Types of vertebral hernias - complete classification

Spine structure

To better understand what the different types of herniated discs are and how they occur, you need to have some understanding of the structure of the spine. The spine consists of 32 osteochondral structures (plus or minus a few units), which are sequentially attached to each other:

The upper 24 vertebrae are connected by discs, facet joints, and musculo-ligamentous apparatus. The joints soften shocks and shocks that are sent to the spine when moving.
The lower nine structures in adults are fused - 5 in the sacrum, 4 in the coccyx.

Almost all vertebrae (except 1 and 2) have a similar structure. They consist of:

Body
– located in front, performs a supporting function. The upper and lower parts are attached to the intervertebral discs.
Arcs
– located at the back, consists of 11 parts (2 legs, 2 plates, 7 processes). The plates are connected to the ligaments, the pedicles are connected to the vertebral body. The processes attach muscles and ligaments and act on them.

Between the vertebrae there is a softening “cushion” - a disc. It consists of a soft center (core) enclosed in a very tough shell (annulus fibrosus).

Any type of spinal hernia occurs when:

The integrity of the ring is compromised.
The core of the disc protrudes into the spinal canal and puts pressure on the nerves, causing pain.

Intervertebral hernias tend to shrink and disappear, so they rarely require surgical intervention. Treatment mainly involves massage, exercise therapy, and analgesics.

Reasons for development

A dorsal hernia does not occur on its own. The exact reason why this particular type of pathology develops has not yet been found. There are a number of factors that contribute to its appearance. These include:

Genetic factor.
Impaired metabolism or nutrition of the disc.
Mechanical impact.

As for the genetic factor, a family predisposition of people to the occurrence of hernias has been proven. If one or both parents had this disease, there is a high chance that their children will also develop it as they grow older. This is due to individual characteristics of the structure of the spine, ligamentous apparatus and predisposition to degenerative processes in general. In some people, the body ages faster, in others - more slowly. This is a genetically determined process. As well as the occurrence of osteochondrosis and spinal hernias.

Metabolic disorders are one of the main factors. On average, obliteration of the vessels supplying the intervertebral disc ends at 27 years of age. After this, the disc is not supplied with blood, but receives nutrients from the surrounding tissues. Metabolism occurs during movement. The higher the physical activity, the less chance of metabolic disorders in the intervertebral discs. In people with low physical activity, hernial protrusions occur more often.

Mechanical impacts mean not only injuries, but also excess weight. Dorsal hernias most often occur when the injury does not occur on the spine itself, but lies in an axis parallel to it. For example, when jumping from a height or hitting the parietal part of the head. Excess weight is also a mechanical impact on the spine. Lifting heavy objects is also dangerous.

Classification according to the type of tissue protruding beyond the vertebra

The situation when the nucleus pulposus stretches and ruptures the fibrous ring is the most typical, but not the only type of spinal hernia.

There are also hernias:

Bone
- nerve roots are compressed by bone growths that have formed along the edges of the vertebra. This option occurs in old age and is accompanied by constant pain.
Cartilaginous
- the result of various inflammations, in which the cartilage tissue has lost its elasticity. She is unable to resist the pressure of the spine, which pushes her into another structure. An example of this option is a Schmorl's hernia (nodule).

Contraindications

However, even if there are strong indications, surgical intervention may not always be performed. If the potential risks from removing a hernia are higher than the likelihood of developing complications of the disease, the operation is not performed. But this does not mean that you will have to forget about it forever and continue to live with constant pain and other symptoms of a hernia.

If there are contraindications, treatment is carried out appropriate to the situation, helping to normalize the body’s condition and sharply reduce the likelihood of unforeseen situations, both during surgery and during the rehabilitation period. If with its help it was possible to achieve normalization of the body’s functioning, the operation is performed. Otherwise, it can only cause harm to the patient or lead to dire consequences.

Surgery is contraindicated if:

severe general condition of the patient, requiring constant monitoring of vital functions;
decompensated heart failure and diabetes mellitus;
hypertensive crisis;
blood clotting disorders;
acute infectious diseases, including skin.

