A herniated disc is one of the most common causes of back pain.. Pathology is characterized by a protrusion of the intervertebral disc located between the vertebral bodies. In most cases, a hernia is a complication of osteochondrosis.. If symptoms appear, you need to consult a doctor and undergo an examination, early detection of pathology increases the effectiveness of treatment. For treatment, conservative methods are used, if there is no effect, an operation is performed..

What is a pathology? An intervertebral hernia is a disease in which the nucleus pulposus of the intervertebral disc protrudes. The mechanism of the development of the disease is associated with the structure of the spine.

An intervertebral hernia is formed due to degenerative processes in the disc that separates the vertebrae. Features of the structure of the spine The spinal column consists of 33-34 vertebrae, which are interconnected by elastic discs. Thanks to the latter, mobility and flexibility of the spine are ensured..

The structure of the disks is as follows:.

nucleus pulposus - located inside, soft, has a gel-like consistency and consists of 90% water;

annulus fibrosus - located outside, hard and strong, it surrounds and delimits the nucleus pulposus.

Cervical discs are smaller, lumbar discs are the largest.

The mechanism of the development of the disease Normally, each intervertebral disc is located strictly between the bodies of two vertebrae. If it goes beyond this interdiscal space, a vertebral hernia develops..

The development of the disease is usually associated with degeneration (wear and tear) of the disc.. The fibrous ring loses its elasticity, tears and cracks may develop. All this leads to protrusion of the nucleus pulposus..

Why pathology developsThe only reason that would lead to the development of the disease does not exist. In most cases, the formation of a hernia is associated with osteochondrosis of the spine.. This is a degenerative-dystrophic disease in which the intervertebral disc loses its elasticity and dries out.. Its height decreases, so any physical activity can lead to injury..

What factors increase the likelihood of intervertebral disc displacement:.

weight lifting;

sharp twisting movements;

prolonged sitting position;

obesity;

excessive physical activity;

overload of the spinal column associated with flat feet and wearing uncomfortable shoes;

abrupt cessation of regular exercise.

Genetic predisposition also plays a role.. A hernia of the intervertebral space can develop not only as a complication of osteochondrosis, but also with trauma and curvature of the spine, in individuals with developmental anomalies leading to an overload of the spinal column.

Any part of the spine can be affected, but most often the lumbosacral and cervical. Clinical symptoms depend on localization, each type of disease has its own symptoms. There are the following types of pathology, taking into account the location:.

Hernia of the lumbosacral region - the most common. In 90% of cases, the protrusion is localized at the level of L4-L5 and L5-S1.

The cervical region is the second most common.

Thoracic - extremely rare.

Depending on the stage of hernia formation, the following varieties are distinguished:.

prolapse;

protrusion;

extrusion;

disc sequestration.

A hernia is a protrusion of the nucleus pulposus of the disc beyond the fibrous ring.. Symptoms appear when the bulge compresses the surrounding nerves and blood vessels.. Clinical manifestations depend primarily on the type of disease.

Common signs include local pain and impaired innervation when squeezing the spinal nerves..

Cervical region The main symptom of the disease is pain in the back of the neck.. Pain worsens with exertion, lessens when lying down. The pain is dull in nature, may radiate to the upper limb.

In addition to the pain syndrome, when the nerves are compressed, there is a violation of innervation:.

numbness of fingers;

trophic skin changes;

occasional dizziness;

headache;

blood pressure fluctuation.

The severity of symptoms depends on the size of the protrusion and the degree of compression of the nerves..

Thoracic Pain is most often localized in the upper back. It increases with physical activity, prolonged stay in an uncomfortable position. Pain can also be localized in the retrosternal region, resembling diseases of the heart or stomach..

The lumbosacral regionPain is localized in the lower back, often radiating to the lower extremities, sacrum, genitals. Pain worsens with exertion, disappears with rest.

There are other symptoms associated with impaired innervation:.

numbness and tingling in the leg;

muscle weakness in the lower limb;

desensitization;

pelvic disorders - urinary and fecal incontinence, erectile dysfunction.

Localization of symptoms can be different - only the thigh, thigh and lower leg, from the buttocks to the fingertips. It depends on which nerve is pinched..

The main symptom with which patients suffering from intervertebral hernia go to the doctor is pain in the spine. Consequences and possible complications With early detection of the disease and initiation of treatment, the prognosis is favorable. Approximately 75% of cases improve within 4 to 6 weeks, but there is a high risk of recurrence.

The clinical picture is not limited to the main symptoms only.. In some cases, complications develop that change the symptoms. Complications can be different, depending on which part of the spine the hernia is located in..

Localization.

Typical complications.

cervical.

The most common complication is vertebral artery syndrome. There is compression of the vertebral artery, which supplies blood to the brain. Clinically, this is manifested by the following symptoms:.

· noise in ears;

· dizziness;

· loss of consciousness;

flashes of light in the eyes;

lack of coordination.

In severe cases, vertebral artery syndrome can cause transient ischemic attacks (TIAs), a transient disruption of the blood supply to the brain..

Thoracic.

A hernia in the thoracic spine can compress the visceral branches that innervate the internal organs. Therefore, a complication of the disease can be a violation of the esophagus, bronchi, liver, pancreas, intestines.

Lumbosacral region.

Most often complicated by radicular syndrome (radiculopathy). This is a condition in which the spinal root is compressed, which leads to severe pain.

Another complication that can develop with all types of disease is discogenic myelopathy.. This is a condition in which a bulging disc causes narrowing of the spinal canal and compression of the spinal cord.. There are motor or sensory disturbances on the one hand:.

paresis of the lower limb (right or left) with loss of tendon reflexes;

loss of sensation;

dysfunction of the pelvic organs - incontinence of urine and feces.

