Intervertebral disc herniation is most often manifested in age-related osteochondrosis due to the dryness and fragility of the annulus fibrosus. But this is just one of the risk factors. Others include:
- Heavy load in the lumbar region due to overweight.
- Weakness of the muscular apparatus.
- Inheritance.
- A sedentary lifestyle and, as a result, constant compression of the vertebral structures.
- Smoking.
- Great physical activity.
According to medical statistics, this disease occurs in men many times more often than in women.
What are the most common causes of the disease:
- Injuries from road accidents or crashes.
- Lifting heavy objects with incorrect load distribution.
- Scoliosis or lordosis, leading to increased stress in certain areas of the spine.
- Dysplasia of the hip joints.
- Chronic diseases, including spinal tuberculosis, neoplasms, syphilis.
- Metabolic disorders (inherited and acquired).
All of these factors cause the cartilage and bones of the spine to be consumed and weakened. And this is the main reason for intervertebral hernia.
Stages of disease development
Without proper treatment, the disease progresses and the condition of the damaged spinal discs worsens. There are four stages in the development of the disease:
- Prolapse. The intervertebral disc is quite displaced, no more than two millimeters. The pulposus nucleus does not protrude beyond the vertebral body.
- The middle exit. The edge of the disc extends beyond the vertebral body at a distance of up to 1. 5 mm, but the displacement of the nucleus is not observed.
- Extraction. The nucleus protrudes beyond the vertebral body.
- Seizure. The nucleus practically falls out and hangs over the vertebrae in the form of a drop. At this stage, there is a risk of rupture of the annulus fibrosus and leakage of fluid secretion.
In the first stage of the disease, a person hardly worries about anything, sometimes he has back pain, but they pass quickly. With the development of the disease the health condition also worsens, the symptoms become more painful and alarming. If the diagnosis is not made in time and the treatment is not started, the consequences are possible: paralysis of the legs and severe disorders of the nervous system.
How does a lumbosacral hernia appear?
An intervertebral hernia can present with the following symptoms:
- Pain in the lumbar region.
- Pain while walking, radiating to the thigh region.
- Numbness of the feet, toes, areas on the surface of the lower leg and thigh.
- Feeling of heaviness in the legs.
- Stiffness of movement.
In order not to delay in seeking medical help, it is worthwhile to analyze the symptoms of the disease more carefully. They can be divided into three groups.
Pain syndrome
Pain with a lumbosacral spine hernia is a major symptom. Even in the first stage, there is pain in the area of the damaged disc, especially after the injury. They may increase or decrease and then re-emerge. Most often, the sacral region does not even hurt, but it hurts, especially with physical exertion or prolonged sedentary work. If a person lies on a healthy side and bends the leg, the pain is completely reduced. This condition can last for several months.
With timely treatment for medical help, removing the problem is easy. Just say goodbye to bad habits and do the physiotherapy exercises recommended by your doctor.
Every day, the affected area will grow and the condition of the disc tissue will worsen. The transition to the second degree of the disease is signaled by increased pain. It is now felt not only in the sacral region, but covers the entire lower back, radiating to the cervical region, to every spinal muscle, buttocks, thighs, legs, feet and toes. Discomfort is manifested by physical activity, even insignificant - coughing or sneezing.
Vertebral syndrome
The added pain in the second stage is accompanied by constant spasms of the back muscles. This leads to even greater concern for the patient. He can not move freely, direct his back, lie down. The gait of such a person becomes unsafe, he always bends to the side in front of the patient, bends.
Due to impaired coordination of movements, the quality of human life deteriorates. He can not perform well the tasks set at work and active rest due to constant pain becomes unrealistic.
Radicular syndrome
If a hernia is left unattended by doctors, a progressive disease leads to compression of the spinal roots, as a result of which they die, and access of blood to the damaged disc tissue is almost impossible. Symptoms characteristic of serious stages of the disease appear:
- Weakening of the leg muscles. The patient can not sit, lie down, jump. Even climbing stairs is difficult for him.
- Numbness of the affected area and surrounding areas. The skin becomes numb and pale, there is a feeling of goose bumps and tingling sensation. Patients complain of hyperhidrosis in the affected area and feet, or, conversely, of excessive drying of the skin.
- Lumbago. The patient suffers from lumbago in the lumbar region with acute, sharp pain, which increases with each movement. If left untreated, it leads to destruction of the thigh and knee joints.
