Spinal hernia: symptoms, causes, diagnosis and effective treatment of intervertebral hernia

A coccygeal hernia is an inflammatory-degenerative pathology of the lower spine, formed by 4-5 fused rudimentary (lost functional significance in the process of evolution) vertebrae and shaped like a curved pyramid. Hernias of this type are rarely diagnosed, since the coccygeal vertebrae are the strongest part of the spine, and the main factor in their deformation is various injuries and injuries. In complicated cases, a coccyx hernia can be combined with spina bifida - a congenital anomaly of the axial skeleton, in which protrusion of the bone marrow occurs outside the spinal canal.

Pilonidal hernia

What is a herniated disc?

Spinal hernia is a painful disease. When it occurs, the integrity of the outer shell of the intervertebral disc, the fibrous ring, is disrupted. Instead of elastic fibers, scar tissue forms. The intervertebral discs are displaced relative to their usual position. The nuclei of the intervertebral disc begin to protrude into the spinal canal. Protrusions can be in both directions, or only on the right or left side.

If left untreated, the annulus fibrosus ruptures. The core fluid enters the spinal canal and compresses the nerve endings. In advanced stages of the disease and lack of timely assistance, a hernia leads to complete loss of mobility.

Most often, a herniated disc affects the lumbosacral region. 65% of all hernias are hernias in the lumbar and sacrum areas. Thoracic hernia is also quite common. Less often, when a hernia is detected, lesions concern the cervical spine and coccyx. They account for about 5-6% of all cases of spinal hernia.

The main functions of the coccyx

Coccydynia is most often observed in women 40-60 years old. Desiring is also diagnosed in children and boys. It is difficult to find a clear location of the source of pain in coccydynia. Feelings radiate to the rest of the body.

The functions of the coccyx are:

It is attached to the sacral part of the spine using a fixed joint. This fixation allows the bones to move apart during labor in a woman.
Muscles and ligaments are attached to the front part of this bone, which are involved in the functionality of certain parts of the genitourinary system and the large intestinal tract.
In the presented area there is a large number of nerve endings that extend to the internal organs. Therefore, we can talk about the vagueness of symptoms.

Why does the disease occur?

The following reasons lead to the occurrence of the disease:

Static overloads , i.e. overloads that are associated with prolonged stay in one position. Moreover, both sitting and standing poses are equally harmful. The greatest occupational risks are experienced by assembly line workers, drivers, seamstresses, and shoe assemblers.
Dynamic overload associated with lifting weights. Loaders, slingers, miners, metal cutters, stampers, pressers and masons are especially susceptible to them. The work performed by personnel in these specialties especially contributes to the protrusion of intervertebral discs in the lumbar region.
Genetic predisposition and individual anatomical features of the structure of endplates on the vertebrae. In this case, most often the patient is diagnosed with a hernia between the 1st and 3rd lumbar vertebrae or the 11th and 12th thoracic vertebrae.
Injuries. Fractures, bruises of the spine, subluxations of individual vertebrae. This is due to the fact that with a fracture or bruise of the spine, the surrounding tissues suffer, scars and adhesions form, and with subluxations, the vertebrae are displaced. In addition, with subluxations in most cases the size of the intervertebral foramina decreases. All conditions are created for the formation of hernias in the lumbar and neck areas.
Presence of osteochondrosis . If left untreated, the cartilage tissue quickly depletes, the intervertebral space decreases, and the outer shell of the intervertebral disc ruptures. Especially often, against the background of osteochondrosis, a hernia of the lumbosacral spine develops.
Presence of scoliosis. The danger of scoliosis is that the spinal column is not just curved, it is deformed. Scoliosis especially contributes to the progression of hernias in the thoracic spine.
Unbalanced diet . Lack of nutrients for the body is a blow to muscle and cartilage tissue and the direct cause of dystrophy.
Excess body weight . Excess body weight is especially dangerous for the lumbar region. Extra pounds place excessive pressure on the lower back. It leads to deformation of the vertebrae, and an intervertebral hernia appears in the lumbar region.

