Herniation of intervertebral discs is more often manifested in age-related osteochondrosis due to dryness and fragility of the annulus fibrosus. But this is only one of the risk factors. Others include:
- High load on the lumbar region due to being overweight.
- Weakness of the muscular apparatus.
- Heredity.
- Sedentary lifestyle and, as a result, constant compression of 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 traffic accidents or falls.
- Lifting heavy objects with improper load distribution.
- Scoliosis or lordosis, which leads to increased stress in certain areas of the spine.
- Hip dysplasia.
- Chronic diseases, including tuberculosis of the spine, neoplasms, syphilis.
- Metabolic disorders (hereditary and acquired).
All these factors cause wear and weakening of the cartilage and bones of the spine. And that 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 has shifted considerably, no more than two millimeters. The nucleus pulposus does not extend beyond the vertebral body.
- Lumbar bulge. The edge of the disc extends beyond the vertebral body to a distance of up to 1. 5 mm, but displacement of the nucleus is not observed.
- Extrusion. The nucleus protrudes beyond the vertebral body.
- Sequestration. The nucleus practically falls out and hangs over the vertebrae in the form of drops. At this stage, there is a risk of rupture of the fibrous annulus and leakage of fluid secretions.
In the first phase of the disease, the person does not worry about anything, sometimes back pain occurs, but it passes quickly. With the development of the disease, the health condition worsens, the symptoms become more painful and alarming. If the diagnosis is not made in time and treatment is not started, the consequences are possible: paralysis of the legs and serious disorders of the nervous system.
How does a lumbosacral hernia manifest itself?
Intervertebral hernia can be manifested by the following symptoms:
- Pain in the lumbar region.
- Pain when walking, radiating to the thighs.
- 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 be late in seeking medical help, it is worth analyzing the symptoms of the disease more carefully. They can be divided into three groups.
Pain syndrome
Pain with lumbosacral spine hernia is a key symptom. Already in the first phase there is pain in the area of the damaged disc, especially after the injury. They can increase or decrease and then re-emerge. More often, the sacral region does not even hurt, but hurts, especially during physical exertion or prolonged sedentary work. If a person lies on the healthy side and bends his leg, the pain completely subsides. This condition can last for several months.
With timely medical treatment, it is easy to solve the problem. It is enough to say goodbye to bad habits and do physiotherapy exercises recommended by your doctor.
Every day, the affected area will increase 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
Increased pain in the second phase is accompanied by constant spasms of the back muscles. This leads to even greater discomfort for the patient. He cannot move freely, straighten his back, stretch. The gait of such a person becomes unsafe, he always leans to the side opposite the patient, hunched over.
Due to impaired coordination of movements, the quality of human life is deteriorating. He cannot perform the tasks set at work well, and active rest becomes unrealistic due to constant pain.
Radicular syndrome
If the hernia is left without medical supervision, progressive disease leads to compression of the spinal roots, due to which they die, and access of blood to the tissues of the damaged disc is almost impossible. Symptoms characteristic of severe stages of the disease appear:
- Weakening of the leg muscles. The patient cannot squat, stretch, jump. Even climbing stairs is difficult for him.
- Numbness of the affected area and surrounding areas. The skin becomes insensitive and pale, there is a feeling of suffocation and tingling. Patients complain of hyperhidrosis in the affected area and legs, or, conversely, excessive dryness of the skin.
- Lumbago. The patient suffers from lumbago in the lumbar region with acute, sharp pain, which intensifies with each movement. If left untreated, it leads to destruction of the hip and knee joints.
- Noticeable thinning of the sore leg, which leads to asymmetry of posture.
- Pelvic organ disorder. Urological and gynecological problems increase, libido disappears, diarrhea and 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 low back pain, it is necessary to schedule an examination with a neurologist. He will perform an examination with medical tests:
- Identification of lower extremity tendon reflexes.
- Leg lift test.
- Determination of sensitivity to heat or cold, pain and vibration on the entire surface of the legs, thighs, buttocks, abdomen and back.
The doctor will then refer the patient for magnetic resonance imaging or CT of the lumbar spine. With the help of tomographic techniques, a three-dimensional image of the affected area will be obtained. It 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 whether urgent surgical intervention is necessary.
Treatment of disc herniation
Vertebral hernia is treated both conservatively and surgically. The choice of technique depends on the stage of disease development, the presence of concomitant diseases and contraindications.
Conservative therapy
The therapeutic course is primarily aimed at relieving pain and alleviating the patient's condition.
What medications can a doctor prescribe:
- Medicines that relieve pain and inflammation. In case of worsening - in the form of injections. When the acute pain is relieved (usually three to four days is enough), oral medications with similar effects are prescribed.