- A noticeable thinning of the injured leg, leading to posture asymmetry.
- Disorder of the pelvic organs. Urological and gynecological diseases are aggravated, lust disappears, diarrhea, urinary incontinence are possible.
In severe cases of spinal hernia, there is a risk of paralysis, disability and even death.
Diagnosis of pathology
If a person has severe back pain, he should make an appointment with a neurologist. He will perform an examination with medical tests:
- Identification of reflexes from the tendons of the lower extremities.
- Leg lift testing.
- Determination of sensitivity to heat or cold, pain and vibration across the surface of the legs, thighs, buttocks, abdomen and back.
The doctor will then refer the patient for an MRI or CT scan of the lumbar spine. With the help of tomographic techniques a three-dimensional view of the affected area will be obtained. Can be used to determine the location and size of the hernia, the stage of the disease.
If there is a risk of spinal cord injury, electromyography, neurography, and contrast myelography are additionally prescribed. With the help of these studies, the doctor will determine if urgent surgical intervention is necessary.
Treatment of disc herniation
A vertebral hernia is treated both conservatively and surgically. The choice of technique depends on the stage of development of the disease, the presence of concomitant diseases and contraindications.
Conservative therapy
The therapeutic course is mainly aimed at relieving pain and alleviating the patient's condition.
What medications can a doctor prescribe:
- Medications that relieve pain and inflammation. In case of deterioration - in the form of injections. When acute pain is relieved (usually three to four days are sufficient), oral medications with a similar effect are prescribed.
- Novocaine blockade with the addition of corticosteroids. A similar method is able to stop the pain for two weeks immediately. Usually, a blockage course is performed with injections into different parts of the damaged disc.
- Central action muscle relaxants. They reduce muscle activity by relieving pain cramps.
- Vitamin-mineral complexes with emphasis on group B elements. They relax the muscles a bit, help tissue regeneration and transmit nerve impulses.
After relieving the pain syndrome, medication intake is reduced. Treatment of the disease is done with physiotherapy and physiotherapy.
Physiotherapy treatment methods are also chosen depending on the patient's condition. This could be:
- Heat or electric shock treatment.
- Electrophoresis with anti-inflammatory drugs.
- Acupuncture and acupressure.
- Hirudotherapy.
- Hydromassage.
Normal massage is allowed only if there is no pain syndrome. A more effective physiotherapy treatment is manual therapy with post-isometric relaxation.
Doctors strongly recommend patients who smoke to quit smoking.
Nutrition adjustments are also important, especially for overweight patients. Fatty, tasty dishes, sweets and alcohol will have to be excluded from the menu. A frugal diet with an abundance of vegetables and fermented dairy products will help the body better withstand the treatment as well as get rid of the pounds that weigh on the back.
Surgical intervention
Conservative treatment usually lasts about two months. If it does not give the desired result, a decision is made to change the therapeutic tactics or perform surgery. The latter is prescribed for severe pain, loss of sensation of the legs, dysfunction of the pelvic organs. Depending on the complexity of the situation, the operation is performed in the following ways:
- Endoscopic method. Three micro-incisions are made in the affected area. A camera is inserted into one for transmission to the monitor. Across the other two, the hernia extension is removed using miniature instruments.
- With the method of percutaneous discectomy. The damaged nucleus is removed through a puncture in the vertebral disc and replaced with an artificial substance.
- With laser reconstruction. It is performed in the form of drilling using a special needle without cut tissue. Laser radiation warms disc structures and stimulates cell regeneration as well as relieves pain.
In difficult cases, endoprosthetics of the vertebral discs is possible - replacement of the damaged organ with an implant.
After complex surgical interventions, rehabilitation will be required. The operated person will need to wear a corset and will not be able to maintain a sitting position for about three months. The further rehabilitation period includes the practice of therapeutic gymnastics and physiotherapy.
Preventive techniques
Like any other disease, disc herniation is easier to prevent than to cure. What you need to do to keep your spinal discs healthy:
- Calculate loads accurately if your work is related to them, or if you are a professional athlete.
- Exact body weight (its index should not exceed 30).
- Choose a good mattress to sleep in the right position (preferably on your back).
- Engage in gentle physical education, swimming, fitness.
- Include exercises in your morning exercises to strengthen your spinal muscular corsets.