Clinical picture: primary and secondary symptoms

The main symptom of a coccygeal hernia in patients of any age is pain in the coccyx area (coccydynia). It can have varying intensity and be combined with painful sensations in the anus and perineum (anorectal pain).

Changes in body position, bending, and turning are rarely associated with coccydynia. Only 35% of patients experience increased pain after prolonged sitting with support on the tailbone, and the sensations themselves become more intense when getting up from a chair or sofa.

It should also be noted that the pain with a coccyx hernia is stronger if a person has been sitting on a hard surface for a long time, so patients with this pathology often place a soft pillow under the buttocks, which allows them to slightly reduce the intensity of the pain syndrome.

Other possible symptoms of a pilonidal hernia may include:

false urge to have a bowel movement, combined with severe cramping or aching pain in the central part of the abdomen (tenesmus);
stool disorder (can manifest itself as causeless diarrhea or prolonged constipation);
sharp pain during bowel movements;
spasms in the perineal area, in which pain often radiates to the anus;
painful urination (rare symptom).

When pressing on the tailbone area, the patient also experiences pain, the severity of which depends on the size of the hernia, the degree of degeneration of the cartilage tissue and the presence of local inflammatory processes.

Secondary signs

Secondary symptoms of a coccygeal hernia are associated with the development of local complications, the most common of which is a fistulous (epithelial) tract, which can also be called a coccygeal cyst.

The formation of a fistula occurs as a result of inflammation and thickening of the epithelium and leads to the accumulation of purulent exudative fluid. If the patient does not receive treatment at this stage, multiple fistula tracts may form, which are easily infected and are a source of pathogenic microorganisms.

Bacteria, entering the systemic bloodstream, can cause an acute inflammatory reaction (sepsis) - a life-threatening condition with a high risk of mortality.

Secondary symptoms of a coccygeal hernia can be represented by the following signs:

behavioral changes (aggression, tearfulness, anxiety, irritability);
headaches turning into dizziness;

With purulent inflammation of the surrounding tissues, the patient's temperature rises (within 38°C-38.5°C), and signs of systemic intoxication may appear: nausea, lack of appetite, drowsiness, lethargy, and rarely vomiting.

Symptoms of a vertebral hernia

Symptoms of a vertebral hernia are divided into two types - general (they can bother the patient if there is a hernia in any part of the spine) and local - indicating a problem in a specific area of the spine: thoracic, cervical, etc.

Common symptoms are pain in the spine or part of it, aggravated by physical activity and relieved by immobile rest, a feeling of severe muscle tension and burning of the skin. Many patients also complain of a crawling sensation and swelling.

Local are symptoms indicating a problem in a specific area (neck, lower back, tailbone).

Symptoms of a hernia in the cervical spine

The most common symptoms of a hernia in the cervical spine are:

Unpleasant sensations, a feeling of squeezing in the neck, in some cases - the appearance of protrusions on the neck.
Severe headaches, especially pulsating in the temporal and occipital regions.
Dizziness caused by compression of the vertebral artery and accompanied by tinnitus, double vision.
Weakness and feeling of lack of oxygen. With problems in the cervical region, there really is not enough oxygen. The hernia creates obstacles on its way to the brain.
Increased blood pressure, accompanied by headaches.

If osteochondrosis has already been diagnosed, and a person may not see a doctor, he may think that he has an exacerbation of osteochondrosis, but the classic treatment regimen for osteochondrosis with a hernia is ineffective.

Symptoms of a hernia in the lumbosacral region

Numbness extending from lower back to thighs.
Sharp, shooting pain in the lower back when lifting loads.
Problems with urination (sometimes incontinence, sometimes urinary retention).
Weakness in the legs, a feeling that “the legs are not listening,” paralysis (with advanced hernias).

Very often, with hernias in the lumbosacral region, a person says: “I tore my back.” This is how it feels.

Symptoms of a hernia in the thoracic region

What distinguishes a hernia in the thoracic region?

Burning and pain in the chest; many patients feel like their heart is hurting.
Pain in the shoulder blades that gets worse during fast walking, walking up stairs and other movements that require deep, intense inhalations and exhalations. With them, shortness of breath also increases.
Deterioration of the thyroid gland.
Unpleasant sensations in the abdominal area,
Loss of sensitivity of the skin in the area of the shoulder blades and below.

