Intervertebral disc herniation occurs more often with age-related osteochondrosis due to the dryness and fragility of the annulus fibrosus.But this is only one of the risk factors.Others include:
- Heavy load in the lumbar region due to excess weight.
- Muscle weakness.
- 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 many times more often in men than in women.
What are the most common causes of the disease:
- Injuries from road accidents or falls.
- Lifting heavy objects with improper load distribution.
- Scoliosis or lordosis, which leads to increased stress on certain areas of the spine.
- Hip dysplasia.
- Chronic diseases, including spinal tuberculosis, neoplasms, syphilis.
- Metabolic disorders (hereditary and acquired).
All these factors cause wear and tear of the cartilage and bones of the spine.And this is the main cause of intervertebral hernia.
Stages of disease development
Without proper treatment, the disease progresses, and the condition of the damaged spinal discs deteriorates.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 extend beyond the vertebral body.
- Lumbar protrusion.The edge of the disc extends beyond the vertebral body by no more than 1.5 mm, but no displacement of the nucleus is observed.
- Extrusion.The nucleus extends beyond the vertebral body.
- Sequestration.The nucleus practically falls out and hangs in the shape of a drop above the vertebra.At this stage, there is a risk of rupture of the annulus fibrosus and leakage of liquid secretions.
In the first stage of the disease, almost nothing bothers a person;sometimes there is pain in the lower back, but it goes away quickly.As the disease progresses, the state of health also deteriorates, 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 serious disorders of the nervous system.
How is a lumbosacral hernia manifested?
Intervertebral hernia can manifest itself with the following symptoms:
- Pain in the lumbar region.
- Pain when walking that radiates to the thigh area.
- Numbness in areas on the surface of the feet, fingers, lower legs and thighs.
- Heaviness in the legs.
- Stiffness of movements.
In order not to delay seeking medical help, it is worth analyzing the symptoms of the disease more thoroughly.They can be divided into three groups.
Pain syndrome
Pain associated with herniation of the lumbosacral spine is a key symptom.Already in the first stage, pain appears in the area of the damaged disc, especially after an injury.They may wax or wane and reappear.Most often, the sacral region does not hurt, but hurts, especially during physical activity or prolonged sitting.If a person lies on his healthy side and bends his leg, the pain subsides completely.This condition can last for several months.
If you seek medical help in time, it is not difficult to get rid of the problem.It is enough to say goodbye to bad habits and do the physical therapy recommended by the doctor.
Every day the affected area grows and the condition of the disc tissue deteriorates.The transition to the second stage of the disease is indicated by increased pain.It is now not only felt in the sacrum region, but covers the entire lower back, radiating to the neck region, individual spinal muscles, buttocks, thighs, legs, feet and toes.Discomfort is manifested by physical activity, even minor - coughing or sneezing.
Spinal syndrome
The 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 or stretch.Such a person's gait becomes unsteady, he constantly bends and bends in the opposite direction to the patient.
A person's quality of life deteriorates due to impairment of movement coordination.He cannot perform his work tasks well, active rest becomes unreal due to the constant pain.
Radicular syndrome
If the hernia is left unattended by doctors, the progressive disease leads to the 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 or jump.He even has trouble walking up the stairs.
- Numbness of the affected area and nearby areas.The skin becomes insensitive, pale, goosebumps and a tingling sensation appear.Patients complain of hyperhidrosis in the painful area and on the legs, or, on the contrary, excessive dryness of the skin.
- Lumbago.The patient suffers from shooting in the lumbar region with acute, sharp pain that increases with every movement.Without treatment, it leads to the destruction of the hip and knee joints.
- Noticeable thinning of the affected leg, leading to asymmetry of posture.
- Disturbance of the pelvic organs.Urological and gynecological diseases worsen, libido ceases, diarrhea and urinary incontinence are possible.
In the case of severe spinal hernia, there is a risk of paralysis, disability and even death.
