Herniated intervertebral discs most often manifest in age-related osteochondrosis due to dryness and brittleness of the fibrous ring. But this is only one of the risk factors. Others include:
- Heavy load on the lumbar region due to overweight.
- Weakness of the muscular system.
- Inheritance.
- A sedentary lifestyle and, consequently, constant compression of the vertebral structures.
- To smoke.
- Great physical activity.
According to medical statistics, this disease occurs in men several times more often than in women.
What are the most common causes of the disease:
- Injuries from road accidents or falls.
- Lifting heavy objects with incorrect load distribution.
- Scoliosis or lordosis, which leads to increased stress on certain areas of the spine.
- Dysplasia of the hip joints.
- Chronic diseases, including tuberculosis of the spine, neoplasms, syphilis.
- Metabolic disorders (hereditary and acquired).
All of these factors cause wear and weakening of the cartilage and bones of the spine. And this is the main reason for the intervertebral hernia.
Stages of development of the disease
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 quite a bit, no more than two millimeters. The nucleus pulposus does not protrude beyond the vertebral body.
- Lumbar protrusion. The edge of the disc extends beyond the vertebral body to a distance of 1. 5 mm, but displacement of the nucleus is not observed.
- Extrusion. The nucleus protrudes beyond the vertebral body.
- Kidnapping. The nucleus practically falls and hangs over the vertebra in the form of a drop. At this stage, there is a risk of rupture of the fibrous ring and loss of fluid secretion.
In the first stage of the disease, a person is almost not worried about anything, sometimes there are back pains, but they quickly pass. With the development of the disease, the state of health also 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 severe disorders of the nervous system.
How does a lumbosacral hernia manifest itself?
An intervertebral hernia can manifest itself with the following symptoms:
- Pain in the lumbar region.
- Pain when walking, which radiates to the thigh region.
- Numbness of the feet, fingers, 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 worthwhile to more carefully analyze the symptoms of the disease. They can be divided into three groups.
Pain syndrome
Pain with a herniated lumbosacral spine is a key symptom. Even in the first stage, there is pain in the area of the damaged disc, especially after the injury. They can increase or decrease and then be reborn. More often than not, the sacral region does not even hurt, but it hurts, especially with physical exertion or prolonged sedentary work. If a person lies down on a healthy side and bends the leg, the pains completely subside. This condition can last for several months.
With timely treatment for medical assistance, it is easy to get rid of the problem. Just say goodbye to bad habits and do the physiotherapy exercises recommended by your doctor.
Each day, the affected area will increase and the condition of the disc tissues 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, radiates to the cervical region, to each spinal muscle, buttocks, thighs, legs, feet and toes. Discomfort is manifested by physical activity, even insignificant: coughing or sneezing.
Vertebral syndrome
The increase in pain in the second stage is accompanied by constant spasms of the back muscles. This leads to even greater discomfort for the patient. Can't move freely, straighten back, stretch. The gait of such a person becomes uncertain, he always bends over from the side opposite the patient, bends over.
Due to impaired coordination of movements, the quality of human life deteriorates. He cannot perform the tasks set at work well, 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 the 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. Climbing stairs is also difficult for him.
- Numbness of the affected area and surrounding areas. The skin becomes numb and pale, there is a feeling of goosebumps and tingling. Patients complain of hyperhidrosis in the affected area and legs or, conversely, excessive dryness of the skin.
- Lumbago. The patient suffers from low back pain in the lumbar region with sharp and sharp pain, which increases with any movement. If left untreated, it leads to destruction of the hip and knee joints.
- A noticeable thinning of the sore leg, leading to postural asymmetry.
- Destruction of the pelvic organs. Urological and gynecological disorders are aggravated, libido disappears, diarrhea, urinary incontinence are possible.
In severe cases of spinal hernia, there is a risk of paralysis, disability and even death.
Pathology Diagnosis
If a person has severe low back pain, they should make an appointment with a neurologist. He will conduct an examination with medical examinations:
- Identification of reflexes from the tendons of the lower limbs.
- Leg lift test.
- Determination of sensitivity to heat or cold, pain and vibrations over the entire 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 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 also prescribed. With the help of these studies, the doctor will determine if urgent surgery is needed.
Disc Herniation Treatment
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 relieving the patient's condition.