- Quit smoking.
- Eat well.
If following these rules becomes a habit, then there is a risk of getting a spinal hernia just as a result of an accident.
Disc herniation is dangerous with severe consequences and the treatment of advanced cases is very long. To avoid surgery and complications, if you have painful sensations in the back, you should go to a neurologist.
Osteochondrosis
The term osteochondrosis itself is derived from two words: osteo - bone and chondrue - cartilage. Simply put, it is cartilage ossification. Although this interpretation is fundamentally wrong. Some in their illusions go even further, and are certain that osteochondrosis is the deposition of salts in the joints. Moreover, it is table salt that is supposed to be eaten in large quantities.
Pathogenesis
In reality, everything happens a little differently. And harder. And table salt, if it plays any role in the onset of osteochondrosis, is very indirect. Osteochondrosis is based on dystrophy and degeneration of the articular cartilage. This is not an independent disease, but a pathological process that can be observed almost anywhere where there is cartilage connective tissue.
However, osteochondrosis in the vast majority affects the spine. Why is she? The fact is that between the vertebrae there is a kind of divider - intervertebral discs (intervertebral). The physiological role of these discs is to cover and protect the vertebral bodies from premature wear due to mechanical stress. The disc consists of an inner fluid pulposus nucleus surrounded by an annulus fibrosus and an upper and lower end plate.
The disk is subjected to extreme mechanical stress, leading to permanent damage to its structures at the cellular level. In humans, these processes are very pronounced - this is our payoff for moving forward. To prevent the disk from being "erased" completely, it must be constantly regenerated, that is, restored. It is the balance of damage-regeneration processes that determines the normal structure of the intervertebral disc. Another curious detail is that the supply of blood and nutrients to the intervertebral discs is carried out not through blood vessels, which are overcrowded in childhood, but diffusely, from the bone tissue of the vertebral bodies. Again, payment for the ability to walk on two limbs, not four.
Because of this, the intervertebral discs are easily damaged anatomically and physiologically. Any negative process in the body leads to an imbalance in the regeneration of damage and the development of dystrophy and degeneration in the discs. A structurally defective disc is no longer able to withstand proper mechanical stress. Under excessive pressure from the upper vertebrae, the discs move in different directions, usually to the sides and back. This process is called a disc herniation.
The vertebral bone tissue, which has lost cartilage lining, is also subject to mechanical wear. Due to the constant trauma to the surface of the anterior edge of the vertebral bodies, pathological growths of bones are formed - osteophytes. Spondylosis develops. Due to the degeneration and displacement of the disc, the intervertebral spaces are reduced, the spinal canal is narrowed and the roots of the spinal nerves are damaged in the so-called. foramale hole.
Causes
The causes or etiological factors of osteochondrosis are different. They can be both local, d. m. th. caused by the pathology of the spine itself and general disorders at the organism level. Any pathology leading to a violation of the structure of the spine or metabolic disorders can be considered as the cause of osteochondrosis. In this regard, there are:
- Changes in the configuration of the spine (scoliosis, pathological lordosis or kyphosis)
- Other defects of the musculoskeletal system - flat feet, narrow shoulder girdle, pelvic abnormalities
- Spinal cord injury
- Weak immunity
- Metabolic disorders - osteoporosis, obesity, diabetes mellitus, thyroid disease
- Diseases of the cardiovascular system - atherosclerosis, hypertension
- Digestive disorders leading to insufficient absorption of nutrients from the gastrointestinal tract
- Inheritance.
It should be noted that the above pathological conditions do not necessarily lead to osteochondrosis. This requires constant exposure to certain predisposing factors - hypothermia, malnutrition, a sedentary lifestyle or, conversely, excessive physical exertion.
Symptoms
Osteochondrosis itself is an asymptomatic process. And at the same time, the signs of intervertebral disc degeneration are different. How so? The fact is that the clinical manifestations of osteochondrosis are based on its complications - disc herniation, spondylosis, sciatica, narrowing of the spinal canal.
Moreover, the clinic is highly variable depending on the predominant localization of the process in the cervical, thoracic, or lumbosacral spine. The last part is most often affected, as it is the lower back that receives the maximum physical activity. Signs of osteochondrosis of the lumbosacral region:
- Pain (lumbodynia, lumbago, sciatica)
- Restriction of movement in the lower back and lower extremities (intermittent claudication)
- Here, paresthesia-type sensitivity disorders - numbness, burning, crawling
- Pathological tension of the lumbar muscles
- In the absence of treatment, disorders of the function of the pelvic organs.
