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Spinal herniation is a common finding on MRI. Magnetic resonance imaging is a modern detailed screening technique that allows you to obtain accurate information about the condition of all structures of the back. Using this method, neurologists can diagnose various degenerative changes in intervertebral discs, including protrusions, intervertebral hernias, prolapse, and extrusions.
Mechanism of formation of intervertebral hernia
The spine is designed to withstand loads. It supports and stabilizes the body in a standing position, providing complete freedom of movement. When lifting weights, uncomfortable positioning of the body, strong and stressful loads, it takes on the main effort. The load is especially severe when lifting heavy objects with outstretched arms. The heaviest load and, accordingly, wear falls on the lumbar region. When age-related or pathological changes begin in the body, tissues change structure and can no longer fully perform shock absorption functions. Under force, they can become deformed and crumble, which disrupts the functions of the spine and can disrupt the functioning of the entire body.
Examination with contrast
During MRI of the lumbar and sacral regions, the use of a contrast agent is usually not required. All changes are visualized in detail in the pictures even without its use.
However, if a tumor is suspected, a contrast method is used, which makes it possible to identify a tumor, determine its shape and structure, extent, benign or malignant nature, and the presence of metastases. Contrast enhancement is also used to diagnose inflammatory processes, the presence of scar tissue, and relapses after surgery.
How does a hernia appear?
The formation of protrusion occurs in several stages:
- Protrusion. The beginning of pathological changes. The fibrous ring becomes less elastic and can shift and become deformed.
- Partial loss of a section of the disc. This is the second stage in which tissue destruction can occur. This process is inevitably followed by displacement of the gel-like core of the disc.
- Prolapse. The nucleus emerges from the disc ring and begins to influence the nerve endings located nearby.
- Sequestration. The process by which a semi-liquid substance from the nucleus penetrates the cavity of the spinal column. This is accompanied by allergic reactions, nerve connections and blood flow in the tissues are disrupted. Due to constant pressure in an area that is not designed for it, there is a loss of sensitivity and the threat of paralysis.
If help is sought in a timely manner, when the process does not involve the nerves and spinal cord, conservative treatment is used and the patient can be completely cured.
Types by degree of protrusion
Another classification distinguishes hernias according to the degree of their extension beyond the intervertebral space and the integrity of the fibrous ring. There are such types - protrusion, prolapse, extrusion, sequestration.
Protrusion
A type of minor spinal hernia, when only the internal fibers of the fibrous ring are damaged, the ring itself does not rupture. The reason is deformation and dehydration of the intervertebral disc, which reduces its elasticity. Cracks appear in the ring, and the fixation of the vertebrae with each other deteriorates.
Bulging occurs under vertical loads. Therefore, if the patient was lying down during the examination, the defect may not be noticed. The formation often occurs in the lumbar spine, less often in the neck and chest. The compression of the nerve endings disappears quickly. The nature of the pain depends on the location of the protrusion:
- thoracic region
- the heart, lungs, and other organs inside the sternum ache; - lumbar zone
- discomfort in the back, numbness in the legs, groin area; - cervical spine
– neck pain, decreased blood pressure, headache, tinnitus.
Prolapse
Prolapse is a medium-sized hernia of the spine, which is characterized by partial release of the nucleus into the spinal canal. The ring may simply stretch too much or tear. The nucleus compresses the nerve roots, causing inflammation and swelling of the tissue.
The appearance of a protrusion is accompanied by chronic pain, impaired sensitivity in the lower back, neck, legs and arms. Discomfort intensifies with sudden movements (coughing, sneezing), and can put a person to bed for several days.
Prolapse usually appears in the lower back. The main reason is spinal injury due to heavy lifting, sudden straightening and turning, working in an awkward position, hypothermia, and stress.
Extrusion
Extrusion is a hernia in which the fibrous ring is torn, but the longitudinal ligament remains intact. Discomfort appears if the nucleus pulposus touches the nerve roots.
Pain symptoms may vary, depending on the size and displacement of the protrusion. With a strong shift, a dull spasm occurs in the neck, which moves to the head and shoulder. Possible numbness, tingling, and loss of skin sensitivity. With breast extrusion, the heart, ribs, stomach, and intestines hurt. When the lumbar region is affected, problems appear in the lower back, groin, and legs. The development of pathology is fraught with impaired urination and erection in men.
Protrusion, prolapse, extrusion, severstration - types of hernias according to the degree of their extension beyond the intervertebral space
Severstration
Sequestration is a severe form of hernia, which is characterized by the formation of a sequester - the prolapse of the nucleus or part of the disc into the spinal canal. Due to rupture of the longitudinal ligament, the nucleus pulposus is completely or partially separated from the disc. It falls into the canal, squeezing the nerves. The mass may remain in place or migrate up or down, simulating a herniation of another vertebra.
