Herniated intervertebral discs are more often manifested in age-related osteochondrosis due to dryness and fragility of the annulus fibrosus. But this is just one of the risk factors. Others include:
- Heavy load on the lumbar region due to overweight.
- Weakness of the muscular apparatus.
- Heredity.
- A sedentary lifestyle and, as a result, constant compression of the vertebral structures.
- Smoking.
- Great physical activity.
According to medical statistics, this disease occurs in men many 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, leading to increased stress on certain areas of the spinal column.
- Dysplasia of the hip joints.
- Chronic diseases, including tuberculosis of the spine, neoplasms, syphilis.
- Metabolic disorders (hereditary and acquired).
All of these factors cause the cartilage and bones of the spine to wear out and weaken. 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 up to 1. 5 mm, but the displacement of the nucleus is not observed.
- Extrusion. The nucleus protrudes beyond the vertebral body.
- Sequestration. The nucleus practically falls out and hangs over the vertebra in the form of a drop. At this stage, there is a risk of rupture of the annulus fibrosus and leakage of fluid secretion.
At 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 on time and treatment is not started, the consequences are possible: paralysis of the legs and serious disorders of the nervous system.
How does a lumbosacral hernia manifest?
An intervertebral hernia can manifest itself with the following symptoms:
- Pain in the lumbar region.
- Pain when walking, radiating 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 analyze the symptoms of the disease more carefully. They can be divided into three groups.
Pain syndrome
Pain with a hernia of the lumbosacral spine is a key symptom. Even at the first stage, there is pain in the area of the damaged disc, especially after injury. They can increase or decrease, and then arise again. More often, the sacral region does not even hurt, but aches, 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 help, getting rid of the problem is easy. It is enough to say goodbye to bad habits and do the physiotherapy exercises recommended by your doctor.
Every 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 manifests itself with physical activity, even insignificant - coughing or sneezing.
Vertebral syndrome
Increased pain in the second stage is accompanied by constant spasms of the back muscles. This leads to even greater discomfort for the patient. He cannot move freely, straighten his back, stretch. The gait of such a person becomes uncertain, he always leans to the side opposite to the patient, slouches.
Due to impaired coordination of movements, the quality of human life deteriorates. He cannot perform well the tasks set at work, 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 off, and blood access to the tissues of the damaged disc is almost impossible. Symptoms characteristic of serious stages of the disease appear:
- Weakening of the leg muscles. The patient cannot squat, stretch, jump. Even climbing the stairs is difficult for him.
- Numbness of the affected area and surrounding areas. The skin becomes insensitive and pale, there is a feeling of goose bumps and tingling. Patients complain of hyperhidrosis in the affected area and legs, or, conversely, excessive dryness of the skin.
- Lumbago. The patient suffers from lumbago in the lumbar region with acute, 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, which leads to posture asymmetry.
- Disruption of the pelvic organs. Urological and gynecological ailments 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.
Diagnosis of pathology
If a person has severe low back pain, he needs to make an appointment with a neurologist. He will conduct an examination with medical tests:
- Identification of reflexes from the tendons of the lower extremities.
- Leg lift testing.
- Determination of sensitivity to heat or cold, pain and vibration 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 picture 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 additionally prescribed. With the help of these studies, the doctor will determine whether an urgent surgical intervention is necessary.
Herniated disc 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 aimed primarily at relieving pain and alleviating the patient's condition.
What pharmaceuticals can a doctor prescribe:
- Medicines that relieve pain and inflammation. In case of exacerbation - in the form of injections. When the acute pain is relieved (usually three to four days are enough), oral medications with a similar effect are prescribed.
- Novocaine blockade with the addition of corticosteroids. A similar method is able to stop pain for two weeks at once. Usually, a course of blockages is carried out with injections into different parts of the damaged disc.
- Muscle relaxants of central action. They reduce muscle activity by relieving pain cramps.
- Vitamin-mineral complexes with an emphasis on the elements of group B. They slightly relax muscles, help tissue regeneration and conduction of nerve impulses.
After relief of the pain syndrome, the intake of pharmaceuticals decreases. Treatment of the disease is due to physical therapy and physiotherapy.
Physiotherapy treatment methods are also selected depending 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 permissible only if there is no pain syndrome. A more effective physiotherapy treatment is manual therapy with post-isometric relaxation.
Doctors strongly recommend smoking patients to give up cigarettes.
Nutritional adjustments are also important, especially for overweight patients. Fatty, savory dishes, sweets, and alcohol will have to be excluded from the menu. A sparing diet with an abundance of vegetables and fermented milk products will help the body to better endure the treatment, as well as get rid of the pounds that weigh on the back.
Surgical intervention
Conservative treatment usually lasts about two months. If it does not give the desired result, a decision is made to change the therapeutic tactics or to perform surgery. The latter is prescribed for severe pain, loss of sensitivity of the legs, dysfunctions of the pelvic organs. Depending on the complexity of the situation, the operation is done in the following ways:
- Endoscopic method. Three micro-incisions are made in the affected area. A camera is introduced into one for broadcasting to the monitor. Through the other two, the protrusion of the hernia is removed using miniature instrumentation.
- By the method of percutaneous discectomy. The damaged nucleus is removed through a puncture in the vertebral disc and replaced with an artificial substance.
- By laser reconstruction. It is carried out in the form of punctures using a special needle without dissecting tissue. Laser radiation heats up the disc structures and stimulates cell regeneration, as well as relieves pain.
In difficult cases, endoprosthetics of the vertebral discs is possible - replacing the injured organ with an implant.
After complex surgical interventions, rehabilitation will be required. The operated person will have to wear a corset and will not be able to take a sitting position for about three months. Further rehabilitation period involves the practice of therapeutic gymnastics and physiotherapy.
