medical patch, ointment, gel.

To improve the nutrition of the nervous tissue of the spinal cord, B vitamins are used: Thiamine, Pyridoxine, Riboflavin.

Physiotherapy

Physiotherapy techniques are an integral part of the complex therapy of the disease. Therapeutic procedures are used to eliminate pain, improve the nutrition of the nervous tissue, relieve muscle spasm. The following types of procedures are applied:

  • Electrophoresis involves the use of direct electric current of low strength for the delivery of drugs directly to the pathological focus. One of the main drugs used in this procedure is lidaza - a specific substance akin to what is contained in the tissue of the intervertebral disc,
  • magnetic therapy is based on the pronounced anti-inflammatory effect of an alternating magnetic field,
  • decimeter therapy uses the anti-inflammatory effect of high-frequency oscillations of the electric field,
  • ultrasound therapy has a beneficial effect on blood circulation in the muscle and nervous tissue,
  • laser therapy has a pronounced anti-inflammatory effect, stimulates the processes of tissue renewal,
  • hydrogen sulfide baths have a positive effect on cell renewal processes, including nerve,

Approximate complex of therapeutic gymnastics in Bubnovsky

  1. Effective stretching of the spine is achieved in the following way: lying on your back, pull on the toes of your elongated legs. The duration of the exercise is 5–10 seconds, the number of repetitions is 3–4.
  2. In order to stretch the spine, it is necessary to take a prone position on the back, alternately bringing the leg bent at the knee to the chest. The duration of the exercise is several seconds, the number of repetitions is 3-5 times.
  3. To strengthen the abdominal muscles is used raising the body from a prone position on the abdomen. Exercise duration 2-3 seconds, the number of repetitions 3 times.
  4. Strengthening the back muscles contributes to the sequential abduction of a straight leg back from the knee-wrist position. The duration of the exercise on one side is 3 seconds, the number of repetitions is 5–10 times.

After learning the exercises, gymnastics is performed by the patient at home.

Surgery

Surgical treatment is indicated for a sequestered hernia in the following cases:

  • severe pain syndrome, significantly limiting physical activity,
  • rapid progression of the disease with the development of neurological symptoms of motor and sensory functions,
  • the ineffectiveness of conservative methods of treatment for six months,

The essence of the surgical intervention is to remove the affected intervertebral disc and then replace it with a special design. Access to the spine is from the processes of the vertebrae and the spinal canal. Modern equipment allows you to perform the operation without cuts through individual punctures using video monitoring and laser technology. The type of anesthesia is selected individually by the doctor based on the type of intended intervention.

Acupuncture

Acupuncture (acupuncture) is an ancient proven treatment method. The basis of this method of therapy is the sighting of the active points of the body by setting special needles. The duration of the session from 20 to 30 minutes.

Acupuncture (acupuncture) - a method of targeting the focus of the disease

Therapeutic massage is used after the disappearance of pain. The procedure helps to improve the outflow of tissue fluid - lymph - and improve blood circulation of the nervous and muscular tissue. In addition, massage normalizes muscle tone.

Massage is the best method of correcting the pathological vertebral muscle tone.

Self-liquidation of the pathological process

Spontaneous resorption of a sequestered hernia is a scientifically proven fact. Convincing data on the frequency of such an outcome of the pathological process in the medical literature is not given. The main mechanisms of self-destruction of the hernia are apparently the following:

  • independent reduction of hernia,
  • the disintegration of the pathological area and its subsequent resorption under the influence of specific proteins, enzymes of the body,

Prognosis and complications

The prognosis of treatment depends on the severity of the lesion of the pathological process of the spinal cord and nerve roots. The duration of a course of conservative therapy can be up to several months.

The rehabilitation period after surgical treatment of sequestered hernia of the spine can be up to several months. In the postoperative period, a complex method of treatment is applied, including physiotherapy, physical therapy, massage, acupuncture, wearing a fixing belt (corset).

In severe disease, the following types of complications may develop:

  • intense pain syndrome
  • movement disorder
  • sensitivity disorder
  • decrease in muscle mass (atrophy),
  • violation of the internal organs (intestines, bladder),

Prevention

For the prevention of the formation of sequestered spinal hernia, the following measures are used:

  • healthy diet
  • metered exercise,
  • industrial gymnastics
  • comfortable workplace
  • application for lifting heavy objects of special devices,
  • Observation of a doctor in sports at the amateur and professional level

The sequestration of a herniated disc is a serious disease that, if not diagnosed correctly, leads to paralysis of the muscles of the extremities and damage to the internal organs. Treatment of the disease is a long and stubborn process. The disciplined implementation of all medical recommendations is the main key to the success of treatment of this pathology.

Development of osteochondrosis

Osteochondrosis can be recognized by pain in the lumbar and neck, by dizziness, when a person begins to stretch. After a rest, a crunch appears at the slightest movement. There are no blood vessels in the intervertebral discs; for normal functioning, the discs are all obtained from the spinal muscles. Weak muscles and physical inactivity lead to disruption of the blood supply to the cartilage tissue, which causes destruction. The casing of the discs loses its strength, bulges appear that have a peculiar medical term “protrusion”. Cracks appear on the spinal disc, and swelling occurs. As a result of this, spinal scoliosis develops in a person.