Over time, the condition worsens, the changes become irreversible.

Diagnostic methods It is possible to suspect the presence of a vertebral hernia by characteristic symptoms, but an additional examination is required to make a diagnosis.. Magnetic resonance imaging (MRI) is considered the gold standard, but sometimes other tests are required..

Diagnostic method.

Who is shown.

Explanation.

Plain radiography.

To all patients.

Accessible, but insufficiently informative research method. On the survey radiograph, you can see signs of osteochondrosis and anomalies in the development of the spine, but it will not be possible to diagnose the pathology of the intervertebral discs.

Magnetic resonance imaging (MRI).

To all patients.

MRI or CT will help to detect pathology. Soft structures such as the intervertebral disc are better visualized on an MRI. The study will help determine the location and size of the protrusion.

Doppler ultrasound (USDG) of blood vessels.

With damage to the cervical spine.

A protrusion of a disc in the cervical spine can compress not only the nervous tissue, but also the vessels. This is an indication for vascular studies (vascular ultrasound).

Electrocardiography (ECG).

With damage to the thoracic spine.

If the disc in the thoracic region is affected, the symptoms may resemble angina pectoris.. An ECG is performed to rule out cardiac pathology..

MRI is the main method for diagnosing intervertebral herniasHow to get rid of the diseaseThere are several methods of treating the disease. Conservative therapy or surgery may be used. The choice of therapeutic tactics depends on several factors - the size and location of the protrusion, the severity of symptoms, the presence of complications, the duration of the disease..

Treatment without surgeryIn 90% of cases, the disease can be successfully treated conservatively. Conservative therapy is complex - medications, paravertebral blockades, physiotherapy and physiotherapy exercises are prescribed. The duration of the course of treatment should be at least 1 month.

Treatment method.

Explanation.

Medical therapy.

Non-steroidal anti-inflammatory drugs (NSAIDs).

NSAIDs are prescribed to relieve pain and relieve inflammation. Systemic NSAIDs are used:.

Meloxicam;

Diclofenac (Dicloberl);

Ibuprofen;

Naproxen.

Muscle relaxants.

Central muscle relaxants are prescribed to relieve muscle tension, as muscle hypertonicity exacerbates nerve impingement. The following drugs are used:.

Mydocalm;

· Miaksil;

· Toccata.

B vitamins.

B vitamins are prescribed to improve the trophism of nerve fibers.

Paravertebral blocks.

Paravertebral blockades are prescribed to relieve pain. The essence of the procedure is the introduction of anesthetics and glucocorticoids into the paravertebral tissues..

Physiotherapy.

In the acute period of the disease, the following physiotherapeutic methods are used:.

UHF;

phonophoresis with hydrocortisone;

electrophoresis.

They are aimed at reducing inflammation and swelling, improving blood circulation..

After relief of acute manifestations, reflexotherapy, mud therapy are used..

Traction therapy has a good effect, which is aimed at increasing the intervertebral distance and reducing the load on the intervertebral disc.

Physiotherapy.

An important component of treatment is physiotherapy exercises (LFK). With the help of special exercises, you can achieve stretching of the spine, strengthening the muscle frame. Thus, the load on the affected disc is reduced.. In addition to exercise therapy, massage is used to improve blood circulation and reduce muscle tension..

The effectiveness of treatment is also influenced by compliance with general recommendations:.

sleep on a hard surface or on the floor;

choose an orthopedic pillow;

avoid strenuous exercise;

move more during the day.

Indications for surgical treatmentSurgery is the most effective and radical method of treatment, but surgical intervention is inevitably associated with a high risk of postoperative complications, so this treatment is not indicated for everyone. Surgery is required in about 10% of cases.

In what cases is surgical intervention indicated:.

Pain syndrome does not stop within 1.5 months of conservative treatment.

The disease was complicated by discogenic myelopathy, vertebral artery syndrome.

There are dysfunctions of the pelvic organs (urinary and fecal incontinence, erectile dysfunction).

The decision on the need for surgery is made on an individual basis.. The age of the patient, general condition, the presence of concomitant diseases are also taken into account..

10% of patients with intervertebral hernia require surgery. Treatment may include laminectomy, microdiscectomy, or endoscopic hernia removal..

Operation name.

Advantages and disadvantages.

Explanation.

Laminectomy.

The only advantage is that there is no need for special equipment. Flaws:.

injury;

high risk of postoperative complications;

long recovery.

Laminectomy is the most traumatic method of treatment. During the operation, the vertebral arch is removed. Its removal leads to the expansion of the cavity of the spinal canal and eliminates its compression.. Currently, laminectomy is rarely used, as less invasive treatments are available..

microdiscectomy.

The advantages include the ability to remove a hernia of any size and location. Disadvantages: relative trauma, risk of complications (but less than with laminectomy).

Microsurgical removal of a hernia (microdiscectomy) is increasingly being used.. The operation is performed under anesthesia, a 3-4 cm incision is made on the skin. Removal of a hernia is performed using a microscope.

Endoscopic removal.

The main advantage is low trauma. Disadvantage - it is impossible to remove large hernias.

The least invasive method of treatment is endoscopic hernia removal. The operation is performed under anesthesia, using a special device - an endoscope.. The device is inserted through small skin incisions..

Postoperative period Recovery time depends on the type of operation (from 2–3 days for endoscopic surgery to several months for laminectomy). After the operation, it is recommended to wear a semi-rigid corset for 1–2 months.. Physical activity is limited for 1 month.

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