Osteochondrosis of the cervix is observed somewhat less frequently than lumbosacral. However, this pathology is also quite common. In addition to the typical signs of pain (cervical pain), decreased sensitivity and movements in the upper extremities, osteochondrosis of the cervix due to impaired blood supply to the brain has its own characteristics. These characteristics are manifested:
- Insomnia
- Headache, dizziness
- Periodic nausea
- General weakness, rapid fatigue
- Blood pressure fluctuations
- Occasional toothache
- Behavioral reactions in the form of tears, nervousness.
The thoracic region with osteochondrosis is affected relatively rarely. Patients in this case are persons forced to sit in a fixed position uncomfortable by profession - students, schoolchildren, programmers, office workers. The symptoms of osteochondrosis in this case will be as follows:
- Chest pain and paresthesia
- dyspnoea
- Feeling of heartbeat
- Restriction of movement in the thoracic spine.
Diagnosing
From all this it is clear that osteochondrosis is a chameleon disease. Due to the similarity of the signs, it is easy to confuse with cerebrovascular accident, hypertension, myocardial infarction, angina pectoris, neurotic disorders. This is why, to establish the correct diagnosis, a comprehensive comprehensive diagnosis is required to accurately determine the symptoms and treatment of osteochondrosis.
This diagnosis, in addition to the traditional questions and clarification of patients' complaints, should include a medical examination and special research methods. These methods include X-ray of the spine, ultrasound of internal organs. Recently, computed tomography and magnetic resonance imaging have been used successfully to diagnose osteochondrosis.
Treatment
Therapeutic tactics for osteochondrosis include the use of:
- medicaments
- Massage
- Physiotherapy procedures
- Physiotherapy (exercise therapy)
- Manual therapy
- Acupuncture.
Treatment for osteochondrosis is mainly aimed at relieving pain and eliminating inflammatory processes in the nerve roots. NSAIDs are used for this purpose. In various combinations, these drugs are widely used in the form of ointments, injections, tablets for the treatment of osteochondrosis. It should not be forgotten that these drugs have a negative effect on the liver, stomach and intestines. By doing so, they can exacerbate metabolic disorders in osteochondrosis. They relieve the pain of blockade well with local anesthetics. True, the effect of these funds is short-lived and in no way affects the course of osteochondrosis as a whole.
It is possible to improve metabolic processes locally and physically with the help of drugs such as chondroprotectors, immunostimulants and mineral vitamins. Chondroprotectors are used in tablets, ointments and ampoules. Among the strengthening agents are used vitamins C, group B, in combination with minerals. In this regard, calcium supplements are the most preferred. Indeed, contrary to some erroneous statements, the basis of osteochondrosis is not an excess, but only a lack of Calcium.
After successful relief of irritation, physiotherapy, massage and exercise therapy are indicated. Calcium electrophoresis, hydrocortisone phonophoresis, amplipulus, paraffin therapy are used as physical procedures. All of these measures are aimed at eliminating pain and inflammation in the nerve roots, ligaments and muscles. Massage for osteochondrosis is performed according to the generally accepted method. The massage area is chosen depending on the localization of osteochondrosis. Expansion of the range of motion is achieved with the help of exercise therapy. At first, in the deterioration phase, there are virtually no dynamic loads. The patient is constantly in an optimal position. At this time, it is desirable to wear immobilizing equipment - a lumbar corset, Shants neck collar. With the removal of deterioration, the volume and duration of movements during exercise therapy increases.
Recently, in the treatment of osteochondrosis, non-traditional methods of treatment have been accepted - acupuncture, manual therapy, osteopathy. Acupuncture is an effect on specific biologically active points located along the spine, kidneys, hands and feet. With manual therapy, the normal position of the vertebrae and intervertebral discs is restored through manual action of the specialist's hands. And in the course of osteopathy, the structural integrity of the musculoskeletal system is ensured using specific techniques. In the absence of the effect of conservative measures for the treatment of osteochondrosis, persistent pain, complications, surgery is indicated. The pathologically displaced disc is removed. Currently, for this purpose, microdiscectomy is performed - endoscopic removal of a displaced disc.