Herniated disc: symptoms and treatment
What is a herniated disc?
Intervertebral hernia is a protrusion of the nucleus of the intervertebral disc into the spinal canal as a result of a violation of the integrity of the annulus fibrosus. It is an inflammatory-degenerative disease that leads to deformation of the intervertebral disc, rupture of the annulus fibrosus and exit of the nucleus outside the vertebral body.
In general, this is a relatively rare pathology. According to statistics, it occurs in no more than 0.15% of the world's population (or about 15 people per 10,000). However, over the past five years, the incidence has increased significantly (almost 3 times).
The greatest load is on the lumbosacral spine, so it is obvious that it is he who undergoes pathological changes in the first place. About 48% of hernias develop at the level between the fifth vertebra and the sacrum, somewhat less often (46%) the disc between the fourth and fifth vertebrae suffers.
Hernias located in the cervical spine are much less common, and cases of damage to the thoracic spine are quite rare.
According to medical statistics, a hernia at one stage or another in most cases is the cause of back pain.
In countries leading in terms of the level of medical care, from 20 (Germany) to 200 (USA) thousand surgical interventions are performed annually for the elimination of an intervertebral hernia.
- What you need to know about herniated discs?
- What is the structure of the spine and intervertebral discs?
- Symptoms of the intervertebral hernia
- Herniated disc pain
- The connection between herniated discs and osteochondrosis
- What are the causes of the occurrence?
- Disease stages
- Complications and consequences
- Diagnosis of the disease
- Herniated disc treatment
What you need to know about herniated discs?
- Intervertebral discs are a kind of shock absorbers that reduce the impact of the vertebrae on each other when they move and the spine moves.
- The pulpous nucleus of the central part of the disc, which has a gel-like consistency, is protected by a hard shell - a fibrous ring.
- When a crack or rupture occurs in the annulus fibrosus, part of the nucleus pulposus of the vertebra is squeezed out into the pulp canal.
- A volumetric intervertebral hernia compresses the spinal nerves located in the same segment of the spine.
- Examination of the patient by a neurologist, MRI diagnostics will help determine the extent and features of the pathology.
- Most often, conservative therapy of intervertebral hernia is practiced: massage, a complex of therapeutic exercises, stretching the spine with the help of special devices. Surgery is rare.
Surgical treatment is not able to eliminate the cause of the herniated discs; it is used to eliminate serious complications that threaten the patient's quality of life. Surgical intervention is fraught with irreversible consequences.
What is the structure of the spine and intervertebral discs?
Intervertebral discs are located between the vertebral bodies. The body is the most voluminous part of the components of the spine.
- Cervical region - 7 cervical vertebrae;
- Thoracic region - 12 thoracic vertebrae;
- Lumbar region - 5 lumbar vertebrae;
- The sacral region, which passes into the coccyx, is located under the fifth lumbar vertebra.
The spine is a single whole, which is at the same time a movable structure. The most important functions of the spine are skeletal support, protection from damage to the spinal cord located in the spinal canal. Protection from injury is provided by the spinous processes - bony protrusions located behind the spinal cord. The bony body of the vertebra, due to its shape and size, is a kind of platform that softens the load on the spine.
Intervertebral discs are a special structure located between the vertebral bodies. They absorb the pressure exerted by the spinal column during human movements. The structure of all discs is the same for each segment - it is a gel-like nucleus pulposus in the center, surrounded by a solid ring of fibrous tissue. The fibrous rings perform a binding function, connecting the vertebrae to each other. If the fibrous ligaments are damaged due to the destruction or degeneration of the intervertebral disc, the patient feels pronounced pain.
Symptoms of the intervertebral hernia
In theory, a herniated disc can affect absolutely any part of the spine, while the symptoms will vary significantly.
Consider the symptoms of an intervertebral hernia, depending on its location:
- Frequent and intense headaches. Headache of unclear localization, throbbing, pressing or bursting. The reason lies in the compression of the nerve roots, as well as the vertebral arteries that feed the brain. As a result, severe vertebrobasilar insufficiency with characteristic manifestations may develop.
- Dizziness. Due to the compression of the vertebral arteries, the cerebellum receives insufficient nutrition.
- Visual hallucinations (photopsies, scotomas). Visual disturbances are explained by a lack of blood circulation in the visual center.
- Weakness, drowsiness and fatigue. When the vertebral arteries are compressed, the brain receives less oxygen and nutrients. As a result, the body is forced to work less intensively and instruct all systems to reduce activity.
- Neck pain. Caused by compression of nerve endings.