Diagnosis of pathology
If a person has severe lower back pain, they should make an appointment with a neurologist.He will carry out an examination with medical tests:
- Detection of reflexes from the tendons of the lower limbs.
- Leg lift test.
- Determination of heat or cold sensitivity, pain and vibration in the legs, thighs, buttocks, abdomen and back.
After that, the doctor refers the patient to an MRI or CT scan of the lumbar region.With the help of tomography techniques, we get a three-dimensional image of the affected area.It can be used to determine the location and size of the hernia, as well as the stage of the disease.
If there is a risk of damage to the spinal cord, electromyography, neurography and contrast myelography are also prescribed.With the help of these tests, the doctor decides whether urgent surgery is necessary.
Treatment of intervertebral hernia
Vertebral hernia is treated with conservative and surgical methods.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 primarily aimed at alleviating pain and alleviating the patient's condition.
What medicines can the doctor prescribe:
- Medicines to relieve pain and inflammation.In case of exacerbation - in the form of an injection.When the acute pain subsides (usually three to four days is enough), oral drugs with a similar effect are prescribed.
- Novocaine blockades with the addition of corticosteroids.This method can relieve pain for two weeks at a time.Usually, a blockade is performed with injections into different areas of the damaged disc.
- Centrally acting muscle relaxants.They reduce muscle activity and relieve painful cramps.
- Vitamin and mineral complexes, with particular attention to B group elements.They slightly relax the muscles, help the regeneration of tissues and the conduction of nerve impulses.
After pain relief, the use of medication decreases.The disease is treated with physical therapy and physiotherapy.
Physiotherapy treatment methods are also selected depending on the patient's condition.It could be:
- Treatment with heat or electricity.
- Electrophoresis with anti-inflammatory drugs.
- Acupuncture and acupressure.
- Hirudotherapy.
- Hydromassage.
Regular massage is allowed only in cases where there is no pain syndrome.A more effective physiotherapy treatment is manual therapy with postisometric relaxation.
Doctors strongly advise patients who smoke to quit smoking.
Nutritional correction is also important, especially for overweight patients.You should exclude fatty, salty foods, sweets and alcohol from the menu.A gentle diet with plenty of vegetables and dairy products helps the body to better tolerate the treatment and to get rid of the kilograms burdening the back.
Surgical intervention
Conservative treatment usually lasts about two months.If it does not give the desired result, then a 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 and dysfunction of the pelvic organs.Depending on the complexity of the situation, the operation is carried out in the following ways:
- Endoscopic method.Three microincisions are made in the affected area.A camera is inserted into one to broadcast to the monitor.After the other two, the protrusion of the hernia is removed with miniature instruments.
- With percutaneous discectomy.The damaged core is removed through a puncture in the disc and replaced with an artificial material.
- With laser reconstruction.They are performed in the form of punctures using a special needle without cutting the tissue.Laser radiation heats the intervertebral disc structures and stimulates cell regeneration, as well as having an analgesic effect.
In difficult cases, disc replacement is possible - replacement of the damaged organ with an implant.
Rehabilitation will be necessary after complex surgical interventions.The operated person must wear a brace and cannot assume a sitting position for about three months.The further rehabilitation period includes therapeutic exercises and physiotherapy.
Preventive techniques
Like any other disease, intervertebral hernia is easier to prevent than to treat.What you should do to keep your discs healthy:
- Calculate the loads accurately if your work involves them or if you are a professional athlete.
- Adequate body weight (index cannot exceed 30).
- Choose a good mattress so that you can sleep in the right position (preferably on your back).
- Engage in gentle exercise, swimming, fitness.
- In the morning exercises, include exercises to strengthen the muscular ligament of the spine.
- Quit smoking.
- Eat well.
If following these rules becomes a habit, then there is a risk of vertebral hernia only as a result of an accident.
Disc herniation has serious consequences, in advanced cases the treatment is very long.In order to avoid surgical intervention and complications, if you experience back pain, you should consult a neurologist.