Symptoms of a coccyx hernia

The symptoms of a coccyx hernia are less pronounced compared to the symptoms of a hernia in other parts of the spine. Very often she did not show herself at all. It happens that a person is injured, he develops a hernia, but the person does not even suspect it, and only in certain circumstances (for example, when sitting on a hard surface) does tailbone pain appear.

In women, a coccyx hernia can occur during painful sensations during pregnancy, childbirth, and the postpartum period.

Often the symptoms of a coccyx hernia are very close to intestinal diseases, hemorrhoids. There is pain in the anal area, there are problems with stool (severe constipation or alternation of constipation and loose stools).

Any of the above signs requires immediate medical attention and diagnosis.

Symptoms of coccygeal hernia

The formation of a false course of the coccyx is possible due to the melting of cartilage and bone tissue.
Next, the epithelium thickens, becomes red and painful.
The subcutaneous discharge of pus that appears contributes to the opening and subsequent development of the fistula.

A long process often leads to the opening of a large number of fistulas directly into the scrotum, genitals, perineum, and anterior abdominal wall.

Dizziness, mainly associated with mental disorders.
Irritability, changes in rest and sleep patterns, anxiety, restlessness.
Disorders of the musculoskeletal system due to the spread and transition of the infectious process to the pelvic area, in particular to the hip, sacroiliac and sacrococcygeal joints.
The appearance of arthrosis due to a long-term inflammatory process in the patient’s body; as a result of this, the axis of the distal parts of the spine shifts and the normal load is redistributed on some joints; Because of this, many women lose the ability to give birth, and some patients experience changes in their gait.
The inflammatory process in the sacrum-coccyx area causes reflex irritation of the bladder and rectum. Because of this, patients experience a violation of the exit of substances from the body (urination, defecation).

Thus, with this pathology, there is no prolapse of the cartilage disc with compression of the spinal cord, as in the lumbar region. The structure of the coccygeal discs is rougher and is not designed to perform a shock-absorbing function.

Rupture of the coccygeal cartilages most often occurs mechanically (trauma, childbirth). In terms of frequency, inflammatory diseases of the pelvis and metabolism (Bechterew's disease, tuberculosis) are in second place.

Other causes of pathology include large pelvic cysts, chronic bladder diseases, and even spasms of the gluteal muscles. These diseases are only provoking factors that weaken the functionality of the sacrococcygeal spine. To form a coccyx hernia, external influence is necessary.

Symptoms of coccydynia are not always a sign of damage to the coccygeal intervertebral disc. They may be due to:

Diseases of the genital organs;
Spasm of the muscles of the gluteal region;
Diseases of the rectum;
Renal pathology.

Only an X-ray examination of the coccygeal vertebrae or magnetic resonance imaging will help to qualitatively differentiate between the pain syndrome caused by a coccyx hernia and other diseases.

Acute signs of pathology appear immediately after a traumatic impact on the sacrococcygeal region. In other cases, people may not know about the presence of pathology throughout their lives. It reminds itself only when sitting on a hard surface or during childbirth, when severe pain occurs as the child passes through the pelvis.

Changes in the mental sphere are accompanied by autonomic disorders (dizziness, feeling of fever without elevated temperature, coldness of the extremities). A person's sleep patterns are disrupted, anxiety and restlessness appear. Often, against the background of coccydynia, migraine (severe localized headache due to vasoconstriction) intensifies;
Changes in the musculoskeletal system occur during the disease due to infection of the damaged disc, as well as the spread of the process to the hip, sacroiliac and sacrococcygeal joints. Arthrosis forms, the cause of which, as a rule, remains unclear to doctors.

Against the background of a displacement of the coccyx axis, the load on the sacral and pelvic joints is redistributed, which changes the person’s walking pattern. Deformation of the pelvic ring makes it impossible for women to give birth naturally;

Pathology of the intestines, reproductive and urinary systems leads to disturbances in defecation, urination and sexual disorders. These disorders are recurrent in nature (periodically appear and disappear).