- Instability of blood pressure. Patients often have false hypertension. The reason is that there are many blood vessels in the neck. They are abundantly innervated, pinching these blood lines causes the brain to receive false signals and triggers reflexes that lead to high blood pressure.
- There is a radiating pain in the shoulder or forearm.
- Muscle weakness (shoulder, arm).
- Numbness in the fingers. Feeling of "flowing".
- Pale skin, sweating.
- Backache. Localization of pain - at the level of the shoulder blades. Girdle pain, aggravated by exertion, coughing, sneezing, deep breathing. They can radiate to the arms, stomach, neck, lower back, shoulders.
- Abdominal pain is rare. It is important to exclude other diseases.
- Decreased sensitivity below the lesion site. Paresis, paralysis develop. This is due to compression of the spinal cord.
Acute pain in the lumbar region (lumbago or lumbago). The pain comes on sharply. It is usually associated with physical activity, heavy lifting. Has a sharp, shooting, burning character. The reason lies in the prolapse of the intervertebral disc and irritation of the nerve roots located in the area of the annulus fibrosus. As a result, a reflex increase in muscle tone occurs and persistent pain syndrome develops with the inability to change posture. Most often, this symptom manifests itself in sick men aged 30 to 40 years.
- Ishalgia (sciatica). It is a severe pain syndrome associated with the pressure of the hernia on the roots of the spinal cord. Compression of the nerve endings leads to irritation of the large sciatic nerve. This explains such a pronounced pain syndrome. The pains are stabbing, shooting, aching. Pain often radiates from the lesion along the back of the leg to the thighs, calves and ankles. As a rule, pains cover one of the legs, depending on the location of the hernia.
- Long-term pain in the lumbar region. They can torment a person for months and years.
- Damage to the motor nerves, which causes a decrease in the tone of the leg muscles.
- Dysfunction of organs located in the pelvic region. In severe cases, it is possible to develop urinary incontinence, uncontrolled defecation, impotence in men.
Compression of the nerves responsible for sensitivity. As a result, the sensitivity of the skin of the legs (groin, buttocks, thighs, lower legs, ankles) decreases, a tingling sensation, "goose bumps" develops.
- Blood supply disorders. The reason is the compression of the nerves that regulate blood circulation. As a result - pallor of the skin, the appearance of spots on the skin.
- Spinal cord injury. It can manifest itself in the form of paresis, paralysis of the lower extremities.
Herniated disc pain
The conventional wisdom that the cause of pain in the spine is mechanical compression of nerve roots has been replaced by the version of "chemical radiculitis". The main goal of surgical treatment is to eliminate the pinching of the spinal nerves. Recently, there has been an active discussion of medical research data on such a cause of pain as chemical inflammation.
The mediator of these painful sensations is the tumor necrosis factor (TNF) molecule, or tumor necrosis factor-alpha.
The causes of the appearance of the inflammatory molecule:
- Intervertebral hernia;
- Fracture of the annulus fibrosus;
- Narrowing of the spinal canal (spinal stenosis)
- Pathology of the facet joints.
The consequences of the influence of the TNF molecule are the appearance of pain and inflammation. Nevertheless, the arrest of the activity of the molecule by drugs does not eliminate the need to eliminate compression of the nerve root and treat herniated intervertebral discs using traditional methods. An excellent alternative to the expensive and sometimes ineffective treatment of "chemical radiculitis" can be hirudotherapy (treatment with leeches).
The most common localization of herniated discs is the cervical and lumbar spine. This pathology rarely affects the thoracic region. Hernias in the overwhelming majority of cases occur in the posterolateral projection of the vertebra. In this part of the vertebra, the effect of compression on the annulus fibrosus is most pronounced, and the support of the posterior and anterior longitudinal ligaments is least felt.
The connection between herniated discs and osteochondrosis
There is a proven connection between osteochondrosis and herniated intervertebral discs. A natural consequence of poor-quality treatment of osteochondrosis is an intervertebral hernia. Diagnosis and treatment of types of osteochondrosis is similar to the diagnosis and treatment of similar cases of intervertebral hernia.
Prevention and treatment of osteochondrosis will lead to the elimination of intervertebral hernia, that is, both the cause and the effect directly depend on each other.
What are the causes of the occurrence?
The causes of hernia are numerous, among them there are several factors that significantly increase the risk of developing pathology:
- Floor. According to studies, cartilage tissue in men is less developed than in women and wears out much faster. Therefore, men are primarily at risk.