Osteochondrosis
The term osteochondrosis itself comes from two words: osteo - bone and chondr - cartilage.Simply put, it is the ossification of cartilage.Although this interpretation is fundamentally wrong.Some people go even further in their misconception and are sure that osteochondrosis is the deposition of salts in the joints.In addition, table salt is deposited, it is said to be consumed in large quantities in food.
Pathogenesis
In reality, everything happens a little differently.And even harder.And table salt, if it plays any role in the occurrence of osteochondrosis, is very indirect.Osteochondrosis is based on dystrophy and degeneration of articular cartilage.It is not an independent disease, but a pathological process that can occur almost anywhere where there is connective tissue.
But still, osteochondrosis affects the spine in most cases.Why is this so?The fact is that there are special spacers between the vertebrae - 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 inner fluid nucleus pulposus surrounded by annulus fibrosus and superior and inferior endplates.
The disc is exposed to enormous mechanical stress, which leads to permanent damage to its cellular structures.In humans, these processes are too pronounced - this is the price we pay for walking straight.In order to avoid completely "erasing" the disk, it must be constantly regenerated, i.e. reset.The balance of damage-regeneration processes determines the normal structure of the intervertebral disc.Another interesting detail is that the discs are supplied with blood and nutrients not through the overgrown blood vessels in childhood, but diffusely, from the bone tissue of the vertebral bodies.Again, the price is for the ability to move on two rather than four limbs.
Because of this, the intervertebral discs are easily damaged from an anatomical and physiological point of view.Any negative process in the body leads to disruption of the damage-regeneration balance, dystrophy and degeneration of the discs.A structurally defective disc can no longer withstand the appropriate mechanical load.Overpressure on the overlying vertebrae causes the discs to move in different directions, usually sideways and backwards.This process is called a herniated disc.
The bone tissue of the vertebrae, which has lost its cartilage cushion, is also subject to mechanical wear.As a result of constant trauma, pathological bone growths - osteophytes - develop on the anterior marginal surface of the vertebral bodies.Spondylosis develops.Due to the degeneration and displacement of the disc, the intervertebral spaces narrow, the spinal canal narrows, and the roots of the spinal nerves in the so-called spinal nerves are pinched.foraminal openings.
Reasons
The causes or etiological factors of osteochondrosis are varied.They can be local, i.e. they can be caused by the pathology of the spine itself or by general disorders at the organizational level.Any pathology that leads to disruption of the structure of the spinal column or metabolic disorders can be considered a cause of osteochondrosis.In this regard, we highlight the following:
- Change in the configuration of the spine (scoliosis, pathological lordosis or kyphosis)
- Other defects of the locomotor system - flat feet, narrow shoulder girdle, abnormalities of the pelvic structure
- Spinal injuries
- Weak immunity
- Metabolic disorders - osteoporosis, obesity, diabetes mellitus, thyroid disease
- Diseases of the cardiovascular system - arteriosclerosis, high blood pressure
- Digestive disorders that lead 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, poor nutrition, a sedentary lifestyle, or, on the contrary, excessive physical exertion.
Symptoms
Osteochondrosis itself is an asymptomatic process.At the same time, the signs of degeneration of the intervertebral disc are varied.How?The fact is that the clinical manifestations of osteochondrosis are based on complications - disc herniation, spondylosis, radiculitis, narrowing of the spinal canal.
In addition, the clinical picture is very variable depending on the predominant localization of the process in the cervical, thoracic or lumbosacral spine.Most often, the last section is affected, since the lower back takes the maximum physical load.Signs of osteochondrosis of the lumbosacral region:
- Pain (lumbodynia, lumbago, sciatica)
- Limited movement in the lower back and lower limbs (intermittent hiccups)
- There are also sensory disturbances such as paresthesia - numbness, burning, crawling
- Abnormal tension of the lumbar muscles
- In the absence of treatment - dysfunction of the pelvic organs.