What drugs can a doctor prescribe:
- Medicines that relieve pain and inflammation. In case of exacerbation - in the form of injections. When acute pain is relieved (usually three to four days is enough), oral drugs 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 at the same time. Usually, a cycle of blocks is performed with injections in different parts of the damaged disk.
- Central action muscle relaxants. They reduce muscle activity by relieving painful cramps.
- Vitamin-mineral complexes with an emphasis on the elements of group B. They slightly relax the muscles, help the regeneration of tissues and the conduction of nerve impulses.
After relief from the pain syndrome, medication intake decreases. Treatment of the disease is due to physical therapy and physiotherapy.
Physiotherapeutic treatment methods are also selected based on the patient's condition. This could be:
- Treatment with heat or electric shock.
- 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 that smoking patients stop smoking.
Nutritional adjustments are also important, especially for overweight patients. Fatty, salty, sweet and alcoholic dishes must be excluded from the menu. A sparing diet with an abundance of vegetables and fermented milk products will help the body cope better with the treatment, as well as shed the pounds that weigh on the back.
Surgical intervention
Conservative treatment usually lasts about two months. If it does not give the desired result, the decision is made to change the therapeutic tactics or to perform surgery. The latter is prescribed for severe pain, loss of sensation in the legs, dysfunctions 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 fed into one for transmission to the monitor. Through the other two, the hernia protrusion is removed using miniature instrumentation.
- With the percutaneous discectomy method. The damaged core 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 punctures using a special needle without dissecting the tissue. The laser radiation heats the structures of the disc and stimulates cell regeneration, as well as relieving pain.
In difficult cases, endoprosthesis of the vertebral discs is possible, replacing the injured organ with an implant.
After complex surgeries, rehabilitation will be required. The operated person will have to wear a corset and will not be able to assume 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, a herniated disc 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.
- Correct body weight (its index should not exceed 30).
- Choose a good mattress to sleep in the correct position (preferably on your back).
- Engage in gentle physical education, swimming, fitness.
- Include exercises in the morning exercises to strengthen the muscular corset of the spine.
- Give up cigarettes.
- Eat well.
If compliance with these rules becomes a habit, there is a risk of contracting a spinal hernia only following an accident.
A herniated disc is dangerous with serious consequences, and the treatment of advanced cases takes a very long time. To avoid surgery and complications, if you have painful sensations in your back, you should see a neurologist.
Osteochondrosis
The term osteochondrosis itself comes from two words: osteo - bone and chondrue - cartilage. Simply put, it is the ossification of the cartilage. Although this interpretation is fundamentally wrong. Some go even further in their delusions and are confident that osteochondrosis is the deposition of salts in the joints. Also, it is table salt that is supposed to be eaten in large quantities.
pathogenesis
In reality, everything happens a little differently. It is more difficult. And table salt, if it plays a 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 noticed almost anywhere where connective cartilage tissue is present.
However, osteochondrosis in the overwhelming case affects the spine. Because? The fact is that between the vertebrae there are a kind of spacers - intervertebral (intervertebral) discs. The physiological role of these discs is to cushion and protect the vertebral bodies from premature wear due to mechanical stress. The disc consists of an internal liquid nucleus pulposus surrounded by a fibrous ring and an upper and lower endplate.
The disc undergoes tremendous mechanical stress, which leads to permanent damage to its structures at the cellular level. In humans, these processes are too pronounced - this is our payment for walking upright. To prevent the disk from being completely "erased", it must be constantly regenerated, ie 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 grew in childhood, but diffusely, from the bone tissue of the vertebral bodies. Again, the payment for the ability to walk on two limbs, not four.
For this reason, the intervertebral discs are easily injured in anatomical and physiological terms. 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 the correct mechanical stress. Under excessive pressure from the overlying vertebrae, the discs are moved in different directions, usually to the sides and back. This process is called a herniated disc.
The bone tissue of the vertebrae, which has lost its cartilage lining, is also subject to mechanical wear. Due to constant trauma on the surface of the anterior edge of the vertebral bodies, pathological bone growths are formed - osteophytes. Spondylosis develops. Due to degeneration and displacement of the disc, the intervertebral spaces decrease, the spinal canal narrows, and the roots of the spinal nerves are violated in the so-called. foraminal holes.
causes
The causes, or etiological factors, of osteochondrosis are diverse. They can both be local, eg. caused by the pathology of the spinal column itself, and general disorders at the level of the organism. Any pathology that leads to a violation of the structure of the spine or metabolic disorders can be considered 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 anomalies
- Spine 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 come? The fact is that the clinical manifestations of osteochondrosis are based on its complications: herniated discs, spondylosis, sciatica, narrowing of the spinal canal.