- Age. Over time, the elasticity of the cartilage tissue decreases, degenerative processes begin in the spine and joints. The risk group includes women over 45 years old and men over 30 years old.
- Past diseases, injuries and surgical interventions in the spine area significantly increase the risk of developing intervertebral hernias.
There are also a number of subjective factors that a person is able to influence:
- Overweight. The large volume of fatty ratios contributes to increased stress on the spine. An obese person also has a decrease in muscle tone. Weakened muscles cannot form a reliable "corset" to support the spine. In addition, metabolic disorders lead to a decrease in the flexibility of the spinal column.
- Bad habits. Smoking comes first. Nicotine reduces the amount of nutrition of the intervertebral discs. As a result, the risk of developing pathology increases.
- Physical inactivity. It has been proven that a sedentary lifestyle provokes the development of a pathological process.
- The physical nature of the work. Constant lifting of weights, work in conditions of increased vibration negatively affect the spine.
- Heredity. Peculiarities of metabolism and genesis of cartilage tissue are transmitted from ancestors. Therefore, if there were persons in the family suffering from such a pathology, the risk of its development in offspring increases in the range from 20 to 75%.
Any intervertebral hernia goes through four stages in its development:
- Disc protrusion. A small rupture forms in the annulus fibrosus of the intervertebral disc. A fragment of the gelatinous nucleus comes out. At this stage, you can cope with an intervertebral hernia on your own without special treatment. The doctor recommends strict bed rest. Physical activity, sudden movements are excluded. The crack of the annulus fibrosus gradually "tightens", the pathological process stops. If the doctor's recommendations are not followed, the hernia will progress. The pressure of the nucleus pulposus on the annulus fibrosus will increase until the disease progresses to another stage. At this stage, shooting pains are already manifested, the hernia reaches about 3 mm in size.
- Partial disc prolapse. The bulging of the nucleus pulposus grows. A hernia can reach 8-10 mm in size. The pains become persistent and pronounced. The blood supply to the intervertebral disc is reduced.
- Complete disc prolapse. The nucleus pulposus extends beyond the annulus fibrosus, while maintaining its structure. The intensity of pain increases significantly. The painful sensations are of a shooting and aching nature, they practically do not disappear on their own without taking analgesics. The motor function is impaired, the working capacity decreases. The pain radiates to the lower extremities.
- Sequestration. Fragments of the nucleus pulposus fall outside the annulus fibrosus. The intervertebral disc is displaced. The hernia pinches the nerve roots, causing intense, prolonged pain.
Complications and consequences
Infringement of an intervertebral hernia. From the moment protrusion is detected, it is necessary that the patient follows the doctor's recommendations. The most important of the recommendations is to minimize physical activity: exclude heavy lifting, sports. If the recommendations of a specialist are not followed, there is a risk of injury.
Infringement occurs by the surrounding tissues (bone structures, muscles). When an intervertebral hernia is pinched, deformation of the structure of the affected intervertebral disc occurs. As a result, pinching of the spinal roots and the development of pronounced symptoms are often observed. In the most severe cases, the hernia pinches the spinal cord, causing dysfunction.
As a rule, pinching occurs:
- Nerve S1. The nerve is pinched not only in the lumbar, but also in the sacral spine.
- Nerve L1. That is, the lumbar nerve is between the fourth and fifth segments.
Protrusion. It is a deepening pathological process of the development of an intervertebral hernia. As the pathology develops, the nucleus pulposus presses more strongly on the annulus fibrosus. At a certain point, the annulus fibrosus ruptures and the nucleus pulposus leaves the structure. This complication is one of the most dangerous, because it is difficult to predict what consequences the development of a full-fledged hernia will entail. There are frequent cases of the development of a posterior hernia, in which the spinal cord is injured and the motor function is completely or partially lost below the site of the lesion.
Diagnosis of the disease
Diagnostic measures for intervertebral hernias include:
For an initial face-to-face appointment with an intervertebral hernia, you should go to an orthopedist or neurologist.
During the appointment, the doctor:
Based on the initial examination, the doctor makes a conclusion about the patient's health status and develops a further examination strategy.
Computed tomography is an effective and informative instrumental study. It is prescribed to patients with suspected intervertebral hernia and allows the most accurate determination of the state of the intervertebral discs and the stage of development of the pathological process (if any).
Thanks to CT, you can get X-ray layer-by-layer images of the spine.
There are a number of relative contraindications for conducting a tomographic study:
In case of urgent need, the study can be carried out, despite the contraindications.