Cervical osteochondrosis is observed somewhat less often than lumbosacral osteochondrosis.However, this pathology often occurs.In addition to the characteristic signs of pain (cervicalgia), reduced sensitivity and movement of the upper limbs, cervical osteochondrosis, which develops due to damage to the blood supply to the brain, also has its own characteristics.These properties are manifested:
- Insomnia
- Headache, dizziness
- Intermittent nausea
- General weakness, fatigue
- Fluctuations in blood pressure
- Occasional toothache
- Behavioral reactions in the form of tearing, irritability.
The chest region is relatively rarely affected by osteochondrosis.The patients in this case are people who, due to their occupation, are forced to sit in a fixed, uncomfortable position - students, schoolchildren, programmers, office workers.The symptoms of osteochondrosis in this case are as follows:
- Pain and paresthesia in the chest
- Shortness of breath
- Sensation of heartbeat
- Restriction of movement of the thoracic spine.
Diagnostics
It is clear from all this that osteochondrosis is a chameleon disease.Due to the similarity of the symptoms, it can easily be confused with cerebrovascular accident, high blood pressure, heart attack, angina pectoris and neurotic disorders.That is why, in order to make the correct diagnosis, a comprehensive, comprehensive diagnosis is needed to correctly determine the symptoms and treatment of osteochondrosis.
In addition to the traditional assessment and clarification of the patient's complaints, this diagnosis should also include a medical examination and special research methods.These methods include radiography of the spine and ultrasound of internal organs.Recently, computer and magnetic resonance imaging have been successfully used to diagnose osteochondrosis.
Treatment
The therapeutic tactics of osteochondrosis include:
- Medicines
- Massage
- Physiotherapy procedures
- Therapeutic physical education (physiotherapy)
- Manual therapy
- Acupuncture.
Medicinal treatment of osteochondrosis is primarily aimed at alleviating pain and eliminating the inflammatory processes of the nerve roots.NSAID drugs are used for this purpose.In various combinations, these drugs are widely used in the form of ointments, injections and tablets for the treatment of osteochondrosis.It should not be forgotten that these drugs negatively affect the liver, stomach and intestines.This can aggravate metabolic disorders in osteochondrosis.Blockades with local anesthetics relieve pain well.True, the effect of these drugs is short-lived and does not affect osteochondrosis as a whole in any way.
It is possible to improve metabolic processes at the local and organizational level with the help of drugs such as chondroprotectors, immunostimulants, and vitamins and minerals.Chondroprotectors are used in tablets, ointments and ampoules.Among the general strengthening agents, vitamin C and group B are used in combination with minerals.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 precisely a lack of calcium.
After successful removal of the exacerbation, physiotherapy procedures, massage and exercise therapy are recommended.Electrophoresis with calcium, phonophoresis with hydrocortisone, amplipulse and paraffin treatment are used as physical procedures.All these measures are aimed at eliminating pain and inflammation of nerve roots, ligaments and muscles.Osteochondrosis massage is performed according to generally accepted methods.The massage area is selected depending on the location of osteochondrosis.Expanding the range of motion can be achieved with the help of movement therapy.Initially, there is practically no dynamic load in the acute phase.The patient is constantly in an optimal position.At this time, it is advisable to wear immobilizing devices - lumbar corset, Shants neck collar.As the exacerbation decreases, the amount and duration of movements during physical therapy sessions increases.
Recently, non-traditional treatment methods are used in the treatment of osteochondrosis - acupuncture, manual therapy, osteopathy.Acupuncture affects special biologically active points located along the spine, ears, hands and feet.With manual therapy, the normal position of the vertebrae and intervertebral discs is restored by the hands of the specialist.During osteopathy, special techniques are used to ensure the structural integrity of the locomotor system.In the absence of the effect of conservative measures for the treatment of osteochondrosis, persistent pain and complications, surgical intervention is required.The abnormally displaced disc is removed.Currently, microdiscectomy is performed for this purpose - endoscopic removal of the displaced disc.