Diagnostics

When hernias appear, a comprehensive diagnosis is important. The sooner the diagnosis is made and treatment is started, the lower the risk of complications such as the formation of fistulas and immobilization of the spine.

Diagnosis of spinal hernia is based on several stages. What does it include?

Examination by a doctor. Oral interview with the patient. For an accurate diagnosis, an accurate picture is important - when the symptoms of the disease appeared, what the nature of the pain is, and whether there are other concomitant diseases.
Assessment of skin sensitivity, motor activity. The doctor palpates the neck, back, chest, lower back, sacrum, and coccyx. Next, the patient is asked to perform a series of movements: raise his leg in a supine position, bend over, squat, etc.
Magnetic resonance imaging . The doctor receives information about the structure of the tissues and sees protrusions of the intervertebral disc membrane.

The radiographic diagnostic method is informative for determining the position of bones and identifying the causes of hernias. It is indicated for almost all patients with symptoms of a spinal hernia - except for pregnant women, as well as patients with bleeding and severe pathologies. X-rays are especially important for patients with hernias resulting from trauma.

Many patients are interested in why both radiography and computed tomography are prescribed for diagnosis. The fact is that these types of diagnostics complement each other well, and each of them is the most effective for achieving its goals. An X-ray allows you to get the most complete picture of the condition of the vertebrae and intervertebral discs, while tomography allows you to study the condition of the soft tissues of the spine (including muscles and ligaments).

X-ray computed tomography (XCT) allows you to combine X-ray and tomographic examination in one procedure. In Minsk, RCT of the spine is available at the 5th Clinical Hospital. The hospital's modern equipment allows specialists to carry out detailed post-process data processing and obtain three-dimensional volumetric reconstructions. Based on them, doctors can accurately diagnose and predict which treatment will be most effective.

Healing pathology

A coccyx hernia does not show symptoms right away. It may not cause discomfort for many years. The fact is that when the hernia is localized, traditionally the spinal cord and nerve roots are not tormented. In addition, the coccygeal spine does not experience vertical overloads. Such individualities lead to the fact that an existing hernia appears only at moments of specific action on the tailbone.

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For a long time, a coccygeal hernia can produce symptoms only in certain situations, for example, when a person sits on a hard surface. Women may experience intense pain at the end of pregnancy and during childbirth. Pain syndrome in the coccyx area is called coccydynia. Its constant manifestations appear after injury.

Pain in the coccyx,
Pain in the intestine, perineum,
Dysfunction of the bladder and intestinal tract.

The pain syndrome can be so severe that it usually prevents you from falling asleep at night and does not go away completely even after taking painkillers. This prevents a person from remaining active and changes his lifestyle.

Inflammation in the coccyx area develops quite rapidly due to the weak blood supply to the given area. For this reason, damage can be significant and lead to the melting of tissue, both cartilage and bone. Acute inflammation may be accompanied by a purulent effect, correspondingly, an increase in temperature and a general deterioration of the condition. All this leads to the development of complications of the coccygeal hernia - the formation of an epithelial tract and fistula.

You can suspect severe changes based on external signs. In the area of damage, the skin becomes reddish and thickens. The infection quickly spreads to other organs if the inflammation spreads to adipose tissue. At a certain point, a fistula is formed, that is, a hole in the tailbone area that goes out. Pus is released through it. With prolonged inflammation, a pair of fistulas may form that extend into the abdominal wall. crotch.

In addition to the listed manifestations of a coccygeal hernia, with the development of pain, secondary manifestations are added. They are based on the body's reactions to pain and inflammation and can have varying degrees of intensity and prevalence.

Secondary symptoms

Anxiety,
Sleep disturbance,
General deterioration of the musculoskeletal system due to inflammation ( this is a complex, local and general pathological process that occurs in response to damage (alteratio) or the action of a pathogenic irritant and manifests itself in reactions aimed at eliminating
),
Acquired problems in the functioning of the intestinal tract and genitourinary system.

This pathology of the coccyx can also be cured using physiotherapy methods. Magnetic therapy, ultrasound, and electrophoresis are widely used. Also, to eradicate this disease, exercise therapy is used, the exercises of which improve the condition and general mood of the patient. These exercises release endorphins and strengthen most of the pelvic muscles.