Although CT is highly informative, doctors prefer MRI because it is more suitable for assessing the condition of the intervertebral discs.
MRI is ideal for determining the condition of the intervertebral disc. In MRI scans, the anatomical features of the spine are visible in every detail.
The indication for examination is the presence of an unconfirmed intervertebral hernia.
There are a number of absolute contraindications for magnetic resonance imaging:
MRI has several undeniable advantages over computed tomography:
Unlike tomographic research methods, radiography does not allow assessing the condition of the intervertebral discs. But it is prescribed to patients with a confirmed intervertebral hernia to exclude pathological changes on the part of the vertebrae themselves.
For diagnostic purposes, a picture is taken in two projections: full face and profile.
There are a number of contraindications:
The essence of the study is the introduction of a contrast agent into the area around the spinal cord followed by computed tomography. The main task of the diagnostic measure is to assess the degree of compression of the spinal cord by hernia. The method requires special skills and is quite complex, therefore it is carried out only in a hospital setting.
There are two main indications for the study: compression of the spinal cord and impaired outflow of cerebrospinal fluid.
Contraindications are standard for computed tomography, but an additional obstacle is the individual intolerance to the components of the contrast agent.
On the subject: What can and cannot be done with an intervertebral hernia?
Herniated disc treatment
Conservative methods of treating herniated discs are not as effective as surgical ones; they rather simply relieve pain, but do not have any pronounced effect. These include the use of NSAIDs and glucocorticoids, physiotherapy, homeosinatria, laser therapy and other techniques.
In the course of conservative therapy, drugs of two groups are used: non-steroidal anti-inflammatory drugs and topical drugs based on glucocorticoids.
Non-steroidal anti-inflammatory drugs (NSAIDs):
Topical glucocorticoid preparations:
- Powerful (Dermovate, Khaltsinonid);
- Strong (Celestoderm-V (Betnovate), Kutiveit, Alupent, Flucinar (Sinaflan, Sinalar), Sikotren, Lorinden (Lokakorten), Lokoid (Latikort), Triacort, Elokom, Fluorocort (Polcortolone in the form of an ointment), Esperon);
- Medium (Ultraan, Deperzolone, Dermatop, Prednisolone in the form of an ointment);
- Weak (hydrocortisone).
The principle of treatment is to start with the weakest drugs and gradually move to stronger ones if the desired therapeutic effect is not achieved. Method of using any of the indicated means: rub a small amount of ointment into the area of hernia localization 1-2 times a day.
Both categories of drugs (NSAIDs and glucocorticoids) are used to relieve inflammation and relieve pain.
On the subject: The use of chondroprotectors for hernia - a list of drugs, are they effective at all?
With intervertebral hernia, three types of physiotherapeutic treatment are used:
Electrophoresis. The essence of the method lies in the introduction of drugs into the body through the action of an electric current. For the treatment of pathology, drugs such as papain and caripain are used.
These drugs reduce the protrusion of the hernia, promote the regeneration of damaged tissues and restore normal blood circulation in the area of the damaged disc.
Method of conducting: two electrodes with different poles (plus and minus) are applied to the patient's skin. A drug is applied to one of the electrodes and penetrates the skin. The parameters of the current are adjusted based on the individual characteristics of the body, so that the patient feels a slight tingling sensation.
- Session duration: 10-15 minutes.
- Treatment course: 10 days. The term can be increased at the discretion of the doctor.
- Indications: confirmed intervertebral hernia during remission (subacute period). It is important that there is no aggravation.
- Contraindications: oncological diseases, heart failure, local inflammatory and infectious processes, skin pathologies, violation of the integrity of blood vessels, increased body temperature, skin trauma at the site of application of the electrodes, intolerance to the injected drugs.
Acupuncture. The essence of the treatment is the introduction of thin needles into biologically active points on the body. The effectiveness of the method has not been fully proven. The duration of treatment is determined by the doctor.
The main contraindication is the presence of purulent lesions in the area of needle insertion.
Diadynamic currents. DDT is a low voltage (constant) current. The effectiveness of the method has been proven and consists in improving blood circulation, anesthetizing the affected area, reducing the excitability of nerve endings.
- Method of conducting: in many respects similar to electrophoresis, with the exception that drugs are not administered, and the essence of the treatment lies directly in the therapeutic effect of the current itself.
- Treatment course: 7-10 days, at the discretion of the doctor.
- Indications: confirmed intervertebral hernia with severe pain in the subacute period.
- Contraindications: inflammation, skin diseases, body temperature over 38 ° C, hypertensive crisis, vascular fragility.
