Can an intervertebral hernia “resolve”? Neurologist answers.

Many patients diagnosed with a hernia of the lumbar spine ask doctors whether it can resolve. If you seek medical help at the initial stage of the disease, undergo treatment and follow all the doctor’s recommendations, you can stop the degenerative process in the vertebral structures and reduce the size of the hernial protrusion. If you neglect the doctor’s prescriptions, the hernia will quickly progress and grow, and the risk of complications will also quickly increase.

Incarceration in the cervical spine on an MRI image.

Can a herniated disc go away?

A herniated disc is formed as a result of rupture of its protective fibrous ring and prolapse of the nucleus pulposus. As the protrusion increases in size, it enters the spinal canal, compresses the nerve endings and arteries. It cannot dissolve and disappear on its own, with the exception of isolated cases.

Herniated discs of the lumbar region develop most often - in 150 cases out of 100,000.

What happens in the body of a person who does not receive treatment for a hernia:

• Limitation of mobility. Due to the pain syndrome, a person cannot perform sudden movements, bending, turning, as they increase the load on the lower back and cause discomfort.
• With excessive physical activity and heavy lifting, the load on the damaged disc increases, as a result, degenerative processes progress and the hernia increases.
• In the affected structures, metabolic disorders occur, the intervertebral disc tissue becomes thinner.

If the factors that cause disc destruction are not eliminated, the herniation will become larger. If you consult a doctor, start drug treatment, physiotherapy, attend exercise therapy, the condition improves, the hernia may decrease in size, but it cannot completely disappear. To obtain positive results, long-term treatment is required - several months and even years.

Probability of disappearance of hernia formation

Cases have been established in which patients' hernial protrusion in the lumbar region decreased by 70%. This is a rare phenomenon, and it is possible only with a sequestered hernia, when the contents of its core enter the spinal canal and are perceived by the body as a foreign body. All the body’s forces are directed toward the breakdown of tissues, and phagocytosis begins. This is a process in which the body’s protective cells, macrophages, recognize the prolapsed fragments of the hernial protrusion as foreign, capture them and dissolve them.

The launch of such a process is possible in the body of young people - up to 23 years old. At an older age, and even more so in the elderly, such a reaction of the body is impossible.

The rate of resorption or resorption of hernial elements also depends on individual characteristics. The chances of rapid dissolution increase with good tissue nutrition. In one patient, 5 blood vessels may approach the affected structures, and in another, 10. In the second case, the process of the body’s fight against pathology will go faster.

A patient with a sequestered lumbar hernia with compression of the S1 nerve root was observed. After examination, surgery was recommended for her. But after 8 months, the clinical manifestations and muscular-tonic syndrome completely regressed, which was confirmed by MRI results (see figure). After independent regression of the vertebral hernia, the patient continued to have moderate pain, which was caused by musculoskeletal pathology (source - scientific article “Regression of the herniated disc of the lumbar spine”, authors - G. Yu. Evzikov, A. I. Isaikin, A. V. Kavelina and etc.). But such cases are rare; one cannot refuse treatment and rely on the possibility of self-resorption of the hernial protrusion.

When receiving adequate conservative therapy, in 50% of patients with diagnosed intervertebral herniation, all clinical symptoms decrease or disappear within a month. For large lumbar hernias, recovery may take up to six months or a year.

Calcification of hernia

Another option when a vertebral hernia disappears is the process of decalcification or its “impregnation” with calcium. If the factors that caused the hernia are eliminated, the calcium concentration in the disc cartilage gradually increases. There is less moisture in the hernial protrusion, it becomes denser and, as it were, “blocks” the hole in the ruptured fibrous disc. The nucleus pulposus can no longer move outward from the middle of the disc; its exit is closed.

There is a gradual stabilization of the patient’s condition, as the protruding part of the hernia slowly dries out, accordingly, the compression of the nerve endings decreases, and the pain subsides. Over time, the size of the hernial protrusion decreases due to the removal of inflammatory edema, which develops when soft tissues and spinal nerve roots are compressed.