Causes of hernia

After sudden movements and weight lifting, there is a strong pressure on the deformed disk. At the same time the substance filling it can flow out. This is a dangerous and painful phenomenon, to avoid its occurrence, one must know that it can provoke osteochondrosis and a hernia.

If, nevertheless, it was not possible to protect oneself, then at least one should be very careful and study the signs of a hernia of the spine, those symptoms by which one can recognize the disease at the initial stage. So it will be easier to deal with it, and prescribe the correct treatment.

Causes of disease

What can start the development of an unpleasant disease and its complications:

  • Prolonged immobility contributes to the violation of blood flow to the muscles, which provokes stagnation in the blood vessels. A person spends most of his time sitting: at his desk, in the classroom, at work, at home on the couch, at the computer.
  • The body has few vitamins and minerals necessary for the body. There is not enough iodine, zinc, vitamins of category B and other important components for the normal functioning of all human organs.
  • Bedding sets matched wrong. People who hold their necks for a long time in a tense state and those who work at the computer should not sleep on high pillows. Feeling discomfort, they change the surface to lower. But this quick change affects the spine extremely negatively.
  • Heredity is one of the main causes of diseases of the spine.
  • As a result of the injury that athletes can get, lifting heavy sports equipment.

Symptomatic symptoms

Pain in the intervertebral hernia is a pronounced symptom in the event that the infringement of the nerve endings occurs. This pain manifests itself and becomes strong with movement. Therefore, the patient tries to move carefully. Muscles are in a state of stress, it is difficult for a sick person to straighten his back, even tilting his head can hurt him. If the hernia of the cervical spine develops quickly, the pain will be more pronounced. You may even experience shortness of breath and problems urinating and emptying your bowels. In a sick person decreases performance.

Hernia can appear in any part of the spine, because of this, the nature of the pain and the symptoms of the disease can manifest themselves in different ways.

Pain in different parts of the spine

The lumbar region is damaged, which means that the lower back hurts, it is given to the thigh, shin and feet. Sometimes the toes are numb, there are discomfort in the groin area. The pains are muffled. Back pain may not stop for several months. Herniated lumbar spine is considered the most common, as is observed in eighty percent of patients who applied to the hospital for help.

If the vertebral part of the neck is damaged, then very often the patient complains of pain in the head, pressure drop, fainting, dizziness, often numb hands, pain in the arm, shoulder. In some cases, patients complain of partial loss of hearing, vision, and imbalance.

Tingling in the fingers is especially felt, numbness in the palms.

The thoracic spine is affected most often in women, they have pain in the chest and under the shoulder blades.

How to recognize the symptoms of hernia and osteochondrosis and distinguish them?

Osteochondrosis is characterized by a painful feeling of numbness in the back, difficulty in movement, pain in the neck and lower back. The same numbness of the extremities as in hernia can occur. It is very difficult to distinguish between the symptoms of two related diseases of the spine, therefore, at the slightest suspicion of similar signs, you should immediately consult a doctor. The pathology of the discs will be clearly visible on the X-ray, and it will be clear to the doctor how much the hernia is developing.

To begin treatment, it is better to conduct additional research with modern methods. These include computed tomography and magnetic resonance imaging.

On the X-ray picture, the picture will look clear, but it is not safe at all, in contrast to new diagnostic methods. MRI absolutely excludes exposure to hazardous radiation, and is able to provide information about the condition of the tissues, cartilage and the spine as a whole.

Self-medication is prohibited

It should not be considered that intervertebral hernia is a harmless disease that does not have clearly expressed violations of some vertebral parts. This ailment costs nothing to make a person an invalid and bedridden for many years.

If the symptoms are clearly expressed, all the same, in no case can not begin self-medication. After all, many diseases are difficult to recognize on their own, they may have similar symptoms.

An experienced doctor will prescribe the correct treatment.

A doctor should always be treated at the first symptoms. The disease tends to develop. An experienced neurologist can help in this case. At the first reception, the patient tells what he is complaining about. He is inconvenienced by a small load on the spine, sitting at the table or he feels pain while lying in bed.

After the patient's complaints, the doctor, knowing about the symptoms of the disease, prescribes an examination, and already when receiving the results, pictures and analyzes - the treatment plan. But an experienced doctor is already alerted by dry skin and abnormal sweating at the site of the hernia. The disease occurs and develops in both men and women, not sparing anyone.

Pregnant women, bearing a fetus, receive a huge load on the spine, and this can cause disc displacement, which is fraught with the appearance of an intervertebral hernia. Therefore, it is necessary to begin the fight against this disease, as early as possible, at its earliest stage, having noticed any of the above symptoms.A comprehensive examination will help to make the most accurate diagnosis and determine the treatment regimen.

Watch the video: Minimally Invasive Spine Surgery (September 2019).