The diagnosis is usually made in older people. A striking symptom is lumbago in the back, which radiates to the legs or arms, followed by numbness, sometimes paralysis.
How does a hernia manifest?
At the very beginning of the development of the pathological process, the patient does not feel serious pain, symptoms are few. The more tissue protrudes, the more the patient feels it. There are three groups of symptoms for intervertebral hernia:
- The main symptom of a herniated disc is pain. At first it is not sharp, may be aching, and go away with a change in body position. The more serious the stage of the process, the stronger the pain. Shooting sensations appear, it is painful for the patient to turn the body, the sensations intensify with physical activity.
- Spinal syndrome. Constant pain causes spasms in the lower back muscles. The patient cannot move fully and is forced to tilt the body in order to relieve some of the load and reduce pain.
- Damage and death of nerve roots due to constant compression. The compression that occurs due to tissue protrusion constantly affects the nerve fibers. This disrupts blood flow, their functions, and later death occurs altogether. The manifestations of this process are: weakness, decreased tone, loss of sensitivity, the appearance of body asymmetry, decreased sensitivity and tone of the skin.
If the protrusion occurs in the posterior direction, any physical work is highly likely to cause severe compression and paralysis.
When should you get tested?
MRI of the lumbosacral spine is performed if there are signs of pathological conditions, including:
- Sharp or aching, pulling or shooting, chronic or periodic pain in the back, lower back;
- Weakness or impaired mobility of the lower extremities;
- Pain radiating to the buttock, groin or leg;
- Limited mobility in the lower back;
- Morning stiffness;
- Sexual dysfunction;
- Disorders of defecation and urination.
An indication for an MRI may be partial paralysis that develops after injury to the lumbar or sacral spine, or the need to monitor a hernia. After 35 years, it is recommended to undergo such a study annually for preventive purposes.
Manifestations depending on the location of the hernia
The characteristics of a hernia are determined by its location. In this area, the nerve roots are pinched and a characteristic clinical picture occurs. The nerve that is pinched during the formation of the lumbar protrusion of the spine runs along the inner surface of the leg from the hip to the ankle. The pain is not necessarily localized along the entire length; it can be reflected in the leg, foot, buttock, or outer side of the thigh. The lower back may also hurt at one point. As the situation develops, the pain may move lower - to the lower leg, heel and toes. In intensity, it can be a constant aching pain or lumbago that occurs when moving.
Basically, the pain becomes more intense with prolonged walking, standing, turning the body, and bending. It is also painful to lift your leg, do a number of exercises, and also drive on uneven roads.
At the beginning of the development of a hernia, pain can be relieved by lying down, bending one leg at the chest. This will help relieve tension and pressure on the nerve endings. In a more complex situation, this method will not help. Movements are constrained, their amplitude is greatly reduced, and the leg gets tired.
Basically, the patient feels compression of the spinal cord as tingling, burning, and numbness. It dulls the pain. The main symptom that the specialist will pay attention to during the examination is muscle tension on the side of the back, painful when pressed.
Preparing for an X-ray
Examination of the cervical or thoracic area does not require any preparation. The same cannot be said about a lumbar hernia. The main preparatory measures are aimed at eliminating gases in the intestines, since their fermentation can seriously distort the diagnostic result:
- A week before the x-ray, exclude all foods that provoke fermentation in the intestines (cabbage, rye bread, beer, legumes);
- Carrying out a cleansing enema immediately before the x-ray.
In addition, the information content of the image also depends on how correctly the patient behaved during the procedure: the laboratory assistant determines the correct position, which is important to follow to the end.
Establishing diagnosis
The diagnosis is made after examination and examination of the patient. First of all, instrumental diagnostics are carried out to help determine whether the tendon reflexes are normal. The patient is asked to raise his straightened leg. Tests are also carried out for sensitivity to vibration, the ability to sense temperature and pain. If there is a hernia, there will be certain manifestations:
- The doctor will determine the sensitivity disorder.
- The patient's movement biomechanics will be changed.
- Tendon reflexes will deviate from normal.
Also, to diagnose protrusion, CT or MRI diagnostics of the spine is performed. These studies will help not only visualize the hernia, but also determine the condition of the surrounding tissues and diagnose narrowing of the spinal canal, if any. If indicated, contrast myelography may be prescribed. After the examination, the degree of pathological changes can be determined and adequate treatment can be prescribed. If the nerves are not affected, the patient complains only of pain, conservative therapy is used.
Reasons for ineffectiveness
X-rays for spinal hernia are not effective due to certain factors:
- There is no way to track the problem in the dynamics of its development. During the procedure, only two projections can be used: direct and lateral. Both are static. They do not allow you to track the state of the problem in detail. In other words, each subsequent image will show no improvement or deterioration in the patient, even after intensive care. This is fraught with serious consequences, especially if the tumor continues to grow and compress blood vessels and nerve endings. Other forms of diagnostics will certainly be required.
