Herniated disc: symptoms, diagnosis and treatment

Pain syndrome in the back, especially in the lower part of the back, is one of the most common reasons for contacting neurologists. The most common diagnosis is osteochondrosis, which includes morphological changes in the bodies of adjacent vertebrae and degenerative changes in the intervertebral disc called hernias. Hernia is just the degree of dystrophic changes in intervertebral cartilage, its thinning, loss of elasticity, replacement of hyaline fibers with fibrous ones.

Structure of the intervertebral disc

The intervertebral disc is a rounded form between two adjacent vertebrae. This disk carries a supporting and damping function, provides a certain mobility of the spinal column. The outer side of the disc is a fibrous ring, consisting of the intersection of collagen fibers.

Inside the fibrous ring is a gelatinous (pulpous) core, consisting of cartilage cells, a small amount collagen fibers and a large amount of intercellular substance that can retain moisture inside the core to ensure turgor. Numerous clinical studies have shown that between the core of the disc and the tissues surrounding it, there is a constant and active exchange of liquid media.

Types and types of dystrophic changes of the intervertebral disc

Herniated disc is a pathology in which parts of the damaged and altered pulpous core are squeezed through the defect of the fibrous ring, provoking its rupture or excessive protrusion beyond normal physiological boundaries, fall into the cavity of the spinal canal or "press" into the body vertebra. If the fibrous ring is preserved, its protrusion under the action of sequesters of the altered gelatinous nucleus is designated as protrusion (protrusion) of the disc. Often the term "protrusion" is used to indicate the size of the hernia, which leads to an incorrect interpretation of the condition.

It should be taken into account that there is a physiological protrusion of the disk, which occurs under the action of an axial load and, as a rule, does not exceed 3 mm. If the protrusion is common, leads to a narrowing of the spinal canal and does not change its size when the spine moves - this is a pathological protrusion. The protrusion of the intervertebral disc is considered clinically significant if it exceeds a quarter of the diameter of the spinal canal or narrows the canal to a critical level of 10 mm.

Thus, the diagnosis of a "herniated disc" refers to the case of penetration of parts of the pulpous nucleus through a rupture fibrous ring beyond its limits or into the body of the vertebra, perforating the hyaline plate (i.e., perforation occurs plates).

In the direction of deposition of the sequester, the hernia is secreted:

• Anterolateral: they perforate the anterior longitudinal ligament, they do not cause motor and sensory disturbances. May provoke a sympathetic syndrome with the involvement of the sympathetic paravertebral chain.
• Zadnobokovye: they represent a threat to the contents of the spinal canal and cause serious neurological disorders.

With respect to the midline, there are:

• median hernias: often have large dimensions, sometimes they can penetrate into the subarachnoid space, while a part of the sequestrum can move along the long space. These hernias often squeeze the spinal cord in the cervical and thoracic areas, the ponytail at the lumbar level, causing paresis and impairment of the pelvic organs. Often it is these hernia that causes the chronic pain process.
• paramedian hernia: are the cause of radicular syndromes with lesions of the roots of the spinal cord, especially at the level of the two lower lumbar discs.
• purely lateral hernia: located in the intervertebral openings and lead to the infringement of the roots located there. Sometimes they can squeeze the anterior radicular artery, which can lead to a spinal cord infarction.
• Hernias of Schmorl (hernia of vertebral bodies): appear more often at a young age. Single forms of these hernias indicate osteochondrosis or trauma. In most cases, they are asymptomatic and are an "x-ray finding".

In clinical practice gradation is used at the stage of hernia development:

• 1. Prolabirovanie - protrusion of the intervertebral disc in size 2-3 mm.
  2. Protrusion - protrusion of the disc from 4-5 mm to 15 mm without displacement of the nucleus beyond the fibrous ring.
  3. Extrusion - the degenerately changed nucleus extends beyond the fibrous ring, the droop of the disk fragment in the form of a drop is often observed.
  4. Sequestration is the deposition of the substance of the gelatinous nucleus into the spinal canal.

The most common disc herniation in the lumbar region (up to 80%), the least likely to find changes in the disc in the thoracic spine (about 1%).

Causes of intervertebral hernia

• 1. Incorrect posture (scoliosis, kyphoscoliosis), undeveloped muscular corset, pathological motor and positional stereotypes.
  2. A sedentary lifestyle, a long stay in a monotonous pose, static loads.
  3. Power and contact sports, improper lifting of weights.
  4. Injuries.
  5. Congenital anomalies of development of bone, cartilaginous, connective tissue, spinal column.
  6. Age changes, osteoporosis.

