Intervertebral hernia: symptoms, treatment, surgery, causes

The intervertebral hernia is the last stage of osteochondrosis of the spine.

The prevalence of this disease is from 45 to 50%.The first symptoms of the disease appear in the 20-30-year-old age.

Gradually the disease progresses and at the age of 50 and over, about 90% of people have certain symptoms of spinal osteochondrosis. Most often, the lumbar region is involved in the pathological process, since it experiences the greatest burden.

The intervertebral hernia is a prolapse of parts or protrusion of the disk into the spinal canal. At the heart of this pathological condition in most cases is the osteochondrosis of the spine. In extremely rare cases, the trauma of the spinal column results in this condition.

Causes of development of

Young patients with an average age of 20 to 30 years should be included in the risk group for the development of this disease. The main predisposing factors of osteochondrosis of the spine and intervertebral hernia are:

• weighed down
  
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• disorder of microcirculation against the background of common diseases
  
• increased load on the spine
  
• weight lifting
  
• obesity
  
• metabolic disorders and other factors.

Symptoms of the intervertebral hernia

An intervertebral hernia, the symptoms of which are associated with the development of discoradical syndrome. It is based on protrusion, which can be accompanied by sequestration of the pulpous nucleus. Sometimes there is a fragmentation of hyaline plates and a fibrous ring.

All this causes the presence of pain, which has different characteristics:

1. 1) The pain can be localized in the place of lesion of the lumbar spine
   
2. 2) Reflected pains that mimic diseases of internal organs. This is due to the infringement of the nerve roots that innervate this or that organ, which leads to various diagnostic errors
   
3. 3) Limitation of mobility in the spine, as the patient spares him because of the onset of pain syndrome.

The pain leads to a spastic condition of the muscles. This is an additional factor that provokes its strengthening. Therefore, an effective analgesic treatment includes the use of drugs that eliminate this muscle spasm. Also, against the background of radicular syndrome, the motor and sensitive roots are compressed. This is manifested:

• weakness of the muscles of the legs
  
• by a violation of the temperature sensitivity, so these patients often have burns or frostbite.

See also, a hernia of the lumbar spine.

Diagnosis of the intervertebral disc

Conducting additional research methods is necessary to establish a definitive diagnosis, on which a further treatment program will depend. Diagnostic search for suspected intervertebral hernia includes the following studies:

• radiographic - pathological protrusion is determined in the spine area
  
• computed tomography
  
• myelography, which allows to obtain a clear image of the soft tissues surrounding the spinal column( a special contrast is introduced into the vertebral column, and then performedX-ray photography series)
  
• magnetic resonance imaging( is a more reliable method of investigation).With this test, you can measure the size of the hernia, identify possible signs of the inflammatory reaction
  
• electroneuromyography allows you to assess the severity of the innervation of certain muscles.

Possible consequences of hernia

Late diagnosis and untimely treatment of a herniated disc can lead to a loss of ability to serve themselves and engage in professional activities, that is, a person can gradually become disabled.

Read also, a hernia in the cervical spine.

Treatment of intervertebral hernia

Conservative treatment of radicular syndrome with intervertebral hernia includes the need to prescribe the following drugs:

1. 1) Antiaggregants that improve microcirculation
   
2. 2) Nonsteroidal anti-inflammatory drugs
   
3. 3) Nootropic drugs that improve metabolism in nervous tissue.

However, over time, these drugs, in combination with anesthetizing punctures and physiotherapy procedures, gradually lead to hypertrophy and ossification( deposition of calcium salts) of the ligamentous apparatus of the spine.


For the relief of a typical pain syndrome with intervertebral hernia, the use of such medications as:

1. 1) Non-steroidal anti-inflammatory drugs
   
2. 2) Muscle relaxants that affect the central links of the regulation of muscle tone. The use of these drugs is justified, since the disease develops compensatory muscle hypertonia. This is accompanied by ischemic changes and the formation on this background of an increased amount of lactic acid, which irritates the nerve endings. The use of muscle relaxants breaks this vicious circle and promotes pain relief
   
3. 3) Chondroprotectors, which are the means of pathogenetic therapy. It allows to activate the function of chondroblasts and to improve the processes of renewal and restoration of the cartilage( connective) tissue, preventing the progression of the disease. The composition of these drugs includes chondroitin sulfate and glucosamine.

In addition, still use:

• anticonvulsants for the treatment of reflex pain
  
• antidepressants
  
• nootropic funds
  
• vascular drugs.

For the time being, it is also recommended to limit the mobility of the spine. Special corsets and means of immobilization are used for this. As the stagnation of pain gradually increase the rate of physical activity. Also at this time, the positive effect is exerted by physiotherapeutic methods of treatment.

Novokainovye blockades have well proven for the coping of the pain syndrome. They are performed only by a neurologist who has been trained in this procedure, since otherwise the probability of technical complications is high.

If conservative treatment, as described above, does not lead to clinical improvement within one week, then there are indications for operative treatment of the intervertebral hernia.

Also emergency surgery is performed in the presence of the following clinical situations:

• disorders of pelvic organs - urinary retention or incontinence, incontinence of gases and stool
  
• severe pain syndrome( hyperalgia)
  
• ischemic disorders of nerve roots.

The operation pursues the following tasks:

• removal of a herniated disc, which is the cause of the pathological process of
  
• complete elimination of compression( compression) of nerve roots and feeding( outflowing) vessels.

In the postoperative period to improve the effectiveness of the treatment, the patient should follow the following recommendations:

1. 1) Adhere to bed rest
   
2. 2) Use antiaggregants, nootropic, nonsteroidal anti-inflammatory drugs, pain medications, antibiotics
   
3. 3) To restore the function of the affected and inactive muscles,electrostimulation
   
4. 4) Gradually, a person is allowed to get out of bed( on the 5th-6th day) using fixing bandages and corsets
   
5. 5) Fixingbelt are worn for half a year
   
6. 6) In the subsequent spring and fall, supportive courses of conservative therapy.

In some cases, surgery may be accompanied by the development of complications. These include:

• hematomas
  
• liquorrhea - discharge of cerebrospinal fluid from the postoperative wound
  
• aggravation of neurologic disorders( sensory disorders, weakness in the lower extremities), which is associated with excessive sprain of the nerve root
  
• infectious complications that can lead to suppuration of the postoperative wound, the development of encephalitis ormeningitis.

See also, exercises with a hernia of the spine.

Prophylaxis of herniated discs

Effective prophylaxis, which would reliably prevent the development of intervertebral hernias, is currently not available. However, you should follow such recommendations as:

• normalization of body weight to combat excess weight
  
• exclusion of injuries
  
• moderate physical activity, excluding increased stress on the spine.

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