Very often, so that the pathological tailbone does not experience overload when in contact with a hard seat, doctors advise using oval or round pads. To reduce pain, manual therapy is used - traction. This method, acting on deformed discs, reduces pain.

Treatment methods

In the early stages, when there is no rupture of the intervertebral disc, non-surgical treatment methods help - physiotherapy, therapeutic exercises, manual therapy and medication. With a progressive form of the disease, surgical treatment is advisable.

Non-surgical methods

Wearing special corsets (orthoses). It does not eliminate the hernia itself, but relieves pain, restores the position of the vertebrae, and relieves muscle strain. Depending on the problem area, it is recommended to wear a lumbar or chest corset. The most unpleasant moment is that wearing a corset for a long time is fraught with muscle atrophy.
Massage . This non-surgical method can provide a good result if there are no disorders of the skin, blood pressure, or inflammatory processes accompanied by an increase in body temperature. During the massage, creams with an anesthetic effect and essential oils are used. Most often, massage is prescribed for hernias in the lumbosacral spine.
Exercise therapy. It is recommended to alternate between exercises aimed at increasing muscle tone and relaxation exercises. Exercises can be performed only at times when the severity of pain is minimal. But it is important that training is regular. The best option is to spend 15 minutes studying every day.

The main difficulty is that massage and exercise therapy must be very dosed, otherwise you can provoke a rupture of the intervertebral disc and increase spasms

Surgery

If non-surgical treatment does not help, in most cases surgical treatment is resorted to. Operations can be divided into several groups:

Traditional discectomy . An open operation, the intervertebral disc, part of it and the vertebral processes affecting the arteries and spinal cord are removed. For a long time it was considered the most popular method of removing hernias, but due to the large area of damage and the need for general anesthesia and long recovery, doctors are resorting to traditional discectomy less and less.
Laminectomy . An operation that involves removing part of the vertebral arch that presses against the nerve root. The operation is abdominal, but less traumatic than traditional discectomy. The operation is performed through a small incision (maximum incision length 10 cm). Depending on the specific situation, it can be performed under general or local anesthesia. Recovery after surgery is quite fast. But under one condition – the absence of complications. And their probability is high. Moreover, this can be either blockage of blood vessels or bleeding.
Minimally invasive operations to remove hernias using an endoscopic method. Access to the problem area is provided through a thin tube. The hernia is removed not through an open cavity, but through an endoscope. The great advantage of the technique is that the patient can get up on the day of surgery, the stay in the clinic does not exceed two weeks, and there is no risk of adhesions forming.

Open and endoscopic hernia removal operations are actively practiced in Minsk at the 5th Clinical Hospital. The head of the neurosurgical department, Alexander Baranovsky, and his team master complex surgical techniques, taking an individual approach to each patient and the severity of the patient’s neurological deficit.

Drug treatment

If for some indication surgical intervention is unacceptable, or if there is a disease, treatment can be carried out with medication at the initial stage. What drugs are prescribed?

Painkillers (mainly in the form of blockades - injections directly into the source of pain on the spine itself). In particular, X-ray-controlled blockades with local anesthetics and steroid hormones have shown themselves to work well in practice.
Muscle relaxants (muscle relaxants) to relieve muscle spasms. They provide good results, but if selected incorrectly, they can cause side effects related to the functioning of the central nervous system. They are selected purely individually - exclusively by a doctor; self-medication is acceptable. Not suitable for people with chronic renal or liver failure
Chondroprotectors. Their use is important for the restoration of cartilage tissue.

Additionally, agents to stimulate blood circulation and B vitamins may be prescribed. If painkillers and muscle relaxants are in the form of tablets, medications are recommended to protect the mucous membrane of the stomach and esophagus.

Manual therapy

Another way to combat hernias is manual therapy. This is a non-invasive procedure that is aimed at restoring the correct position of the vertebrae (reposition). The procedure is not aimed at eliminating a hernia in one of the sections, but at improving the biomechanics of the entire spine.

A huge advantage of manual therapy is that not only the problem with the spine itself is solved, but also the accompanying problems caused by the appearance of a hernia are eliminated. Swelling and inflammation go away.