- An X-ray image can only make a preliminary diagnosis; an accurate diagnosis will require an MRI.
- Since cartilage tissue, which is what a spinal hernia is, allows the rays of an X-ray machine to pass through it well, it is quite problematic to see its pathology.
In connection with all of the above, a fair question arises: if a vertebral hernia is not clearly visible on an x-ray, then why doctors so strongly recommend this type of diagnosis. It's all about its accessibility for all categories of citizens.
Why is a lumbar hernia dangerous?
Any hernia brings not only pain, but also a serious risk of disruption of the body and paralysis. Vertebral protrusion in the lumbar region has a number of dangerous accompanying manifestations:
- Blood circulation in the pelvis is disrupted, due to which the organs do not receive proper nutrition. This provokes problems with the excretory system and disruption of the internal genital organs.
- The spine is curved due to muscle tone. This causes compression of internal organs and can provoke other pathologies not directly related to the spine.
- Sensitivity decreases, numbness and limited body mobility are observed.
- Shooting appears - severe sharp pain during physical activity or movement.
- Knee reflexes may disappear, and mobility of the ankle and foot may change.
- The most serious consequence is paralysis.
What doctors will see
The two main projections of the procedure allow you to see the vertebral arch and spinous processes. Regardless of the degree of development of the hernial tumor, the image will definitely show the following nuances:
- Distance between disks.
- distinct contouring of each of the vertebrae: the slightest irregularities in the outlines can become a signal. For example, with a Schmorl's hernia, a peculiar concavity of the vertebra is present, and if additional processes are detected, osteochondrosis is diagnosed.
- Bone density level. Bones fixed in one place are particularly brightly colored in the image.
At first glance, all this is quite enough to make the correct diagnosis. In reality, it turns out completely differently. All these are indirect signs of a vertebral hernia; in fact, it will not be possible to consider a serious pathology. But at the same time, one should not underestimate the effectiveness of X-ray examination as part of the general identification of back problems.
Operation
Radical intervention is used when it is necessary to free the spinal cord and nerves from the pressure of protruding tissues. The most popular methods are:
- Endoscopy is an operation through an incision in the spine using a probe. A camera and instruments are inserted through a small hole, and displaced tissue is removed.
- Disc endoprosthetics. Damaged elements are removed. A prosthetic structure is installed in their place.
- Percutaneous discectomy. Access is made through a puncture, the deformed core is removed and replaced with a special compound.
- Laser reconstruction – the hernia is removed by evaporating moisture from the tissue.
Main contraindications
For all its information content and safety, MRI has some contraindications. They are mainly associated with the peculiarities of the influence of a magnetic field on metal products. The procedure is not performed if the patient has ferromagnetic implants, pacemakers, artificial middle ear simulators, Ilizarov apparatus and other similar devices. MRI is prohibited for people who have metal plates, shell fragments, pins or other elements in their bodies.
Tomography is not recommended for women in early pregnancy or people with mental illness. The procedure is carried out with caution in case of heart failure in the decompensated stage and some other serious diseases. Claustrophobia can create certain problems.
The effectiveness of treatment of any disease depends on the quality of diagnosis.
The timeliness of restoration measures also plays an important role. MRI of the sacral and lumbar region shows various diseases, allows you to accurately diagnose at the earliest stages of the disease and begin treatment on time. Rate this article: (2 rated 5 out of 5)
Preventive measures
Spinal herniation can be prevented. There are a few simple rules for this:
- Nutrition and weight control. Excess weight increases the load on the spine.
- Rejection of bad habits.
- Regular physical activity - morning exercises, warm-up during sedentary work.
- Sleep on a hard mattress, choose the right pillow.
- Preventive examinations with a doctor, timely seeking medical help if alarming symptoms appear.
By contacting a neurologist at the Central Clinical Hospital of the Russian Academy of Sciences in a timely manner, you can avoid complications and return to a normal lifestyle as soon as possible.
Comparison with other methods
Other methods can be used to study the lumbosacral region. Previously, pathologies in this area were identified using x-rays - x-raying the human body using electromagnetic waves of a certain length. They are called X-rays.
This technique is simple and cheap, but at this wavelength it has a harmful effect on the body. Its result can be the development of pathologies, including life-threatening ones. In addition, x-rays do not make it possible to obtain a three-dimensional image and examine all the details of the structure under study. As a result of the procedure, a shadow image is obtained that only follows the contours of the internal organs.
Computed tomography is a more modern method that provides a clear layer-by-layer image of the object of study. The procedure takes longer than an x-ray, but the resulting image can be rotated on a computer screen, which increases diagnostic capabilities. The radiation dose to the patient's body with CT is lower than with X-rays, but ionizing radiation is still present. For this reason, the procedure should not be performed too often.