Furthermore, the clinic is highly variable depending on the predominant localization of the process in the cervical, thoracic or lumbosacral spine. The last section is most often affected, since it is the lower back that performs the greatest physical activity. Signs of osteochondrosis of the lumbosacral region:
- Pain (low back pain, low back pain, sciatica)
- Restricted movement in the lower back and lower limbs (intermittent claudication)
- Here, sensitivity disorders of the type of paresthesia - numbness, burning, crawling
- Pathological tension of the lumbar muscles
- In the absence of treatment, disturbances in the function of the 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 (neck pain), decreased sensitivity and movements of the upper limbs, cervical osteochondrosis due to impaired blood supply to the brain has its own characteristics. These features manifest themselves:
- Insomnia
- Headache, dizziness
- Periodic nausea
- General weakness, rapid fatigue
- Fluctuations in blood pressure
- Sometimes toothache
- Behavioral reactions in the form of crying, irritability.
The thoracic region with osteochondrosis is relatively rarely affected. Patients in this case are people forced to sit in a fixed uncomfortable position by occupation: students, schoolchildren, programmers, office workers. Symptoms of osteochondrosis in this case will be as follows:
- Chest pain and paraesthesia
- Dyspnea
- Sensation of heartbeat
- Movement restriction in the thoracic spine.
Diagnostics
From all this it is clear that osteochondrosis is a chameleon disease. Due to the similarity of the signs, it is easy to confuse it with cerebrovascular accident, hypertension, myocardial infarction, angina pectoris, neurotic disorders. That is why, in order to make the correct diagnosis, a comprehensive complex diagnosis is required to correctly determine the symptoms and treatment of osteochondrosis.
This diagnosis, in addition to the traditional questions and clarifications about patient complaints, should include a medical examination and special research methods. These methods include x-ray of the spine, ultrasound of internal organs. Recently, MRI and computerized resonance have been used successfully to diagnose osteochondrosis.
Treatment
Therapeutic tactics for osteochondrosis involves the use of:
- Medicines
- Massage
- Physiotherapy procedures
- Physiotherapy (physical therapy)
- Manual therapy
- Acupuncture.
Medicines for osteochondrosis are mainly aimed at relieving pain and eliminating inflammatory processes in the nerve roots. For this purpose, NSAID drugs are used. 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 aggravate the metabolic disorders in osteochondrosis. They relieve block pain 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 in the body with the help of drugs such as chondroprotectors, immunostimulants and vitamins with minerals. Chondroprotectors are used in tablets, ointments and ampoules. Among the fortifying agents, vitamins C, group B, in combination with minerals are used. In this regard, calcium preparations are the most preferred. In fact, contrary to some erroneous statements, the basis of osteochondrosis is not an excess, but only a calcium deficiency.
After successfully relieving the exacerbation, physiotherapy, massage and physical therapy are shown. Calcium electrophoresis, hydrocortisone phonophoresis, amplipulse, paraffin therapy are used as physical procedures. All these measures are aimed at eliminating pain and inflammation in the nerve roots, ligaments and muscles. Massage for osteochondrosis is carried out according to the generally accepted method. The massage zone is selected based on the localization of osteochondrosis. Expansion of the range of motion is achieved with the help of physical therapy. At first, in the phase of exacerbation, there are practically no dynamic loads. The patient is constantly in optimal posture. At this time, it is preferable to wear immobilization devices: a lumbar corset, Shants neck collar. When the exacerbation is removed, the volume and duration of movements during physical therapy increase.
Recently, in the treatment of osteochondrosis, non-traditional methods of treatment have been received: acupuncture, manual therapy, osteopathy. Acupuncture is an effect on special biologically active points located along the spine, on the auricles, hands and feet. With manual therapy, the normal position of the vertebrae and intervertebral discs is restored through the manual action of the hands of a specialist. And in the course of osteopathy, the structural integrity of the musculoskeletal system is ensured through specific techniques. In the absence of the effect of conservative measures for the treatment of osteochondrosis, persistent pain, complications, surgical intervention is indicated. The pathologically displaced disc is removed. Currently, for this purpose, microdiscectomy is performed - endoscopic removal of a displaced disc.