The process of soaking a hernial bulge with calcium takes several months for sizes no more than 4 mm. If the intervertebral hernia is large, defoliation can take up to 2–3 years.

Chemonucleolysis

Chemonnucleolysis is a treatment method in which a special drug, chemopapain, is injected into the hernial sac through a catheter under local anesthesia. The enzymatic drug liquefies the tissue of the hernial protrusion, which the doctor then removes from the body.

This minimally invasive method of treating a hernia can be performed once a week. As a result, small disc bulges resolve in about a month. To prevent the hernia from appearing again in the same place, a special modeling compound is injected into the fissure of the fibrous ring. Subsequently, it prevents the nucleus pulposus from protruding outward.

Resolving a hernia in this way does not lead to complete recovery. The drug destroys the hernial sac, but disruption of biochemical processes in one vertebra provokes structural destruction of neighboring vertebrae, increasing the risk of the formation of new vertebral hernias. To stabilize the condition, it is necessary to constantly carry out treatment and engage in physical therapy.

Thoracic and cervical regions

These sections were united, because the spinal cord passes through them in the central canal of the spine. We will not dwell in detail on the typical symptoms of osteochondrosis, which indicate the existence of a disc herniation. These are, for example, symptoms such as:

• pain in the neck or chest, which radiates to the arm or shoulder, girdle pain like intercostal neuralgia;
• diffuse sensitivity disorder, numbness, tingling in the neck,
• weakness in the neck, arm muscles, hands or fingers;
• autonomic disorders associated with changes in blood pressure, coldness and redness of the skin, changes in skin temperature.

In addition to the above symptoms, it is necessary to list the dangerous signs of spinal cord damage. They should be regarded as a complicated course of a sequestered hernia in the cervical and thoracic spine, and require immediate hospitalization in a neurosurgical hospital on the board, with transportation according to the rules of a probable spinal fracture. These symptoms include:

• progressive weakening of pain and temperature sensitivity on one half of the body, which indicates compression of the lateral column of the spinal cord;
• the presence of severe weakness in the legs, or even at the level of the body on one side, and on the other side - loss of pain and temperature sensitivity, which indicates transverse myelitis, or compression, pronounced swelling of half the diameter of the spinal cord;
• The most dangerous symptom is compression of the entire diameter of the spinal cord by sequestration (hematoma, edema, complete transverse myelitis). In this case, the patient will have a complete absence of all types of sensitivity downward from the localization of the sequestrum, and at the same time central paralysis and the presence of central type urinary disorders will be observed.

In the event that we are talking about a thoracic or lower thoracic lesion, then this will be paralysis in the legs. If we talk about the most unfavorable localization of a complicated sequestration in the area of ​​the upper cervical thickening, then we will be talking about spastic tetraplegia, that is, complete paralysis of the arms and legs and loss of all types of sensitivity.

Thus, in the event of a sudden development of edema or injury to the structures of the spinal cord, both the thoracic and especially the cervical and upper cervical localization of a sequestered hernia is a “time bomb.” In the event of the development of injury or compression of the spinal cord, a transformation of the usual complaints occurs - the cessation of pain impulses, and the transformation of complaints towards the appearance of loss of sensitivity and the development of paralysis.

What treatment can speed up the process?

You can help your body cope with a vertebral hernia and improve your well-being by contacting the clinic. First, conservative treatment is prescribed, which includes:

• drug therapy;
• physiotherapy;
• physical therapy.

For lumbar disc herniation, the following medications are indicated:

• Analgesics for quick pain relief - Ketonal, Ketorol.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve inflammation and reduce pain - Diclofenac, Voltaren, Ibuprofen.
• Muscle relaxants for relieving muscle spasms - Mydocalm.
• Angioprotectors to improve blood circulation in affected tissues - Actovegin.
• Chondroprotectors for restoration and regeneration of affected vertebral structures - Chondrolon, Artra, Alflutop.
• Diuretics to relieve swelling - Triampur, Hypothiazide.
• B vitamins to restore metabolic processes - Milgamma, Neuromultivit.

In the absence of acute pain, physiotherapy is prescribed:

Physiotherapy methods help improve lymph and blood flow, reduce pain, relieve inflammation and swelling, and improve the conductivity of nerve endings.

63 patients (32 men and 31 women) aged 20–67 years with lumbar disc herniation were examined and treated. In parallel with taking medications, treatment was carried out with laser and diadynamic currents (device in the photo). As a result, pain and neurological syndromes were reduced due to improved hemodynamics and bioelectrical activity of muscle tissue (source - scientific article “Complex treatment of intervertebral hernias of the lumbosacral spine”, authors - M. Yu. Gerasimenko, N. N. Petrova).

Complex therapy additionally includes massage, acupuncture, hirudotherapy, spinal traction (traction), and manual manipulation. Active use of these techniques is contraindicated in patients with intense pain syndrome, as well as with signs of compression of the nerve roots.

A mandatory component of conservative treatment for intervertebral hernia is physical therapy (PT). The doctor selects a set of exercises individually for each patient, based on the diagnosis and symptoms. Physical activity strengthens the muscle corset, unloads the spine, reducing the load on the affected discs. This relieves pain and improves well-being.

Treatment of a herniated lumbar spine in medical centers in the Czech Republic can significantly reduce the size of the hernial protrusion and avoid surgery. This is facilitated by modern techniques, the best doctors, and excellent technical equipment. After a course of therapy in Czech clinics, patients return to their normal lifestyle, forgetting about pain and other symptoms caused by a vertebral hernia.

Rehabilitation

Only after surgical intervention and removal of the sequestrum can symptomatic therapy such as acupuncture, physical therapy, manual techniques, and other exercises be used without the risk of injury to the structures of the central nervous system. In the postoperative period, physiotherapy, electrophoresis with vitamins, and novocaine are indicated.

Electrophoresis.

When a hernia won't go away

You should not count on solving the problem without medical intervention for any type and size of lumbar hernia. An unfavorable prognosis for those patients who refuse to go to the doctor, or who, having received doctor’s orders, do not follow them.

If at a young age there is minimal chance of tissue regeneration with a small hernial protrusion, this does not happen in elderly patients. Regenerative and metabolic processes in their tissues are very slow.

A hernia cannot resolve if it was diagnosed more than 5 years ago, the patient did not receive treatment and suddenly decided to undergo therapy. In this case, recovery requires a lot of effort and time, and in case of complications, surgical intervention, for example, video endoscopic microdiscectomy, may be indicated. The endoscope for this manipulation can be seen in the photo.

Prevention of disease development

The development of lumbar intervertebral hernia occurs due to regular microtrauma of the cartilage tissue of the discs. This area of ​​the spine bears the maximum load. To prevent the development of hernial protrusions, it is necessary to avoid lifting heavy objects; if physical activity is present, it should be moderate.

Regular physical therapy is required to maintain the spine; swimming and yoga are suitable. Following the principles of proper nutrition allows you to get rid of excess weight, which also overloads the spine.

Thus, the idea that an intervertebral hernia of the lumbar spine can go away on its own is just an illusion. You should not keep it in mind when making a diagnosis. Even with a small protrusion, you should undergo a course of treatment. Without treatment, the hernial protrusion will only increase. The pathology is dangerous because it pinches nerve endings and the spinal cord, which leads to limited mobility and disability.

Clinical symptoms

Common signs for a sequestered hernia of all localizations will be great danger, rapid development of progressive neurological symptoms. In cases of localization in the cervical and thoracic region, these are symptoms of spinal cord damage, similar to a spinal stroke, very severe pain when exposed to the roots. As a rule, the onset associated with the formation of sequestration is always manifested by acute and severe pain.