Mar 06, 2018
Herniated disc - is the most common and most severe manifestation of osteochondrosis of the spine, which is the protrusion of the central part of one of the flat rounded pads located in the joints between the bones of the spine. Symptoms of a herniated intervertebral disc occur when you touch the nerve that comes out of the spinal cord, or directly to the spinal cord. At the same time, a painful radicular syndrome develops, which can be accompanied by paresis or paralysis of the muscles of the lower extremities, a sensitivity disorder, a violation of the pelvic organs.19% of patients with herniated intervertebral discs need surgical treatment.
Dystrophic changes in various parts of the spine are most pronounced, usually between the ages of 20 and 50, and are one of the most common causes of temporary disability, and sometimes lead to disability of the patient. Up to 50% of all surgical operations in hospitals of the neurosurgical profile are performed regarding the pathology of the discs at the lumbosacral level.
Each disc has a soft gelatinous inner part surrounded by a rigid outer ring, which allows it to work as a shock absorber between the bones of the spine. Weakness or trauma can lead to the internal part being squeezed through an outer ring, which may already have microscopic cracks due to the aging process. In some cases, this can lead to pinching of one of the spinal nerves and cause pain and numbness in the neck, arm or leg. The intervertebral disc may then burst. As a result, the soft gel-like mass flows through the outer shell and can begin to press on the nerve. Intervertebral discs in the neck and, especially, in the lumbar region are often prone to ruptures.
Disease occurs as a result of rupture of the intervertebral disc. In this case, a hernia is formed, which, protruding back and to the side, presses on the root of the nerve at the site of its exit from the spinal canal. Inflammation develops, accompanied by an increasing edema. This explains why pain and loss of sensitivity appear only a day after the onset of the disease. The stiffened nerve root sends painful impulses to the brain, which are perceived by the patient as if they come from another, often remote part of the body, for example the leg. The part of the nerve that is outside the pressure of the hernia almost ceases to function, which leads to a sharp decrease in sensitivity and the appearance of weakness in the leg.
Almost all patients with the main complaint is a pain syndrome. As a rule, pain occurs in adolescence after physical exertion, uncomfortable position in the workplace or in bed. Just as with "lumbago", the disease often occurs when tilted with a simultaneous turn to the side, often in conjunction with lifting the severity. There is also a sudden, not particularly severe pain in the lumbar region. Then, within a day, pain and weakness develop in one of the legs, sometimes with a loss of sensitivity on the inside of the foot and lower leg or on the outside of the foot and the inner side of the shin. During movements, coughing, sneezing, or physical exertion, back and leg pains intensify and often become so intense that the patient needs bed rest. Some relief of the state can be achieved in the lying position by lifting your legs or laying them on a pillow.
There are two stages in the development of the disease. At the first stage, there is pain in the lumbar region, which indicates the onset of a degenerative-dystrophic process. Under the influence of disorders in the vertebral-motor segments, the rather complex structure of the fibrous ring changes, in it radial cracks form, which reduces its strength. As a result, the gelatinous nucleus is bulged, making it difficult to circulate in this zone;there is edema of local tissues, the nutrition of the root of the spinal cord decreases, the adhesion process may develop. The fibrous ring, the posterior longitudinal ligament, the dura mater, the intervertebral joints are all innately innervated. There is a pain syndrome, which leads to the fixation of the pathological zone due to the strain of the muscles of the back and as a result, compensatory curvature of the overlying parts of the spine occurs. So a vicious circle is formed. Subsequently, the process leads to pronounced dystrophic changes in the joint-ligament apparatus.
At the second stage, the character of the pain syndrome changes. Compression root syndrome arises, which is caused by mechanical compression and tension of the rootlet. This causes edema of the root, disrupts its blood supply. With direct contact of the herniated intervertebral disc with the spine, chemical irritation causes a more intense pain syndrome. Often, when root pain occurs pain in the lumbosacral region weakens or disappears. Apparently, this is due to a decrease in internal disk pressure as a result of rupture of the fibrous ring. Pain syndrome can be caused not only by compression of the spine or spinal cord, but also feeding the root of the vessel.
Clinical manifestations. Distribution and localization of radicular pain generally correspond to the innervation zone of the compressed root. Pain is often "lamas", may be permanent or transient.
In general, the drives L4-L5 and L5-S1 are affected. The level of L3-L4 suffers only in 2-4% of cases. In addition to pain, sensitivity disorders can occur: increase( hypesthesia), decrease( hypoesthesia), in some cases, complete absence( anesthesia) of sensitivity as such.
Autonomic disorders are observed in the form of lowering the temperature of the skin, varying degrees of swelling, sweating, and dry skin. Quite often patients take a compelled position. Compensatory postures that reduce the degree of pressure on the spine and tension it, are manifested by scoliosis, restriction of flexion and extension of the trunk, tension of the long back muscles. Sometimes patients can not straighten their legs because of pain. Movement disorders in the form of paresis or paralysis are rare, they are typical for neglected cases. There may be trophic disorders in the form of weight loss due to muscle atrophy.
In the early stages of the disease, symptoms of irritation predominate, with symptoms of loss of function leading to the forefront.
The human body has a powerful ability for self-healing and regeneration, which can be fully attributed to damage to the intervertebral discs. Usually the disease passes for two or three months, with the observance of bed rest and rest - the best prerequisites for a quick recovery without complications. Just like with other diseases of the lumbar spine, it is recommended to lie on your back with your feet raised or placed on the pillow, changing your body position and looking for a comfortable painless pose. To reduce severe pain, it is possible to take painkillers, as well as anti-inflammatory drugs. They, unfortunately, do not accelerate the process of recovery in any way, they are only able to significantly reduce the sufferings of the patient. After 3-4 weeks of pain, as a rule, significantly weaken, but the damage to the disc itself is not yet cured, so in order to avoid possible complications in the form of chronic low back pain, rest for at least a whole month is necessary.
Surgical treatment is indicated in the presence of permanent pain syndrome( with treatment terms from 2 weeks to 3 months), an increase in neurologic symptoms, a syndrome of lesion of the lower major vertebral nerves - a violation of the pelvic organs, a decrease in potency, numbness of the perineum.
Another method of treating the intervertebral hernia in the acute stage is spinal traction. This is a very old way, the interest to which has been steadily increasing lately. A pressure creates a differential pressure in the intervertebral space, which makes it possible to "suck in" the hernia. At the same time, it is necessary to find the correct direction of action and to choose the appropriate force so as not to damage the spine even more. Sometimes the patient is advised to pull the tract himself, in accordance with the pain. If the procedure is performed correctly, the pain should decrease rather than increase.
Summing up, we can say that the methods of treating the intervertebral hernia are as follows: