Treatment of intervertebral disc herniation in Petrozavodsk

Dubovskaya Nadezhda Alexandrovna

Chief physician of the Clinic, neurologist
Author of the article

Most often, intervertebral hernia appears in the lumbar and cervical spine. This is a rather painful and dangerous disease. Since intervertebral discs serve as shock absorbers to balance the load on the spine, damage to them can have consequences for the entire body and cause a number of unpleasant symptoms. A herniated disc is a rupture of an intervertebral disc. This happens due to a sudden unnatural load on the cervical vertebrae (for example, due to injuries). The consequence is disc deformation and rupture. Further along the chain: the pulpous substance is squeezed into the spinal canal (most often), the nerves are pinched - pain and other ailments occur.

What are the signs of a cervical hernia? Symptoms of a cervical hernia:

As a rule, all patients with cervical intervertebral hernia experience the same, fairly typical symptoms, from which the doctor can easily determine the diagnosis.

First of all:

• severe pain in the neck and when turning the head, shoulder, or arm;
• numbness of the hands or fingers;
• a feeling of “goosebumps” crawling throughout the body;
• weakness in the muscles of the neck and shoulders;
• loss of mobility of the cervical spine due to pain;

There are also less typical symptoms, but still recognizable to a good neurologist:

• frequent dizziness, ringing or noise in the ears and head;
• darkening of the eyes (for example, when tilting the head forward or leaning back);
• decreased vision or hearing;
• the appearance of anxiety, the development of phobias, obsessive states;
• changes in character, obsession, irritability.

However, the nature of the pain, its intensity and specific localization depend on exactly where in the cervical spine the hernia occurred:

• hernia C4-C5 (the 5th intervertebral nerve root is pinched). There is pain and weakness in the forearm and deltoid muscles, especially if you try to raise your arm above shoulder level.
• hernia C5-C6 (the 6th intervertebral nerve root is pinched). The outer part of the elbow hurts, there is pain in the biceps area. A characteristic symptom may also be a feeling of tingling or numbness in the thumb.
• hernia C6-C7 (the 7th intervertebral nerve root is pinched). There are a number of characteristic symptoms here: weakness and pain in the triceps area, numbness in the thumb and middle fingers, and the outer part of the elbow. There may be a feeling of “cottoniness” or “goosebumps” in the hand.
• hernia C7-T1 (the 8th intervertebral nerve root is compressed). There is pain in the lower arm and little finger. Tingling, numbness, and weakness may also occur.

It should be noted that a cervical hernia can cause other painful conditions. After all, with the appearance of a hernia, the vessels are compressed, and the posterior parts of the brain suffer from insufficient blood supply. Patients may experience weakness, nausea, and dizziness. Increased blood pressure and panic attacks may occur. Also, a hernia of the cervical spine (especially if it is located high) can cause migraines - regular intense attacks of headaches. In especially severe cases, vision, attention, memory are impaired, and insomnia appears.

What is a cervical hernia

The spinal column is divided into 4 sections: cervical, thoracic, lumbar and coccygeal. In the cervical area there are 7 elements C1-C7 with 5 intervertebral discs between them. The disc is a shock absorber; it is responsible for the mobility of the spinal column and helps reduce the force of impact due to injury. Disks consist of the following parts:

• nucleus pulposus - a jelly-like secretion containing water and collagen;
• The annulus fibrosus is a tough, fibrous bone tissue located around the nucleus pulposus.

When bending or hitting, the core in the fibrous ring is deformed, which serves to ensure mobility and shock absorption. If the bone structure is damaged, the core is depleted, or an injury occurs, due to such curvature of the core, the ring begins to gradually collapse. Initially, stretching and deformation of the ring in one direction is observed with a displacement of the core into the stretching zone. Over time, cracks appear in the area where the bone tissue is stretched, which leads to even greater displacement of the core. This stage of disease development is called “protrusion”.

Over time, if the body is affected by negative factors and no therapy is carried out, the ring ruptures and the nucleus protrudes beyond the disc. This phenomenon is called a hernia. At the last stage, the part of the nucleus pushed outward is separated. This leads to the formation of severe swelling in the affected area, which disrupts the functionality of the intervertebral disc.

Disc herniation in the lumbar spine

Intervertebral hernia (intervertebral hernia, herniated intervertebral disc) is one of the most common and dangerous diseases of the spine. This is nothing more than a protrusion of the intervertebral disc, which impinges on the nerve roots of the spinal cord. Most often, herniated discs in the lumbosacral region are affected.

The main reason for the development of intervertebral hernia in the lumbar region is progressive osteochondrosis.

Causes

Predisposing factors are:

• metabolic disease
• consequences of injuries of the lumbosacral spine
• excessive physical activity, sudden bending, heavy lifting
• curvature of the spine (scoliosis), dysplasia (underdevelopment) of the hip joints
• obesity
• muscle weakness
• sedentary lifestyle
• age-related changes
• heredity
• sedentary work

Kinds

Anatomically, the most vulnerable is the lower part of the lumbar region and the articulation of the 5th lumbar vertebra with the sacrum. In connection with this, hernias of the lumbosacral spine most often form in the interval between the 4th and 5th lumbar vertebrae and between the 5th lumbar vertebra and the sacrum.

Symptoms

The main symptom is pain, which slowly increases as the disease progresses.

Initially, the pain syndrome is dull, aching, localized at the site of the lesion. It can intensify with tension, physical activity and sudden movements. At rest, it is less intense.

Subsequently, the pain spreads to the lumbar muscles and lower limbs. It takes on a sharp and shooting character. Depending on which segment of the spinal column the hernia has formed, the pain may radiate (spread) to the buttocks, thighs, legs, heels and feet. If you don't see a doctor.

Lumbodynia, that is, “lumbago” in the lumbar region. There is acute pain, sharply intensifying even with the slightest movement. The patient may remain in this condition for up to several weeks.

In addition, as the disease progresses, the sensitivity of the skin is impaired, a crawling sensation and a feeling of numbness appear. There is also an increase in sweating or, conversely, dry skin in the area of ​​the damaged root.

If the hernia protrudes backwards, then paralysis is possible - in this case, the disease can lead to complete disability of the person, dysfunction of the pelvic organs.

Diagnostics

When you contact the Bone Clinic, you will undergo an x-ray, which helps identify pathology in the bone structure of the lumbar spine.

In addition, if necessary, the doctor will prescribe a magnetic resonance imaging scan, which will not only reliably localize the hernia, but also determine its size. Also, according to indications, ultrasound and laboratory tests are prescribed.

Treatment

Depending on the stage of the process, treatment tactics can be either conservative or surgical.

That is why, when the first symptoms of the disease appear, you need to consult a specialist and not self-medicate. Only with timely contact with a specialist can the progression be stopped and possible complications prevented.

Methods used in the Bone Clinic:

• Physiotherapeutic procedures relieve painful symptoms and muscle spasms
• massage helps restore tone to the neck muscles and improve trophism of soft tissues
• Exercise therapy can restore the functioning of muscles and ligaments, swimming is especially useful
• hirudotherapy relieves swelling and improves blood circulation

To restore tissue and prevent the progression of the disease, doctors at the Bone Clinic can prescribe drug therapy.

Prevention

The main activities are:

• exclusion of excessive loads, both sports and professional
• normalization of body weight
• sleeping on a moderately firm mattress
• active lifestyle
• strengthening the muscle corset, swimming
• giving up bad habits

Types and stages

While the hernia is forming, several stages of deformation in the intervertebral discs go through. In addition, the disease is divided into several types, which is due to the area of ​​protrusion of the nucleus pulposus in relation to the vertebrae.

Depending on the type, a hernia of the cervical spine can be:

• lateral – the nucleus protrudes to the side of the vertebra;
• anterior - there is a protrusion in the direction opposite to the spinal cord (one of the less serious varieties);
• posterior - the nucleus increases in the direction of the spinal cord, where the vascular tissue with the spinal processes is located, which leads to serious consequences;
• paramedian - the disc is deformed sideways and at the same time deviates from the spinal cord.

Considering the anatomical features of postural deformation, posterior and lateral cervical hernias are most often diagnosed, which can lead to serious complications. Less dangerous is the anterior type of hernia, and this is a very rare disease - it is diagnosed only in 5% of cases.

Let's take a closer look at the stages of development of a cervical hernia:

1. Thinning of the fibrous ring occurs with penetration of the nucleus deep into the bone tissue up to 2 mm.
2. The formation of cracks in the tissues of the ring with a deepening of the core by 4 mm is noted.
3. There is a rupture of the ring with protrusion of the nucleus by 4-6 mm.
4. The hernia increases to 8 mm.
5. The protruded portion of the nucleus separates and prolapses into the spinal cavity. This stage of pathology formation is called sequestration.

After reaching stage 3, serious health problems occur in the form of circulatory disorders, deterioration of nutrition in the brain, and destruction of the connection between the spinal cord and brain.

Symptoms and types of C5-C6 protrusion

Passing at the level of the intervertebral disc located between the 5th and 6th cervical vertebrae, the spinal roots are responsible for the innervation of the muscles at the base of the neck, under the collarbones, the lateral surfaces of the arms, and thumbs. Therefore, with protrusion of C5-C6, pain can occur not only in the neck, but also radiate to these parts of the body. Sensitivity may also be impaired, resulting in a sensation of goosebumps, numbness, inadequate sensation of heat and cold, etc.

Limitations of mobility are often observed, as a result of which the patient loses the ability to perform the full range of movements with his hands and freely turn his head. The situation is aggravated by the fact that in response to pain, the surrounding muscles reflexively contract, that is, they spasm. This further increases the severity of the pain syndrome and interferes with the free execution of movements. With C5-C6 protrusion, limited mobility usually manifests itself in a decrease or complete loss of the patient’s ability to bend the arm and straighten the wrist.

In addition, the nerve roots passing in close proximity to the C5-C6 disc are responsible for the functioning of the vocal cords and tonsils. Therefore, when they are compressed, frequent tonsillitis and laryngitis can occur, which often become chronic.

Sometimes neurological disorders that occur with protrusion of C5-C6 provoke disturbances in the functioning of large blood vessels passing through the neck - the vertebral arteries. As a result, their spasm occurs, which leads to increased blood pressure, headaches, decreased memory, attention, sleep disturbances and redness of the facial skin.

Thus, the symptoms of C5-C6 protrusion are:

• sharp, shooting pain in the neck, radiating to the shoulders and arms, aggravated by turning or tilting the head, coughing, sneezing (the sensation can be compared to an electric shock);
• headaches, often in the nature of migraines;
• limited mobility of the neck and/or arms;
• paresthesia, i.e. the presence of numbness, a crawling sensation in the shoulders and arms;
• dizziness;
• change in voice timbre, hoarseness;
• noise in ears.

Sometimes there is swelling and redness of the tissue in the projection of the C5-C6 disc.

In this case, the nature of the manifestation of symptoms depends on in which part of the spinal canal the C5-C6 protrusion is located. If it is median, that is, localized strictly in the center of the spinal canal, all symptoms will appear on both sides of the body simultaneously or alternately. But if the C5-C6 protrusion is paramedian or foraminal, that is, located to the left or right of the center of the spinal canal or even grows into the foraminal openings, signs of the disease will appear on the corresponding side of the body. Moreover, they will be especially intense during the formation of foraminal protrusion, since it is formed in the narrow natural openings of the spine, where the spinal roots pass. Therefore, even if it is small in size, it will cause compression of the nerve roots.

Protrusions can also form in the direction opposite to the spinal canal. In this case, they are called anterior. They do not pose a serious threat, extremely rarely cause discomfort, but they also occur infrequently.

Causes

Intervertebral hernia is formed under the influence of several factors:

• A strong impact on the body of the nucleus in the cervical intervertebral disc is fraught with prolonged pressure on the fibrous ring.
• A decrease in the volume of water in the core or depletion of bone tissue in the ring.
• Disorders of the nutritional process in tissues. All components that make up the structure of the intervertebral discs are normal if a person follows the correct diet. In addition, nutrients enter the tissue of the intervertebral disc through blood vessels located in the paravertebral zone. When stagnation develops in this area, the nutritional process is disrupted.
• Postural distortions. Normally, there is a uniform distribution of the load along the spinal column. If your posture is poor, compression increases in the cervical spine, causing the disc to become deformed.
• Injury Violation of the bone structure in the intervertebral discs leads to the formation of cracks - a weak point for the formation of a protrusion.
• Sedentary lifestyle. Insufficient motor activity over time leads to decreased blood circulation in the spinal canal. At risk are office workers, drivers and people who have to spend a lot of time in a sitting position. Impaired blood circulation is fraught with a decrease in the rate of restoration of vertebral tissue, which leads to dehydration of the core in the disc.

The impact on the body of factors that contribute to the formation of a cervical hernia is observed in many people. It is recommended to seek medical help if you experience any discomfort in the neck area so that treatment can begin in a timely manner.

Treatment of C5-C6 protrusion

The tactics of conservative treatment of C5-C6 intervertebral disc protrusion are developed separately for each patient. It is always complex and may include:

• drug therapy;
• osteopathy;
• traction therapy;
• manual therapy;
• physiotherapy (phonophoresis, carboxytherapy, ozone therapy);
• Individual lessons with a rehabilitation doctor.

All patients are advised to reconsider their lifestyle and habits. It is important to change your diet and include fresh vegetables and fruits in your diet, as well as increase your level of physical activity to lose weight. It is extremely important to avoid straining your neck, so when working at a computer you should take breaks every hour and stretch your neck. Sometimes patients are recommended to wear a Chance collar, i.e., a neck brace. It is designed to reduce the load on the cervical discs, especially the affected C5-C6.

If the protrusion of C5-C6 has managed to provoke the development of chronic diseases of the tonsils, appropriate treatment is additionally prescribed.

Drug therapy

The main goals of drug treatment are to reduce the severity of the inflammatory process and eliminate symptoms that bother the patient. To achieve them, patients are prescribed a complex of medications, which may include:

• NSAIDs (non-steroidal anti-inflammatory drugs) - are produced in almost all forms and have anti-inflammatory and analgesic properties;
• corticosteroids are a group of drugs with powerful anti-inflammatory properties that are used for serious inflammatory processes, but are prescribed mainly in short courses and in the form of injection solutions, since with this method of administration they provide a minimal risk of side effects;
• muscle relaxants – drugs that help eliminate the tone of overly tense muscles, thereby reducing the severity of pain;
• B vitamins - used to improve the quality of nerve impulses from the spinal cord to the corresponding organs and tissues;
• vitamin D is a remedy responsible for the condition of bone tissue, as well as for higher brain functions, such as memory, memory, attention, speech;
• chondroprotectors are drugs with unproven effectiveness in the treatment of protrusion, but according to manufacturers they can accelerate the processes of disc regeneration (prescribed mainly for diagnosing osteochondrosis of other intervertebral discs). We recommend Mermaids Marine Collagen to our patients.

If the patient suffers from very severe pain that makes him unable to work, which is most often observed with foraminal protrusion of C5-C6, he can apply for a blockade. This procedure involves injecting an anesthetic solution, sometimes along with corticosteroids, directly into the area where the compressed nerve passes. As a result, pain of any intensity quickly passes. But the blockade does not have a pronounced therapeutic effect, but only allows you to temporarily improve your well-being and return the person to work. It is recommended to carry them out no more than 4 times a year.

Manual therapy

Manual therapy can be called the basis of treatment for C5-C6 protrusion. With its help, it is possible to directly influence the causes of the development of the disease, as well as effectively combat radicular syndrome. But this requires the help of a truly qualified specialist who has a keen understanding of the peculiarities of the structure of the spine and segmental innervation.

As a rule, patients are advised to undergo a course of manual therapy sessions, which includes 10-15 procedures. It can be started after the acute inflammatory process has subsided, which is achieved through drug treatment.

Most patients observe a significant improvement in well-being after 1-2 sessions. But in no case should you stop there and stop the course of manual therapy, as all the results will be nullified.

When carrying out a full course of treatment, it is possible to achieve:

• increasing the distance between the vertebral bodies and normalizing their position on the spinal axis, which leads to a reduction in the load on the C5-C6 intervertebral disc and the creation of favorable conditions for its recovery;
• normalization of muscle tone, both eliminating spasms of overly tense muscles and increasing the tone of too relaxed ones, thereby reducing pain and also increasing support for the spine;
• eliminating functional blocks and increasing mobility;
• releasing nerve roots and restoring normal transmission of nerve impulses from the spinal cord to the corresponding organs, which allows eliminating signs of neurological deficits, including sensory disturbances, and improving the functioning of relevant internal organs;
• improving blood circulation and lymph flow, which makes it possible to improve the quality of nutrition of all tissues, including discs that do not have their own direct blood supply, as well as accelerate the elimination of metabolic products.

In addition, by improving the condition of the entire spine thanks to manual therapy, immunity is increased, the functioning of all internal organs is improved, there is an increase in efficiency and the effects of stress are eliminated.

Traction therapy

Spinal traction or traction therapy for C5-C6 disc protrusion is also often used, especially in combination with manual therapy sessions. The essence of the method is to smoothly stretch the spine along the central axis using a special table and belts.

Due to its use, it is possible to increase the distance between the vertebral bodies, which reduces the pressure on the C5-C6 disc. As a result, favorable conditions are created for its restoration, and the likelihood of rupture of the fibrous ring and the transition of the protrusion into intervertebral hernia of C5-C6 is reduced.

Immediately after the procedure, the patient must put on the Chance collar.

Exercise therapy

Physical therapy plays an important role in the treatment of intervertebral disc protrusion. When it forms in the C5-C6 disc, exercises for the cervical spine will be indicated, but they must be selected individually. The rehabilitation doctor takes into account, in addition to the type of protrusion, the patient’s level of physical fitness, his age and existing concomitant diseases, as well as other factors.

The first classes are recommended to be carried out under the supervision of a rehabilitation specialist. This will ensure that you learn the correct technique for performing each exercise so that it will bring maximum benefit. All movements are performed in a smooth rhythm, without jerking. The load increases gradually and only with the permission of the doctor.

Exercise therapy is required to be done daily. From the moment the protrusion of C5-C6 is discovered, such exercise should become a useful habit that will be maintained throughout a person’s life.

Symptoms

In the early stages of development of the described pathology, there is a periodic manifestation of symptoms that can increase with physical exertion or at the end of the day. After the hernia develops to an advanced stage, constant, debilitating discomfort appears. In addition, symptoms may change. This is due to the fact between which vertebrae of the cervical region the hernia has formed.

Among the general signs of the disease it is worth noting:

• acute pain syndrome in the cervical region and possible irradiation to the interscapular or thoracic region, as well as the arms;
• nausea with dizziness;
• increased fatigue and inattention;
• changes in blood pressure;
• insomnia.

Let's get acquainted with the features of the signs of pathology depending on which elements of the spine the hernia is located between.

With the development of a hernia between the 2nd and 3rd vertebrae, which are responsible for supplying blood to the eyes and tongue, taste sensations decrease, the neck bends to one side, and dark circles appear in the eyes.

The formation of pathology between the 3rd and 4th vertebrae, responsible for feeding the nose and lips, the sense of smell is impaired, and the lips become numb.

If a hernia has formed between the 5th and 6th vertebrae, which are responsible for the blood supply to the throat and vocal cords, the voice changes and there is a feeling that there is a lump in the throat.

If a hernia has developed in the disc of the 7th vertebra, problems with the thyroid gland and a strong tendency to develop bronchitis and asthma are noted.

Since the symptoms of a cervical hernia can be localized in different areas and affect the sensory organs, hands and blood pressure, they are often confused with signs of other diseases, which makes diagnosis difficult.

Disc herniation in the thoracic spine

Pain and subsequent restriction of movement are common. Of all locations, it is most rarely found in the thoracic region compared to the lumbar and cervical spine.

As the process progresses, the hernia puts pressure on the spinal cord root, causing various disorders.

Causes

Among the main causes of hernia in the middle part of the back, doctors identify osteochondrosis. You can read about the treatment of osteochondrosis using traditional methods in another blog article

Predisposing factors are:

• metabolic disease
• consequences of injuries of the lumbosacral spine
• excessive physical activity, sudden bending, heavy lifting
• curvature of the spine (scoliosis), dysplasia (underdevelopment) of the hip joints
• obesity
• muscle weakness
• sedentary lifestyle
• age-related changes
• heredity
• sedentary work

Symptoms

In the initial stage of the disease, the patient feels a burning sensation, discomfort and stiffness in the chest and back. In this situation, the main thing is to contact a neurologist and orthopedist in time in order to promptly receive qualified help. One of the main symptoms is girdle pain. In addition, there may be a loss of sensation in the legs and arms, and general muscle weakness. Often in people with this disease, reflex muscle activity increases.

Consequences

A hernia in the middle part of the spine is a very insidious disease, since its symptoms are often mistaken for other diseases. As a result, the hernia grows more and more, squeezing the roots of the spinal cord. What is dangerous is the development of paralysis.

Treatment

Depending on the stage of the process, treatment tactics can be either conservative or surgical.

That is why, when the first symptoms of the disease appear, you need to consult a specialist and not self-medicate. Only with timely contact with a specialist can the progression be stopped and possible complications prevented.

Methods used in the Bone Clinic:

• Physiotherapeutic procedures relieve painful symptoms and muscle spasms
• massage helps restore tone to the neck muscles and improve trophism of soft tissues
• Exercise therapy can restore the functioning of muscles and ligaments, swimming is especially useful
• hirudotherapy relieves swelling and improves blood circulation

To restore tissue and prevent the progression of the disease, doctors at the Bone Clinic can prescribe drug therapy.

Prevention

The main activities are:

• exclusion of excessive loads, both sports and professional
• normalization of body weight
• sleeping on a moderately firm mattress
• active lifestyle
• strengthening the muscle corset, swimming
• giving up bad habits

Diagnostics

To establish a diagnosis, you should consult with an orthopedic traumatologist or neurologist. To begin with, a survey and examination of the patient is carried out. The doctor questions the patient about signs of concern, checks posture and nervous reactions in the hands. The doctor collects anamnestic data regarding injuries received and vertebral pathologies suffered.

To confirm the presence of a cervical hernia, a full examination is prescribed. Less informative and rarely used techniques are computed tomography and x-ray examination.

X-rays help determine the position of the spinal elements and the size of the disc between them. To determine the condition of soft tissues, nerves and blood vessels, they resort to a more informative method - MRI of the cervical region. CT is not as informative as MRI, although it can be prescribed if an MRI machine is not available.

Myelography involves using contrast to inject the cavity between the vertebrae to visualize their structure. The use of this method allows you to clearly imagine the state of the tissues, however, there are a certain number of limitations to conducting such a study.

How to treat a herniated cervical spine

If a cervical hernia is detected, complex therapy is required, and only in accordance with medical prescriptions. The average duration of treatment is from 3 months to six months. If there is no regeneration of the intervertebral discs at the end of this period, the doctor may prescribe surgical treatment for a cervical hernia.

Drug therapy

For intervertebral hernia of the cervical spine, the following groups of medications are prescribed:

• Painkillers. Against the background of severe pain leading to a decrease in the patient’s quality of life, treatment with drugs to relieve spasm in nerve receptors in the form of tablets, ointments or injections is indicated.
• Muscle relaxants. In the area where the cervical disc is destroyed, muscle spasm develops, which contributes to poor circulation and poor posture. To relieve muscle spasms, taking muscle relaxants is indicated.
• Chondroprotectors. Medicines of this pharmaceutical group help restore tissue in the fibrous ring.
• Vitamins. This group of drugs helps improve immunity in general.

Any medications can be taken only after medical consultation.

Physiotherapy

For therapeutic purposes, for cervical hernia, it is recommended to perform a special gymnastic complex. The purpose of the classes is to activate blood circulation, relieve muscle tension, and relieve pain. Exercises help to stretch the spine and free up space between the elements of the spine in the cervical region.

When performing exercises, you should consider some rules:

• movements should be smooth with minimal load on the cervical area;
• performing gymnastics is allowed only during the process of remission, after the removal of severe pain;
• If you feel severely unwell after exercise, you should stop training and consult your doctor.

Massage

Proper massage against the background of a cervical hernia helps to relieve swelling from the receptors of the spinal canal, activate tissue nutrition, thereby increasing hydration in the core. Performing a massage helps relieve pain and overall relaxation.

The procedure involves making light, stroking movements along the spinal column without touching the vertebrae. At the end of the massage, the patient should not feel pain. A person should feel warm and completely relaxed. The procedure can be carried out using various techniques: manual massage, vacuum or hydromassage.

This method of therapy for cervical hernia will bring the desired effect at the initial stage of the formation of the pathology. If the disease has developed to stage 3 or 4, this can lead to worsening of the condition and increased pinching of nerve receptors.

Physiotherapy

If a cervical hernia is diagnosed, the doctor may prescribe the use of physiotherapeutic procedures as an auxiliary treatment:

• shock wave therapy;
• electrophoresis;
• laser therapy.

The use of these techniques leads to a decrease in nucleus prolapse and swelling in the damaged area.

Operation

If there is no effect from the use of conservative treatment methods, the doctor may prescribe surgery. If the patient is left untreated, the disc may rupture, leading to paralysis.

Surgical treatment of cervical hernia involves removing the damaged disc, followed by fusion of adjacent spinal elements or installation of an implant. After surgery, the patient requires rehabilitation, which usually takes at least 3 months. In the future, the patient is required to perform exercises, massage and other preventive measures.

University

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You often hear from patients: they say, doctors treated osteochondrosis and radiculitis, then they did an MRI/CT scan of the spine, but it turned out that there was a herniated intervertebral disc (IVD), and now it seems that only surgery can save it. Is this really the only way out?

There are many opinions on this matter, since doctors of different specialties deal with the problem. Neurologists discourage surgery, chiropractors guarantee a complete cure, and neurosurgeons declare that only they will relieve suffering, otherwise irreversible damage may occur.

Which method of treating a herniated intervertebral disc is better, which hernia should be operated on with an open approach, and in which cases should it be minimally invasive? Particularly impressive are films demonstrating minimally invasive, expensive interventions, for example, laser vaporization, after which the patient is completely cured - send him into space right now.

To properly understand the problem, it is necessary to recall the main points of the pathogenesis of the disease.

How do intervertebral disc herniations grow?

A healthy intervertebral disc consists of end plates, a fibrous ring, in the center of which is the nucleus pulposus - this is a very strong elastic formation that can withstand significant loads. Therefore, with spinal trauma, spinal fractures are more often observed than damage to the IVD. Over the years, degenerative processes (eating disorders) develop; they begin with the intervertebral disc, move to other elements of the spinal motion segment and are defined as spinal osteochondrosis. This is a chronic multifactorial relapsing disease; a genetic predisposition to it is observed in 80% of people. It is important to note that disc degeneration (degeneration) and its natural aging are one process, but at different speeds, complicated by herniation. Early age-related wear and tear of the spine is an expression of the lack of human biological perfection - as a tribute to nature for the transition to a vertical position.

Initially, intradiscal changes (protrusion) of the IVD are observed, then the fibrous ring cannot withstand the load, and the nucleus pulposus ruptures it, forming a true IVD hernia (prolapse). Nuclear prolapses can have different directions: upward or downward, the so-called Schmorl’s hernia (clinically insignificant); anterior; and the most unpleasant - posteriorly, when fragments of the nucleus fall into the epidural space of the spinal canal and often lead to a disco-radicular conflict. In this case, the degenerative process spreads both up and down to other IVDs (most often to L4-L5, L5-S1, C5-C6, C6-C7) and even parts of the spine - most often the lumbar, then the cervical (up to 30%) and less often - chest (less than 1%).

The best known in clinical practice is the scheme of stages of posterior hernia formation proposed by Armstrong J. (1952):

• Stage 1: initial dystrophic changes in the nucleus pulposus and the posterior part of the fibrous ring (Fig. 1),
• Stage 2: posterior displacement (protrusion) of the nucleus pulposus (Fig. 2),
• Stage 3: prolapse of the sequestra of the nucleus pulposus into the spinal canal, where its resorption or fibrosis begins (Fig. 3).

In the “pre-computer era,” many researchers noted that disc sequestration resolves, and this process occurs faster in the vascularized epidural space. New high-resolution neuroimaging methods have made it possible to observe this process over time. The first portion of the prolapsed nucleus pulposus can significantly decrease in size on CT during the period of remission, but unsuccessful movement or overload leads to the repeated prolapse of another portion of the nucleus, causing an exacerbation.

At first, neurosurgeons who removed IVD hernias considered them benign tumors-chondromas and did not associate the pathology with the IVD.

The research of the Dresden School of Pathologists, led by G. Schmorl (1926), helped to understand this. In a post-mortem analysis of 5,000 spines of people of different ages, cartilaginous nodules were found in 38% of cases (usually in people over 50 years of age). These results are echoed by modern data obtained on volunteers: in 50% of CT scans of the spine and in 37% of myelographies performed on the population of all ages, pronounced pathological changes in the IVD were determined. And the patients had no complaints. The older the patient, the more often spinal osteochondrosis appeared on CT/MRI, and in old age (>60 years) it is observed in 100% of cases.

What to do with a 10 mm hernia if conservative treatment is ineffective

The question is posed specifically, but it cannot be answered unambiguously. It is clear that surgical assistance is already necessary.

In Belarus, several methods of surgical treatment of intervertebral disc herniations are used.

Percutaneous minimally invasive hernia removal . This is an attempt to eliminate the disc-radicular conflict with minimal trauma to the spine without disturbing its stability. During percutaneous operations, when the nucleus pulposus is reduced (evaporated) or mechanically removed (without opening the spinal canal) to reduce intradiscal pressure. It is impossible to influence the prolapsed sequestra of the IVD hernia. Therefore, the indications for these interventions are hernias less than 6 mm (see “Medical Bulletin” dated 02.12.2009 No. 7, “HERNIA AND THE “HUNDRED” OF THE NEUROSURGEON’S ROADS, Percutaneous methods for treating intervertebral disc herniations (IVD)’). It is believed that with this size, the fibrous ring has not completely ruptured and the process of hernia formation is at stages 1–2.

For hernias larger than 10 mm, other surgical technologies are suitable. Now there are already more than a hundred of them known, and new ones are appearing.

Standard microdiscectomy . It is called the gold standard for neurosurgical treatment of IVD hernias. The prolapsed part and remnants of the nucleus pulposus in the IVD are removed. With the acute development of the disease (patients note that something “crunched” or “shot” in the back), treatment results are good in middle-aged and young people. Although the operation involves minimal tissue trauma (the skin incision for experienced neurosurgeons is 2–3 cm), it still aggravates the degenerative-dystrophic process in the operated IVD and reduces its height, as a result of which the predicted result is not always achieved. To preserve the functionality of the IVD after removal of the hernia, it was proposed to suture the wound of the fibrous ring. A new operation was specially developed - annuloplasty (J. Cauthen, 2002). However, it turned out to be ineffective due to high loads and low regenerative potential of the fibrous ring; relapses of the hernia were observed again.

The results of standard microdiscectomy worsen due to the age of the patients, long duration of the disease, and repeated microdiscectomies at the same level; improve - manifestations of osteochondrosis only at one level, removal of large IVD hernias (> 6 mm according to CT).

Indications for standard microdiscectomy have been developed for a long time and are based on the neurological manifestations of hernias. They are divided into relative and absolute. Regarding the absolute indications for standard microdiscectomy, all authors are unanimous: compression of the cauda equina, intractable severe pain, or myeloradiculoischemia with paralysis of certain muscle groups (similar to an acute abdomen) require urgent intervention. But the justification of microdiscectomies for relative indications is not recognized by everyone (Ya. Yu. Popelyansky, 2003; E. L. Tolpekin, F. V. Oleshkevich, 2006).

Epidurochemonucleolysis. Targeted prolonged treatment with a complex of drugs (bupivacaine, lidase, Vit. B12) through a catheter placed through the lower sacral opening into the epidural space, under RTG control. The technique makes it possible to deliver drugs directly to the area of ​​the disc-radicular conflict without violating the integrity of the anatomical structures. The criterion for effectiveness is a reduction in the size of the hernia during control CT examinations. When analyzing the results of treatment using this technology, it was revealed that the best results were obtained for hernias larger than 6 mm, when there is a rupture of the fibrous ring and posterior longitudinal ligament, and lidase directly affects the sequestra of IVD hernias.

Based on the facts of the pathogenesis of the disease and the above treatment results, it cannot be argued that the size of IVD hernias is a fundamental factor for indications for surgical treatment. There is no clear correlation between the size of the hernia and the severity of neurological manifestations, and, conversely, with acutely developed intractable low back pain with a pronounced clinical picture of radiculopathy, in most cases we find large IVD hernias.

Who will judge the neurosurgeon and orthopedist?

Posterior intervertebral disc herniation is a pathology of the musculoskeletal system and peripheral nervous system, therefore, in the principles of providing surgical care, there are two positions - neurosurgeons and orthopedists.

Most neurosurgeons believe that the main cause of suffering is compression of the nerve structures caused by IVD herniation, and its surgical removal is the key to recovery.

Orthopedists adhere to other positions, paying primary attention to the degenerative-dystrophic process in the IVD, and therefore direct their efforts to restoring the correct anatomical relationships in the spinal motion segment.

The ideal solution to the problem would be not only the elimination of the disc-radicular conflict, but also the restoration of the function and height of the IVD. This is not yet an achievable goal. Surgical treatment for multilevel lesions also remains unresolved.

In recent decades, at the intersection of these disciplines, a new science has emerged - vertebroneurology. Conferences and symposia on this topic are convened almost every year. In 1992, at a Soviet-American symposium on the treatment of spinal osteochondrosis, the American vertebroneurologist A. White noted that the effectiveness of treatment for such patients depends on the quality of the teamwork of multidisciplinary “spinal” teams, which should include a therapist, surgeon, psychiatrist, radiologist, physiotherapist. The leading doctor of the team should not be a surgeon, but a specialist who knows the patient better, his psychosocial status, working conditions, financial circumstances, and rehabilitation resources. Such a doctor would take responsibility in making decisions on surgical treatment, pre- and post-operative management. In our country, the solution to this problem lies in the creation of vertebroneurology centers, where patients could receive emergency and planned care from all specialists working in this field. Patients with back pain would not have to visit a neurologist (therapist) at the clinic several times, then wait for a CT/MRI examination, which significantly increases the preoperative period.

In the clinic of neurology and neurosurgery of the Belarusian State Medical University, a method of step-by-step treatment of patients with neurological manifestations of spinal osteochondrosis has been developed and implemented according to the principle of increasing radicalism:

1. therapeutic paravertebral blockades with hormonal and enzyme preparations, or transsacral epid-urochemonucleolysis;

2. standard microdiscectomy with endoscopic assistance;

3. standard microdiscectomy + epidurochemonucleolysis (for multilevel pathology);

4. standard microdiscectomy + dynamic stabilization of the spine with a U-implant (in case of severe dynamic instability and repeated operations).

Evgeniy TOLPEKIN, neurosurgeon, candidate of medical sciences. Sciences Medical Bulletin , November 26, 2009

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MBST therapy

This technique is used in the treatment of hernia of the cervical spine. It helps restore cartilage tissue in joints and reduce the stage of arthrosis. This treatment method uses high-pulse magnetic resonance to cartilage at the cellular level.

When exposed to a hernia or protrusion in the lumbar and thoracic or cervical and thoracic regions of the spinal column, the following is noted:

• regeneration of spinal discs at the cellular level;
• reduction of edema in the tissues of the damaged area;
• weakening of acute and chronic pain syndrome;
• facilitating body movements when standing up, standing, and moving.

You can undergo treatment for a cervical hernia in Moscow at ArthroMedCenter. MBST therapy will relieve pain and swelling, and will also help restore damaged discs.

Conservative treatment of C5–C6 disc herniation

After confirming the diagnosis and assessing the size of the C5-C6 hernia, which does not contradict the possibility of conservative treatment, the patient is prescribed complex therapy aimed at reducing the severity of pain, eliminating the neurological deficit and eliminating the causes that led to the development of the pathology. For these purposes I may appoint:

• drug therapy;
• osteopathy;
• manual therapy;
• massage;
• physiotherapy (phonophoresis, carboxytherapy, ozone therapy);
• individual sessions with a rehabilitation doctor

Patients are also advised to make lifestyle changes to reduce the effects of factors predisposing to the development of osteochondrosis and subsequently hernias. It is very important to avoid straining the neck. Therefore, if the patient’s work involves the need to remain in a forced position for a long time or sit for a long time, every hour you should take a short break and leave your workplace to warm up or just walk.

In certain cases, patients are advised to wear a Chance collar, which is a neck brace. Its goal is to reduce the load on the cervical spine and, accordingly, the C5-C6 intervertebral disc.

Additionally, treatment of concomitant pathologies, including heart and vascular diseases, is prescribed.

Drug therapy

Drug treatment is aimed at eliminating the symptoms of a C5-C6 hernia, eliminating the inflammatory process and improving the condition of the intervertebral discs. It always includes a complex of medicines, the list of which is selected strictly individually. The main groups of drugs used for intervertebral hernias are:

• NSAIDs - recommended both during the acute period and after its end to reduce pain, local swelling and inflammation;
• muscle relaxants – used to eliminate muscle hypertonicity and spasms, which has a positive effect on the patient’s condition and breaks the vicious circle of “pain - spasm - pain”;
• corticosteroids – used for severe inflammation that cannot be controlled by other means;
• B vitamins – help improve the conduction of impulses along nerve fibers and reduce neurological symptoms;
• vitamin D is a remedy responsible for the condition of bone tissue, as well as for higher brain functions, such as memory, memory, attention, speech;
• chondroprotectors - are prescribed to improve nutrition, activate metabolic processes in the intervertebral disc and restore them, but the effectiveness of such drugs does not have a strong evidence base. We recommend Mermaids Marine Collagen to our patients.

Spinal traction

Traction therapy or spinal traction is used in a certain category of patients to increase the distance between the 5th and 6th vertebrae of the cervical spine. This reduces the pressure on the intervertebral disc located between them and there is a possibility of releasing the pinched nerve. This leads to an improvement in the patient’s condition and creates favorable conditions for disc restoration.

The procedure involves the use of special equipment in the form of a couch and belts, with which the patient’s body is fixed in the desired position and stretched along the axis of the spine.

Physiotherapy

Physiotherapy is used after the end of the acute period in order to improve the course of metabolic processes, reduce the inflammatory process and eliminate increased muscle tone.

Most often, patients with C5-C6 hernias are recommended to undergo a course of procedures:

• electrophoresis;
• laser therapy;
• ultrasound therapy;
• UHF.

As a rule, 10–15 procedures are prescribed. After completing a course of physical therapy, patients often report significant improvement in their condition, increased range of motion in the arm and neck, and a decrease or complete disappearance of pain.

However, in some patients, physical therapy may worsen the condition. In such situations, it should be abandoned immediately.

Manual therapy

One of the most effective methods of conservative treatment of a C5-C6 hernia, which allows one to truly eliminate the causes of the formation of pathological protrusion, eliminate compression of the nerves and create conditions for disc restoration without surgery, and not just influence the symptoms of its appearance, is manual therapy. But not every chiropractor is able to help in such a sensitive case.

The fact is that the neck and cervical spine are a very complex area, working with which requires special skills and knowledge. Some of the most important nerves and large blood vessels are concentrated here, and the vertebrae are small and fragile. Therefore, a careless or incorrect movement by a specialist can cause more harm than good.

Therefore, if you have a C5-C6 hernia, contact only a highly qualified chiropractor who is thoroughly familiar with the methods of treating pathologies of this part of the spine. One of the most effective methods for treating cervical spine hernias is the original Gritsenko method. It has more than 95 patents and has been successfully used for more than 20 years, during which it has managed to prove its high efficiency and safety.

The method allows not only to improve tissue trophism, reduce muscle spasms, but also to positively influence the condition of the spine and intervertebral discs. Thanks to the use of special techniques, a chiropractor is able to return the vertebrae to the anatomically correct position, reduce their pressure on the intervertebral disc, and most importantly, eliminate the pressure of certain anatomical structures on the spinal roots.

This makes it possible not only to quickly eliminate almost all the symptoms of a hernia, but also to improve nerve conduction, which has a positive effect on the sensitivity and mobility of the hands, and also reduces the risk of developing heart and vascular diseases. With the help of manual therapy sessions correctly carried out according to the Gritsenko method, it is possible to get rid of discomfort in the throat, tinnitus, headaches and a number of other consequences of nerve compression in the shortest possible time.

Prevention

To eliminate the possibility of the formation of a cervical hernia or slow down the progression of this pathology, the following requirements should be met:

• Adhere to proper physical activity. When leading a sedentary lifestyle, you should decide on the appropriate form of physical activity. You can do dancing, swimming or yoga. You must attend classes at least twice a week. People whose work involves lifting heavy objects should avoid excessive stress on the spinal column and use a support bandage.
• If your posture is poor, you should not ignore the symptoms; you need to start treatment.
• It is necessary to normalize body weight, since extra pounds lead to increased stress on the musculoskeletal system.
• Go for a massage periodically.
• Normalize your diet by adding foods containing large amounts of calcium and protein.

When a cervical hernia is detected, most often the problem can be dealt with without resorting to surgery. You can return to your normal lifestyle in a short period of time. However, symptoms may reappear in the future. Therefore, it is recommended to use long-term methods to control pathology and perform a set of exercises to prevent possible problems with intervertebral discs.