Schmorl's hernia

Schmore's hernia can be posterior, anterior, central or lateral

With a Schmorl's hernia, the protrusion does not affect the nerve fibers, so pain is rare. The pathology affects the endplates that separate the disc from the adjacent vertebral bodies. With such a hernia, the cartilage of the plates penetrates the vertebral body, which consists of spongy tissue. This fundamentally distinguishes it from other types of disc herniations.

The pathology usually affects the lumbar or thoracic region. It is hereditary. Formed when a child begins to grow rapidly. Soft tissues have time to stretch, but bone tissues lag behind. Because of this, voids appear in the spongy body of the vertebra, into which the endplates are pressed.

A Schmorl's hernia of the lumbosacral region can be caused by trauma when the disc becomes displaced, forming a defect. Another reason is degenerative diseases of the spine (osteoporosis, osteoarthritis), when cartilage loses its elasticity, forming a knot.

This hernia usually has no symptoms. It is dangerous because the intervertebral disc can fall into the vertebral body, disrupting its function. At the same time, the nodule is the weakest point of the vertebra and can cause damage to it during heavy physical exertion or a strong blow.

Each type of intervertebral hernia has serious complications, so you should not delay treatment.
See how easy it is to get rid of a hernia in 10 sessions

Rehabilitation

After surgery, the rehabilitation period begins. Its severity and duration depend on the type of hernia surgery performed. Therefore, after nucleoplasty, patients can return to their normal routine on the same day and only give up heavy physical work and bending. After endoscopic removal and microdiscectomy, rehabilitation is more complex and requires a hospital stay of about a week.

Patient 15 years old with disc herniation L4-L5: left

After discharge, the patient receives detailed recommendations. During the rehabilitation period, drug therapy, wearing an orthopedic corset, exercise therapy, and physiotherapy are indicated. Sometimes patients are recommended sessions of manual therapy, kinesitherapy, swimming, and yoga.

Patient 15 years old the day after removal of a herniated disc L4-L5.

Primary and secondary hernias

Protrusions are:

primary
- a healthy spine has been subjected to severe stress or injury;
secondary
– diseases of the spine (disc destruction, scoliosis, osteochondrosis, rheumatism).

The main cause of primary intervertebral protrusions is disc degeneration, provoked by heredity, metabolic disorders, trauma, and age-related deformities. Poor blood supply is a common cause of degenerative secondary disc changes. The capillaries do not fit right next to it, so it receives nutrition when moving. When a person leads a sedentary lifestyle, blood does not reach the disc, and it becomes thinner over time.

One common cause of secondary disc degeneration is that the surrounding muscles contract too much, causing them to squeeze the disc in a vice-like manner, cutting off blood flow. It loses moisture and becomes brittle.

Whatever the cause of the intervertebral hernia, lack of treatment is fraught with consequences. Acute pain can deprive a person of mobility and even become bedridden.

Extrusion Prevention

To avoid the appearance of this pathology altogether, it is necessary to take care of your health, starting from childhood. For example, children should learn to always maintain correct posture, especially when sitting at a desk and doing homework. Bags for school books and supplies should be in the shape of a backpack - options for carrying over one shoulder are not suitable for a child, they can lead to curvature of the spine. It is also important to control body weight - excessive weight can negatively affect the entire spinal system.

How to Avoid Disc Extrusion

Both children and adults should lead a healthy lifestyle and exercise. Moreover, we are not talking about severe types. But at a minimum, gymnastics or morning exercises should be present in everyone’s life. This will strengthen the muscular corset of the body, due to which the load on the spine will be less.

If you want to learn in more detail how to identify a spinal hernia, as well as consider the main signs of the disease and diagnosis, you can read an article about this on our portal.

Classification of hernias by location

The annulus fibrosus often ruptures in the lumbosacral region. Less often - in the neck area, very rarely - in the chest.

Hernia of the lumbosacral region

The intervertebral discs in the lower back not only cushion the impacts of the vertebrae against each other, but also help support the upper body. They also provide the ability to move in a wide range (in all directions).

The main causes of protrusion in the lumbosacral region are heavy loads and disc degeneration. A common symptom is dull pain in the lower back, which is accompanied by joint stiffness. When moving, the discomfort intensifies and occurs after standing or sitting for a long time, or walking a short distance. Leaning forward, laughing, sneezing, or other sudden action may make the symptom worse.

The pain can be so excruciating that a person is unable to straighten the spine normally or even move. A tear in the annulus fibrosus causes sciatica, leg discomfort along the sciatic nerve at the back of the leg.

Other symptoms of intervertebral hernia in the lumbar region:

Pain in the legs is worse than discomfort in the lower back. (But if it spreads down the leg along the sciatic nerve, it is sciatica).
Burning, sharp, electric, or stabbing pain.
Discomfort occurs in different places, depending on the location of the protrusion. It can be felt in the lower back, buttocks, thighs, lower legs, and even the feet and toes.
The pain usually affects one side of the body.
Neurological symptoms – numbness, tingling in the leg, foot, fingers.
Problems lifting the foot when moving.

If a herniated disc is caused by muscle spasms in the lower back, it can be relieved by:

Spend 1-2 days in bed, placing a pillow under your knee;
apply heat or ice;
sit, leaning on a comfortable backrest.

The fibrous ring often ruptures in the lumbosacral region

Thoracic hernia

The middle part of the back is the most immobile part of the spine, so hernias rarely appear here. The main reasons for their occurrence are disc deformation, trauma, cracks, and changes in the shape of the vertebrae. Sometimes scar tissue forms between the disc and the spinal cord, which can cause an anulus fibrosus defect.

Common symptoms of a thoracic hernia:

pain in the upper, middle part of the back;
“compression” of the heart, tingling, shooting in the chest;
headaches when a person sits or lies in a certain position;
numbness, pins and needles or burning in the legs;
problems with walking, it hurts to move the lower limb;
weakness in arms or legs;
problems with urination or bowel movements.

Cervical hernia

The main causes of cervical hernia are disc deformation, scoliosis, and osteochondrosis. The pain can be mild, aching or acute.

Symptoms of a cervical hernia:

The pain radiates to the right or left shoulder, between the shoulder blades. It spreads throughout the arm and can reach the hand and fingers.
Numbness, tingling in the shoulder, arm, hands.
Weakness of the arms and hands.
Certain positions or movements of the neck increase pain.
Stiffness in the neck, difficult to bend or turn to the side.

Possible complications or what will happen if the operation is not performed on time

Intervertebral hernias are a very dangerous disease, which, in the absence of timely treatment and removal, can lead to serious consequences, namely:

paralysis of the limbs or the entire body below the level of nerve damage (typical of advanced hernias of the cervical spine, leading to injury and death of the nerves);
loss of control over the processes of defecation and emptying the bladder due to disruption of their innervation;
disturbances in the functioning of the respiratory organs, heart, kidneys, caused by infringement of the corresponding spinal roots;
persistent erectile dysfunction;
prolapse of the vaginal walls;
disability;

With timely surgery, in 95% of cases it is possible to defeat the disease, completely eliminate the risks of complications and significantly improve a person’s quality of life, returning him to full working capacity. Modern operations are characterized by a high degree of safety, so you should not be afraid of them, since delay is fraught with the development of serious consequences, which are much more dangerous than a neurosurgeon’s scalpel and occur much more often than complications of operations. And if you pay close attention to your health and undergo a full course of treatment when the slightest deviation from the norm is detected, then you will not only be able to cope with the hernia using percutaneous surgery methods, but also not bring the situation to the point where you have to undergo surgery.

Classification of hernias depending on size

The larger the size of the protrusion, the worse the state of health. The smallest formation appears in the neck area, the largest in the lower back. The classification of intervertebral hernias by size is as follows:

Small (from 1 to 5 mm).
Medium (from 6 to 8mm).
Large (from 9 to 12 mm).
Huge (from 12 mm).

Small, medium, and large formations are treated using traditional methods. Huge protrusions require surgery if they severely compress a spinal nerve, causing urinary and fecal incontinence, paralysis, and in men - impotence.

What types of intervertebral hernias are most difficult to treat?

4 stages of treatment for intervertebral hernia

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.

Which doctor treats protrusions

First of all, one can never say that a patient has a foraminal protrusion or hernia until the doctor sees it with his own eyes, examining MRI scans of the corresponding part of the spine, performed with a sufficiently high resolution (1.5 Tesla).

Accordingly, the patient must first be examined by a neurologist and prescribed magnetic resonance imaging. CT, or X-ray computed tomography, is less informative. No other diagnostic methods allow an accurate diagnosis.

Perhaps, in the case of a prolonged course of the disease, a significant decrease in strength in the legs and in the presence of sensitivity disorders, it is still possible to conduct electroneuromyography, which will show how severe the disorders are in the corresponding nerve roots of their peripheral nerves. This study can determine prognosis, for example, in determining the degree of disability. But ENMG is an auxiliary diagnostic method; it does not show the actual presence of hernias.

Anatomical classification of hernias

Depending on whether the nucleus is attached or has lost connection with the disc, the following types of vertebral hernias are distinguished:

Loose
– there is a connection between the bulge and the disc, so it stays in place.
Vagus
is a sequestered hernia, when the nucleus loses connection with the disc and severely compresses the nerves and spinal cord. The formation can move a long distance and wander throughout the spine.
Displacement
– occurs under the influence of sudden load, pressure or injury to the spine, which causes dislocation of the disc core. When the pressure goes away, the core returns to its place or remains protruded.

Topographic classification of hernias by location

Another classification divides spinal hernias depending on where they protrude.

Intraspinal protrusion

The hernia protrudes into the spinal canal, affecting the spinal cord. There are many nerve fibers in this area, compression of which can lead to various problems of internal organs, including paralysis.

Based on the direction of prolapse, the following types of intraspinal hernias are distinguished:

Posteromedian
- the nucleus protrudes into the back and compresses the midbrain in the center of the canal. This is dangerous because it bears the heaviest load. There are nerves that innervate the functioning of internal organs. Nerve compression can radiate to any part of the body. In severe cases, intervertebral hernia causes paresis.
Median or medial
- the nucleus falls out in the center of the spinal canal and can compress the spinal cord. In severe cases, surgery is necessary, otherwise the function of the pelvic organs may be impaired.
Peri-median (paramedian)
- intervertebral hernia occurs near the midline, can compress nerve fibers and cause paralysis of the legs. Also, a paramedian hernia causes spinal canal stenosis and parapesis (weakening of the muscle strength of the limbs).
Posterolateral
– exits through the posterior half of the annulus fibrosus on the side of the midline. It happens:
Extraforaminal
- located outside the foraminal foramen, on the side of the roots of the vertebral arches. Discomfort occurs when a large sequester envelops the nerve root on all sides. The pain persists constantly, the intensity does not decrease, surgical intervention quickly corrects the situation.
Lateral
- the nucleus detaches from the disc and ends up in the lateral recess, the narrowest place at the entrance of the nerve into the lumen of the spinal canal. If the formation remains there, the pain persists constantly, radiating to the leg, analgesics do not help. Need surgery.

Intraspina bifida protrudes into the spinal canal, affecting the spinal cord

Posterior protrusion

With a posterior (dorsal) hernia, the protrusion is characterized by prolapse into the posterior part of the spinal canal. In severe cases, it causes not only pain, but also paralysis of the limbs, problems with urination and defecation. Such a hernia often requires surgical treatment.

Anterior protrusion

Anterior (ventral) is the safest type of intervertebral hernia, since it falls anterior to the vertebral body. There are also anterolateral views located beyond the anterior semicircle of the vertebrae. This part bears the least load, so its occurrence is harmless and rarely causes pain. Anterior hernias are discovered by chance during an x-ray.

Diffuse protrusion

It is characterized by damage to the entire fibrous ring, which is evenly stretched under the pressure of the core. The most dangerous is the posterior diffuse formation. It can block the spinal canal, compress the spinal cord and nerve roots. At a certain stage, the ring may rupture and the core may come off. Typically, a diffuse hernia is located in the lumbar region, but is often fixed in other parts of the spine.

Diagnosis of the disease

The main method for diagnosing L4–L5 intervertebral hernias is MRI. This is a highly informative, safe for humans, instrumental study that allows us to give the most accurate assessment of the condition of the intervertebral discs.

The procedure can be carried out in open and closed type devices. The second option is more preferable, since closed devices have greater power, which has a positive effect on the information content of the study and the clarity of the resulting image.

MRI in open devices can be performed only if it is impossible to perform it in a closed one due to the patient’s fear of closed spaces or for other reasons. Such devices generate a magnetic field of up to 1.2 Tesla.

The duration of an MRI is on average 20 minutes. During this entire time, the patient should remain absolutely still so that the resulting images are as clear as possible. If suddenly during the study he feels discomfort, he can call a specialist at any time and interrupt the study by pressing a special button.

Patients are also prescribed CT scans and x-rays of the spine in several projections. These studies are designed to provide information about the condition of bone structures and the position of the vertebrae. Thus, with their help, it is possible to detect concomitant pathologies, often combined with intervertebral hernias of L4–L5. Using CT and X-rays, it is possible to diagnose vertebral instability, the formation of specific bony protrusions at the edges of the vertebral bodies (osteophytes), the degree of curvature of the spine, and also assess the height of the discs.

In our clinic, you can also learn in more detail about the composition of your body and the state of the vascular system, which is involved in the blood supply to internal organs, skeletal muscles, and the brain. Our experienced doctors will explain the data obtained to you in detail. Bioimpendansometry calculates the ratio of fat, muscle, bone and skeletal mass, total fluid in the body, and basal metabolic rate. The intensity of recommended physical activity depends on the state of muscle mass. Metabolic processes, in turn, affect the body's ability to recover. Based on the indicators of active cell mass, one can judge the level of physical activity and nutritional balance. This simple and quick test helps us identify disturbances in the endocrine system and take the necessary measures. In addition, it is also very important for us to know the condition of blood vessels for the prevention of diseases such as heart attacks, hypertension, heart failure, diabetes and much more. Angioscan allows you to determine such important indicators as the biological age of blood vessels, their stiffness, stress index (which indicates heart rate), and blood oxygen saturation. Such screening will be useful for men and women over 30, athletes, those undergoing long-term and severe treatment, as well as everyone who monitors their health.

In this case, body composition analysis gives us information that adipose tissue predominates in the body, and the musculoskeletal component is in relative deficiency. These data will help the rehabilitation doctor competently draw up a physical activity plan, taking into account the individual characteristics of the patient.

Approach to the treatment of different types of hernias at the Paramita clinic

If lumbago occurs frequently, buy an anesthetic ointment (Indomethacin, Diclofenac). You can apply a piece of ice to the affected area, after wrapping it in a towel, to avoid damaging the skin. Keep for 15 minutes, then remove. But, if the intervertebral hernia is not treated, the pain will last for several weeks and may become permanent. Depending on the dislocation, the patient is unable to bend normally, turn his neck, raise his arm, leg, stand, or sit.

Don't ignore the pain. Paramita Clinic specialists use in their work:

exercise therapy exercises;
proven methods of alternative medicine - acupuncture, manual therapy, massage, reflexology, etc.;
physiotherapy - electrophoresis, Darsonval, laser therapy, shock wave therapy.

We use non-surgical hernia treatment techniques
Read more about our unique technique

Before prescribing treatment, the doctor prescribes diagnostics - x-rays, CT, MRI. They allow you to assess the condition of soft and bone tissues, the size and location of the hernia, and accurately determine its type.

Surgery for any type of hernia should be resorted to only if the analysis shows the impossibility of another solution - severe constant pain from a spinal hernia, the risk of paresis, paralysis.

Themes

Intervertebral hernia, Spine, Pain, Treatment without surgery Date of publication: 09.17.2020 Date of update: 01.12.2020

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