Preventive techniques
Like any other ailment, herniated discs are easier to prevent than to cure. What you need to do to keep your spinal discs healthy:
- Calculate loads accurately if your job 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, then there is a risk of getting a spinal hernia only as a result of an accident.
A herniated disc is dangerous with serious consequences, and the treatment of advanced cases is very long. To avoid surgery and complications, if you have painful sensations in the back, you should see a neurologist.
Osteochondrosis
The term osteochondrosis itself is derived from two words: osteo - bone, and chondrue - cartilage. Simply put, it is cartilage ossification. Although this interpretation is fundamentally wrong. Some in their delusions go even further, and are confident that osteochondrosis is the deposition of salts in the joints. Moreover, it is table salt that is supposedly eaten in large quantities.
Pathogenesis
In reality, everything happens a little differently. And harder. And table salt, if it plays any 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 noted almost anywhere where there is connective cartilage tissue.
Still, osteochondrosis in the overwhelming case affects the spine. Why is that? 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 an annulus fibrosus and an upper and lower endplate.
The disc undergoes tremendous mechanical stress, leading to permanent damage to its structures at the cellular level. In humans, these processes are too pronounced - this is our payment for upright walking. To prevent the disk from being completely "erased", it must be constantly regenerated, that is, 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 are overgrown 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.
Because of this, the intervertebral discs are easily injured in the anatomical and physiological terms. Any negative process in the body leads to an imbalance in damage-regeneration, and to the development of dystrophy and degeneration in the discs. A structurally defective disc is no longer able to withstand the proper mechanical stress. Under excessive pressure from the overlying vertebrae, the discs are displaced in different directions, usually to the sides and posteriorly. This process is called disc herniation.
The bone tissue of the vertebrae, which has lost its cartilage lining, also undergoes mechanical wear. Due to constant trauma on the anterior edge surface 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 infringed in the so-called. foraminal holes.
Causes
The causes, or etiological factors, of osteochondrosis are diverse. They can be both local, i. e. caused by the pathology of the spine itself, and general disorders at the organismal level. Any pathology leading to a violation of the structure of the spinal column or to metabolic disorders can be considered as 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 inadequate absorption of nutrients from the gastrointestinal tract
- Heredity.
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, on the contrary, excessive physical exertion.
Symptoms
Osteochondrosis itself is an asymptomatic process. And at the same time, the signs of intervertebral disc degeneration are diverse. How so? The fact is that the clinical manifestations of osteochondrosis are based on its complications - disc hernias, spondylosis, sciatica, narrowing of the spinal canal.
Moreover, the clinic is very 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 takes on the maximum physical activity. Signs of osteochondrosis of the lumbosacral region:
- Pain (lumbodynia, lumbago, sciatica)
- Restriction of movement in the lower back and lower extremities (intermittent claudication)
- Here, sensitivity disorders of the type of paresthesia - numbness, burning, creeping
- Pathological tension of the lumbar muscles
- In the absence of treatment, disorders of 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 (cervicalgia), decreased sensitivity and movements in the upper extremities, cervical osteochondrosis due to impaired blood supply to the brain has its own characteristics. These features are manifested:
- Insomnia
- Headache, dizziness
- Periodic nausea
- General weakness, rapid fatigability
- Fluctuations in blood pressure
- Occasionally toothache
- Behavioral reactions in the form of tearfulness, irritability.
The thoracic region with osteochondrosis is affected relatively rarely. Patients in this case are persons 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:
- Pain and paresthesia in the chest
- Dyspnea
- Feeling of heartbeat
- Restriction of movement in the thoracic spine.
Diagnostics
From all this it is clear that osteochondrosis is a chameleon disease. Due to the similarity of 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 in order to correctly determine the symptoms and treatment of osteochondrosis.
This diagnosis, in addition to the traditional questioning and clarification of patient complaints, should include a medical examination and special research methods. These methods include X-ray of the spine, ultrasound of internal organs. Recently, computed and magnetic resonance imaging have been successfully used to diagnose osteochondrosis.
Treatment
Therapeutic tactics for osteochondrosis involves the use of:
- Medicines
- Massage
- Physiotherapy procedures
- Physiotherapy (exercise therapy)
- Manual therapy
- Acupuncture.
Medication for osteochondrosis is mainly aimed at pain relief and at the elimination of 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. By doing this, they can aggravate metabolic disorders in osteochondrosis. They relieve the pain of blockade 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 at the local and body level 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 most preferred. Indeed, contrary to some erroneous statements, the basis of osteochondrosis is not an excess, but just a deficiency of Calcium.
After successfully relieving exacerbation, physiotherapy, massage, and exercise therapy are shown. As physical procedures, electrophoresis with calcium, phonophoresis with hydrocortisone, amplipulse, paraffin therapy are used. 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 depending on the localization of osteochondrosis. The expansion of the range of motion is achieved with the help of exercise therapy. At the beginning, in the exacerbation phase, there are practically no dynamic loads. The patient is constantly in an optimal posture. At this time, it is desirable to wear immobilizing devices - a lumbar corset, Shants' neck collar. As the exacerbation is removed, the volume and duration of movements during exercise 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 ears, on the hands and on the feet. With manual therapy, the normal position of the vertebrae and intervertebral discs is restored through the manual action of a specialist's hands. And in the course of osteopathy, the structural integrity of the musculoskeletal system is ensured using specific techniques. In the absence of the effect of conservative measures for the treatment of osteochondrosis, persistent pain, complications, surgery is indicated. The pathologically displaced disc is removed. Currently, for this purpose, microdiscectomy is performed - endoscopic removal of a displaced disc.