- Blockade of novocaine with the addition of corticosteroids. A similar method can stop the pain for two weeks at a time. A course of blockades is usually performed by injecting into different parts of the damaged disc.
- Centrally acting muscle relaxants. They reduce muscle activity by relieving painful cramps.
- Vitamin-mineral complexes with an emphasis on the elements of group B. Slightly relaxes muscles, helps tissue regeneration and conduction of nerve impulses.
After relieving the pain syndrome, medication intake is reduced. Treatment of the disease is carried out by physical therapy and physiotherapy.
Physiotherapy methods of treatment 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 postisometric relaxation.
Doctors strongly recommend that patients who smoke give up cigarettes.
Adjusting your diet is also important, especially for overweight patients. Fatty, salty foods, sweets and alcohol will have to be excluded from the menu. A frugal diet with plenty of vegetables and fermented dairy products will help the body better tolerate treatment, as well as get rid of the weight that weighs on your 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 surgery. The latter is prescribed for severe pain, loss of leg sensitivity, pelvic organ dysfunction. 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. The camera is introduced into one for broadcast on the monitor. Through the other two, the protrusion of the hernia is removed with miniature instruments.
- Percutaneous discectomy method. The damaged nucleus is removed through a puncture in the spinal disc and replaced with plastic.
- Laser reconstruction. It is performed in the form of punctures using a special needle without dissecting the tissue. Laser radiation warms disc structures and stimulates cell regeneration as well as relieves pain.
In severe cases, endoprosthetics of the spinal discs are possible - replacement of the injured organ with an implant.
Rehabilitation will be required after complex surgical interventions. The operated person will have to wear a corset and will not be able to take a sitting position for about three months. The further period of rehabilitation 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 spine healthy:
- Accurately calculate loads if your job is related to them or if you are a professional athlete.
- Correct body weight (its index should not exceed 30).
- Choose a good sleeping mattress in the correct position (preferably on your back).
- Engage in mild physical education, swimming, fitness.
- Include exercises in the morning exercises to strengthen the muscular corset of the spine.
- Leave the cigarettes.
- Eat well.
If following these rules becomes a habit, there is a risk of spinal hernia only as a result of an accident.
Herniated disc is dangerous with serious consequences, and the treatment of advanced cases is very long. To avoid surgery and complications, if you have painful sensations in your back, you should visit a neurologist.
Osteochondrosis
The term osteochondrosis itself is derived from two words: osteo - bone and chondrue - cartilage. Simply put, it is the cartilage ossification. Although this interpretation is fundamentally wrong. Some go further in their delusions, and are convinced that osteochondrosis is the deposition of salt in the joints. Moreover, kitchen salt is reportedly eaten in large quantities.
Pathogenesis
In reality, everything happens a little differently. And stronger. And kitchen salt, if it plays any role in the development of osteochondrosis, is very indirect. Osteochondrosis is based on dystrophy and degeneration of articular cartilage. This is not an independent disease, but a pathological process that can be observed almost everywhere where there is connective cartilage tissue.
However, osteochondrosis in many cases affects the spine. Why is that? The fact is that there are some kind of spacers between the vertebrae - intervertebral (intervertebral) discs. The physiological role of these discs is to cushion and protect vertebral bodies from premature wear due to mechanical stress. The disc consists of the inner fluid nucleus of the pulposus surrounded by the annulus fibrosus and the upper and lower end plates.
The disk is subjected to enormous mechanical stress, which leads to permanent damage to its structures at the cellular level. In humans, these processes are too pronounced - it is our compensation for upright walking. In order to prevent the disk from being completely "erased", it must be constantly regenerated or restored. It is the balance of the damage and regeneration process that determines the normal structure of the intervertebral disc. Another interesting detail is that the supply of intervertebral discs with blood and nutrients does not take place through blood vessels, which healed in childhood, but diffusely, from the bone tissue of the vertebral body. Again, paying for the ability to walk on two limbs, not on four.
Therefore, intervertebral discs are easily injured in anatomical and physiological terms. Every negative process in the body leads to an imbalance of damage-regeneration, and to the development of dystrophy and degeneration of the discs. A structurally defective disk is no longer able to withstand the corresponding mechanical stress. Under excessive pressure of the upper vertebrae, the discs move in different directions, usually to the side and back. This process is called a herniated disc.
The bone tissue of the vertebrae, which has lost cartilage, has also undergone mechanical wear. Due to the constant trauma on the anterior marginal surface of the vertebral body, pathological bone growths - osteophytes - are formed. Spondylosis develops. Due to degeneration and displacement of the disc, the intervertebral spaces are reduced, the spinal canal is narrowed, and the roots of the spinal nerves in the so-calledforaminal holes.