On the subject: A set of the best exercises for lumbar hernia of the spine
Laser therapy is a relatively new and little-known method. In recent years, it has been increasingly spreading and gaining well-deserved popularity. Its essence is as follows: an endoscope with a built-in needle is inserted into the lesion site. A cable with a laser diode and a built-in video camera is pulled through the lumen of the needle. During irradiation, tissues are heated to 70 ° C. The surrounding tissues are not destroyed, however, the substance of the nucleus pulposus gradually evaporates. As it evaporates, the core shrinks and stops putting pressure on the surrounding tissue.
Over time, chondrocytes replace the destroyed tissue of the annulus fibrosus. In this way, it is possible to partially or completely cure an intervertebral hernia.
A fairly well-known method abroad. Its essence is similar to the essence of acupuncture (acupuncture). With the help of thin needles, homeopathic medicines are injected into the active zones of the body (acupuncture points). There are only two contraindications: intolerance to the medicinal substances used and pustular skin lesions at the injection site.
The effectiveness of the method is questionable, since the therapeutic effect of the homeopathic medicines themselves has not been proven. There are no exact data on the number of patients cured. Meanwhile, the practitioners themselves claim that the technique is reliable.
Other treatments for herniated discs without surgery
- Manual therapy. The essence of the method lies in the physical impact of a specialist on the body. By its very nature, manual therapy is a mixture of traditional Chinese medicine and therapeutic massage. The method is effective in combating diseases of the musculoskeletal system. However, the safety of manual therapy for patients with hernia has not been proven. In the course of therapeutic manipulations, displacement of a hernia and infringement of the spinal cord can occur. Before resorting to this technique, it is recommended to consult an orthopedist and neurosurgeon.
- Kinesitherapy. The method is a special case of manual therapy. Its essence lies in the patient making the movements required of him with the help of a treating specialist. Such exposure is potentially dangerous for patients with any type of hernia, as displacement of the damaged disc and pinching of the nerves and spinal cord can occur. The course is 12 sessions. The maximum result can be achieved after 2-3 full courses.
- Cryotherapy. The essence of the treatment method lies in the effect that cold has on the blood vessels. A container with liquid nitrogen is placed on the affected area. After 30-120 seconds, the container is removed from the skin surface. As a result of a sharp effect of low temperature, stenosis of the blood vessels occurs. At the end of the exposure to cold, the vessels expand sharply, providing an inflow of a huge volume of blood. In this way, the nutrition of the affected disc is improved and the regeneration processes are stimulated. Learn more about cryotherapy.
- Hirudotherapy. Otherwise - treatment with leeches. The essence of the method lies in the biological action of leech saliva. Penetrating into the affected area, saliva contributes to the destruction of fragments of the prolapsed nucleus pulposus. In addition, a powerful immune response to a foreign substance is initiated. The blood supply to the affected area is dramatically increased due to minor inflammation. Read more about hirudotherapy.
- Osteopathy. Controversial method of treatment. Its essence lies in the mechanical manipulations of the doctor, aimed at eliminating the pathological changes that caused the development of the hernia. As in the case of manual therapy, as well as with kinesitherapy, treatment is dangerous and can end very badly.
Surgery is a last resort.
Therefore, there are several absolute indications for the operation:
- Disorders of the pelvic organs due to compression of the spinal cord: urinary and fecal incontinence, impotence;
- Strong, prolonged pain syndrome against the background of conservative therapy;
- Paralysis, paresis, movement disorders, muscle tone and sensitivity disorders.
Often doctors insist on surgery even without prior conservative treatment. This is fundamentally wrong. In this way, clinics and doctors profit from patients. It is known that hernias tend to heal on their own, and this is confirmed by the data of numerous studies. For this reason, it is important to find a competent and honest professional.
In order to cure pathology, they resort to the following surgical methods:
- Disc prosthetics. The damaged disc is removed completely, then replaced with an artificial implant;
- Laminectomy (classic). During the operation, a part of the intervertebral arch is removed and the spinal canal is opened. The operation is complex, traumatic and risky, therefore it is used less and less;
- Endoscopic intervention. An endoscope is used to eliminate pathology. The operation is performed without an incision. Access to the affected area is through a puncture. The advantages of the method are low invasiveness and minimal rehabilitation period;
- Microsurgical operation. The essence is the use of miniature surgical instruments at high magnification. It allows removing almost any type of hernia without unnecessary damage to the surrounding tissue.
Read more: All types of hernia repair operations - indications and consequences
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.