Symptoms of intervertebral hernia

All symptoms can be divided into 2 groups: irritation and lesions.

With irritation of the spinal cord and nerve roots, a pain syndrome develops of varying degrees of intensity, local or irradiative in the course of the irritated root. Often, there are violations of sensitivity in the form of paresthesias, feelings of numbness in the limbs. At the same time, deep and vibration sensitivity decreases, tendon reflexes can increase.

With organic damage to the structures of the nervous system, symptoms of loss appear: a decrease in tactile and pain sensitivity up to anesthesia, atrophy and decreased strength and tone of the muscles innervated by the damaged spine, impaired pelvic function, chronic pain syndrome. When neurological examination, the decrease or loss of tendon reflexes, the appearance of pathological motor signs are noted.

Diagnostic criteria

To make an accurate diagnosis, the doctor first conducts an objective examination, and then assigns additional diagnostic methods.

When there is pain in the back area, you need to see a doctor. In addition to pain caused by hernial protrusion, there are many other etiological causes that need to be differentiated.

To establish the correct clinical diagnosis, a doctor's examination is very important. The doctor should be very careful about complaints and anamnesis of the disease. It is necessary to clarify the localization and nature of pain, in what position is the pain intensified, and in what subsides, Whether there is an irradiation of a pain, whether there are motor and sensitive infringements, time of day with peak of painful Feel. It is equally important to find out the onset of the disease, the provoking factors, the dynamics of the development of symptoms. It is necessary to detail in detail the way of life, working conditions. Then follows the neurological examination with the study of reflexes, sensitivity, tone and strength of muscles, the presence of pathological motor signs, symptoms of tension. After that, palpation should be performed to detect violations of the biomechanics of the spine, trigger points, redistribution of muscle tone. Having carried out such a thorough examination and detailing complaints and anamnesis, the doctor can make a preliminary diagnosis.

The next step is radiography. This method does not give an accurate answer about the presence of hernia, its size and location, because the X-rays pass through the hernia. But there are X-ray signs that point to a possible affected segment. This method of research is more screening, the cost of the study is small, but the method allows to determine, what research is needed in the future, and at an early stage of diagnosis helps differentiate others pathology.

At the same stage, it is advisable to conduct a clinical study of blood with rheumatic tests. This will help confirm or exclude inflammatory or rheumatological diseases.

Computer tomography and magnetic resonance imaging allow the most accurate visualization the presence of a hernia, its relationship with surrounding structures, the size of protrusion, the condition of the pulpous core. CT allows you to see more clearly the dense bone structures, the spinal cord it visualizes worse. But this method is cheaper, and it is more often used to study the lumbosacral spine. MRI is preferably used in the investigation of the cervical region and when the doctor suspects the inclusion of the spinal cord in the pathological process. This study is expensive, it has more contraindications.

Treatment of a herniated intervertebral disc

With the initial manifestations of pain and neurological syndromes caused by disc herniations, pharmacotherapy is used. Use analgesics, steroid and non-steroidal anti-inflammatory drugs, vitamin therapy, chondroprotectors, muscle relaxants, anticonvulsants, drugs that improve blood circulation. Medication therapy can be well combined with physiotherapy. Positive methods such as the influence of diadynamic currents, magnetotherapy have proved themselves. There are techniques for introducing certain drugs into the area of ​​damage by electrophoresis.

With a decrease in the severity of the pain syndrome, you can resort to the help of a chiropractor, a massage therapist. It is useful to use such techniques as post-isometric relaxation, underwater and dry traction, exercises on Evminov's board. And, of course, physical therapy for the formation of proper posture and muscle corset.

Do not forget about acupuncture, pharmacopuncture.

There are methods of surgical treatment of herniated intervertebral discs. Indications for such operations are very limited: growing paresis, disruption of pelvic organs, disabling pain syndrome. Some doctors believe that the presence of a sequestering hernia is also an indication for prompt intervention. There are several ways of surgical treatment, choose the most suitable method for each patient individually.

Any of the methods of treatment implies a change in lifestyle, the formation of the right stereotypes of physical and static activity, work on oneself. Without this, treatment will be ineffective and the disease can return.

Channel "Russia-1 the program "On the most important" on the topic "Intervertebral hernia "

The first channel, the program "Live Healthily" with Elena Malysheva on the theme "Intervertebral hernia "