Causes
The causes and etiological factors of osteochondrosis are different. They can also be local, ie. caused by pathology of the spine itself, and general disorders at the level of the organism. The cause of osteochondrosis can be considered any pathology that leads to a violation of the structure of the spine or metabolic disorders. 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 anomalies
- Spinal cord injury
- Weak immunity
- Metabolic disorders - osteoporosis, obesity, diabetes mellitus, thyroid disease
- Diseases of the cardiovascular system - atherosclerosis, hypertension
- Digestive disorders that lead to insufficient absorption of nutrients from the gastrointestinal tract
- Heredity.
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, sedentary lifestyle or, conversely, excessive physical exertion.
Symptoms
Osteochondrosis is in itself an asymptomatic process. At the same time, the signs of intervertebral disc degeneration are diverse. How that? The fact is that the clinical manifestations of osteochondrosis are based on its complications - herniated disc, spondylosis, sciatica, narrowing of the spinal canal.
Moreover, the clinic is very variable depending on the dominant localization of the process in the cervical, thoracic or lumbosacral spine. The hindquarters are most commonly affected, as the lower back takes on maximum physical activity. Signs of osteochondrosis of the lumbosacral region:
- Pain (lumbonia, lumbago, sciatica)
- Restriction of movement in the lower back and lower extremities (intermittent claudication)
- Sensitivity disorders of the paresthesia type occur here - numbness, tingling, crawling
- Pathological tension of lumbar muscles
- In the absence of treatment, disorders of pelvic organs.
Cervical osteochondrosis 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 movement in the upper extremities, cervical osteochondrosis due to impaired blood flow to the brain has its own characteristics. These characteristics are manifested:
- Insomnia
- Headache, dizziness
- Periodic nausea
- General weakness, rapid fatigue
- Fluctuations in blood pressure
- Occasional toothache
- Behavioral reactions in the form of crying, irritability.
The thoracic region with osteochondrosis is affected relatively rarely. Patients in this case are people who are forced to sit in a fixed uncomfortable position - students, schoolchildren, programmers, office workers. The symptoms of osteochondrosis in this case will be as follows:
- Chest pain and paresthesias
- dyspnea
- Feeling of heartbeat
- Restriction of movement in the thoracic spine.
Diagnosis
It is clear from everything that osteochondrosis is a chameleon disease. Due to the similarity of the signs, it is easy to confuse it with cerebrovascular infarction, hypertension, myocardial infarction, angina pectoris, neurotic disorders. Therefore, making a correct diagnosis requires a comprehensive complex diagnosis in order to correctly determine the symptoms and treatment of osteochondrosis.
This diagnosis, in addition to the traditional examination and clarification of patient complaints, should include medical examination and special research methods. These methods include X-rays 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:
- Medications
- Massage
- Physiotherapy procedures
- Physiotherapy (exercise therapy)
- Manual therapy
- Acupuncture.
Osteochondrosis medications are 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. In this way, they can worsen metabolic disorders in osteochondrosis. Local anesthetics alleviate the pain of blockage. True, the effect of these funds is short-lived and in no way affects the course of osteochondrosis as a whole.
Metabolic processes at the local and physical level can be improved with the help of drugs such as chondroprotectors, immunostimulants, vitamins and minerals. Chondroprotectors are used in tablets, ointments and ampoules. Among the strengthening agents, vitamins C, group B, are used in combination with minerals. In this regard, calcium supplements are most preferred. Indeed, contrary to some misconceptions, the basis of osteochondrosis is not an excess, but only a lack of calcium.
After successful elimination of exacerbation, physiotherapy, massage and exercise therapy were presented. Calcium electrophoresis, phonophoresis with hydrocortisone, amplipulse, paraffin therapy are used as physical procedures. All these measures are aimed at relieving pain and inflammation in nerve roots, ligaments and muscles. Massage for osteochondrosis is performed according to the generally accepted method. The massage zone is selected depending on the localization of osteochondrosis. Expansion of the range of motion is achieved with the help of exercise therapy. Initially, in the exacerbation phase, there are virtually no dynamic loads. The patient is constantly in the optimal position. At this moment, it is desirable to wear immobilization devices - lumbar corset, Shant's neck collar. As the exacerbation is removed, the volume and duration of movement during exercise therapy increases.
Recently, non-traditional methods of treatment have been received in the treatment of osteochondrosis - acupuncture, manual therapy, osteopathy. Acupuncture is an action on special biologically active points that are located along the spine, on the ear shells, on the hands and feet. With manual therapy, the normal position of the vertebrae and intervertebral discs is restored by the manual action of the specialist's hands. And during osteopathy, the structural integrity of the musculoskeletal system is ensured by special 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. Microdiscectomy - endoscopic removal of the displaced disc - is currently being performed for this purpose.