But despite the effectiveness of the technique, manual therapy is not suitable for all patients. There are so-called reducible and irreducible hernias. Reducible hernias can be treated quickly with the help of manual therapy. Irreversible hernias cannot be treated with manual therapy. This is not only ineffective, but also dangerous.

That is why manual therapy can only be carried out after a detailed diagnosis and exclusively by an experienced specialist. Only he will correctly assess whether manual therapy can be carried out in a particular case, whether it will lead to injury to internal organs, the formation of adhesions, and even strangulation of the hernia itself, which can only be eliminated through surgery. By the way, some of the operations in the 5th hospital are precisely operations aimed at eliminating strangulated hernias caused by manual therapy in institutions with low-skilled specialists

If conservative treatment is ineffective

In cases where drug correction in combination with exercise therapy and physiotherapeutic methods is ineffective, surgical treatment is indicated. Surgical intervention also becomes necessary when epithelial ducts form, since they are a constant source of infection and can cause purulent inflammation of the epithelium. Pathological mobility of the spine resulting from a coccygeal hernia may also be an indication for surgical treatment.

Recovery

Regardless of how the hernia is removed, restoration is required. What is it built on?

On drug and electrotherapy, aimed at reducing pain after surgery (especially important for patients who have undergone open surgery).
Wearing special corsets. It helps to consolidate the effect, support the spine in the correct position, relieve stress from the vertebrae, and prevent relapse of the disease. If the hernia was surgically removed and the operation was extensive, then in the first weeks it is recommended to alternate wearing rigid and semi-rigid corsets, and then wear a semi-rigid one for about three months. If the operation is minimally invasive, then sometimes only wearing a semi-rigid corset for two months is enough.
At therapeutic exercises. Exercise therapy is organized strictly under the supervision of a doctor. The main exercises for the patient are static movements aimed at keeping the back muscles in a contracted state for several seconds.
On control of being in a vertical position. In the first month after surgery, you can be in an upright position for no more than 1.5 hours at a time.

The exact recovery time after hernia removal depends on age, the presence of concomitant diseases, and the hernia treatment method used.

Diseases of the coccyx - specialists in Moscow

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Tugutov Alexander Viktorovich

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Zhdanov Igor Vyacheslavovich

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Prevention

If your loved ones have encountered such a problem as a herniated spine, your work requires constant stay in one position, you are at risk. And prevention in this case is mandatory. What does it include?

Regular exercise, including exercises to strengthen the muscle corset and stretching of the back muscles, and also, if possible, sign up for a pool and go swimming.
Proper nutrition. It is important that the body has enough protein and calcium. Therefore, the consumption of cottage cheese, kefir, and chicken should be regular.
Vitamin therapy. If you eat few vegetables and fruits and often catch colds, do not neglect vitamin therapy. A weakened body is a direct target for spinal diseases.
Taking chondrocyte supplements for connective tissue elasticity. Especially if there are signs of osteochondrosis, arthrosis, or recent injuries.

Body weight control. Excess weight is especially dangerous for the spine. After all, it creates additional pressure and stress on the vertebrae. And, in the event of the slightest injury, the appearance of a hernia in this case is a natural process. Avoid high-calorie foods and smoked foods.

Causes

The main causes of coccygeal hernias are strong falls and impacts in the buttocks and lower spine. The pathology does not develop immediately after the injury and often makes itself felt only after 6-8 months.

Other causes of hernias in the coccyx area:

Adhesive processes in the pelvis.
Congenital spinal deformities.
Frequent spasms of the pelvic muscles.
Diseases of the genitourinary system.
Female gynecological diseases - endometriosis, purulent hematometra, genital tract infections.
Cysts and other neoplasms in the area of the sacrum and pelvic organs.
Infectious diseases accompanied by metabolic disorders - tuberculosis, ankylosing spondylitis.

The risk group for coccygeal hernia includes athletes involved in martial arts, cycling, and weightlifting. Also, a coccyx hernia often occurs in pregnant women and women after childbirth as a result of intense stress on the pelvic area and spine. Physical inactivity, excess weight, and abuse of bad habits increases the predisposition to pathology.