Sequestration of herniated disc
Sequestration of a herniated disc is a prolapse of a disc outside the spinal canal. In this case, the nucleus pulposus hangs down from the intervertebral fissure, like a drop. Most often, the sequestration of the hernia leads to the fact that the fibrous capsule ruptures and the nucleus flows out. Damage to the spinal cord and the development of compression myelopathy are not excluded, since the hernia reaches a very impressive size (12 mm or more).
Sequestration of a herniated disc in 80% of cases leads to disability of the patient. Hernia sequestration is the terminal stage of the formation of herniated intervertebral discs according to the Decolux AP classification, which was proposed in 1984 and remains relevant at this point in time.
Depending on the direction in which the sequestration falls out, the following types of hernias are distinguished:
- Anterolateral hernia. In this case, the prolapsed nucleus pulposus is located outside the anterior semicircle of the vertebral body. The sequestrum exfoliates or perforates the anterior longitudinal ligament of the spine, causing neurological symptoms.
- Posterior lateral hernia. Such a hernia exits through the posterior half of the annulus fibrosus.
- Median and paramedian hernia. The first hernia is sequestered along the midline, and the second hernia is located in the immediate vicinity of the midline.
- Foraminal or lateral sequestered hernia. Such a hernia is located on the side of the posterior longitudinal ligament.
Content:
- Reasons for sequestration of herniated disc
- Sequestration symptoms
- Sequestered hernia treatment
Reasons for sequestration of herniated disc
Sequestration of a herniated disc is the result of the destruction of the intervertebral disc, which most often occurs against the background of osteochondrosis.
Possible reasons for the formation of sequestration and prolapse of the nucleus pulposus are as follows:
- Anomalies in the development of the spinal column, including: Klippel-Feil syndrome, fusion of the vertebrae, wedge-shaped vertebrae, etc.
- Excessive stress on the spine.
- Spine injury. Severe bruises of the spine, its fractures and other injuries are dangerous.
- Lifting weights.
- Obesity.
- Intense physical exercise or hard physical work.
- Metabolic disorders. This includes diseases such as diabetes and hypothyroidism.
- Hereditary predisposition.
- Deterioration of the nutrition of the annulus fibrosus due to the presence of bad habits.
- Features of labor activity. At risk for the formation of a sequestered hernia of the spine are motorists, accountants, people working at a computer, etc.
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Curvature of the spine (lordosis, kyphosis, etc.), uneven load on the spinal column, which, for example, can occur with dysplasia of the hip joints.
However, early osteochondrosis is the main risk factor for a sequestered hernia. Due to degenerative-dystrophic changes occurring in the spine, the disc begins to lose moisture. This negatively affects its elasticity. Over time, the disc decreases in height and becomes unable to withstand the loads that are placed on it, namely the increased pressure of the vertebrae. As a result, even minor physical efforts can injure the disc, leading to its displacement with the subsequent formation of a sequestration.
Sequestration symptoms
Symptoms of sequestration of a herniated disc are quite intense, so it is simply impossible not to pay attention to them:
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Patients complain of severe back pain, which they most often characterize as a lumbago. The pain is very intense, they force a person to quickly seek medical help.
- Limb movement is limited. If the hernia is located in the cervical or upper thoracic region, then the arms are affected, and if in the lower back or in the sacrum, then the legs.
- As the disease progresses, paralysis of one or both limbs develops.
- Numbness in the extremities is another symptom indicating sequestration of the hernia.
- On the arm or leg from which the nerve bundle was squeezed, a decrease in temperature is observed. The skin may become drier, or, conversely, there will be increased sweating.
- As the disease progresses, provided that adequate medical care is not provided to the patient, atrophy of the muscle tissue of the affected limb will increase.
- Since the immune system begins to produce antibodies to fight the formed sequestration (the immune system perceives it as a foreign body), symptoms of intoxication will be present. There is general weakness, joint and muscle pain, nausea.
In addition, the symptoms of a sequestered herniated disc largely depend on where it is located: in the cervical, thoracic or lumbar spine. First of all, this concerns the place of localization of pain (in the lower back, in the sacrum, headaches, chest pains). Secondly, different limbs will suffer: arms or legs. Thirdly, there are different complications that provoke sequestered hernias of one or another part of the spine. So, if the pathological focus is located in the lumbar spine, then the patient may develop cauda equina syndrome, and if the hernia is in the cervical spine, then complete paralysis and respiratory arrest are not excluded.
Sequestered hernia treatment
Treatment of a sequestered hernia can be both operative and medication. It will not be possible to definitely avoid surgical intervention if complications develop: radicular syndrome, discogenic myelopathy, vertebral artery syndrome with TIA. However, doctors are in no hurry with surgical intervention, as there are high risks of postoperative complications (bleeding, spinal cord infection, spinal root injury, etc.). As a rule, it is not possible to refuse the operation only in 10-15% of cases, and in 90% of cases, medical correction of the existing disease is possible.
The patient is prescribed muscle relaxants, drugs from the NSAID group, hormonal glucocorticoid agents, vitamin-mineral complexes with an emphasis on vitamins of group B. Drug correction must be supplemented with physiotherapeutic methods, including: UHF, electrophoresis with Novocaine, diadynamic currents.
The prognosis with timely treatment started is favorable, provided that the neurological deficit was quickly eliminated. With prolonged myelopathy, even successful removal of a sequestered hernia will lead to disability of the patient.
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.
