Prolapse of the intervertebral disc is the first stage of the formation of an intervertebral hernia, when only the first disturbances and changes in the structure of the disc occur, without compromising the integrity of the fibrous ring. These changes are completely reversible if treatment is started in a timely manner. The size of the prolapse can range from 1 to 3 mm. Most often, this condition is found in women 30-35 years old. In 49% of cases, the lumbar vertebrae are affected, in 46-47% - the thoracic vertebrae, and the cervical vertebrae are least often affected. If you do not seek medical help in a timely manner, prolapse becomes a chronic and progressive course of intervertebral hernia.
Causes
The first changes in the structure of the intervertebral disc can develop in the presence of a number of causative factors:
- Metabolic disorders;
- The presence of chronic diseases of the spinal column (rheumatoid arthritis, ankylosing spondylitis, osteochondrosis, spinal curvature, etc.);
- Long-term violation of proper nutrition technology (lack of nutrients, vitamins, minerals);
- Spinal injuries (dislocations, fractures, bruises, etc.);
- Frequent stress on the spine (work at a summer cottage, occupational hazards - loaders, etc.);
- Obesity and overweight;
- Age-related changes.
The risk of developing intervertebral disc prolapse increases when a person is exposed to certain predisposing factors:
- Female;
- Pure vegetarianism (complete refusal of animal food);
- Age from 30-40 years;
- Diabetes;
- Smoking and alcohol abuse;
- Decreased thyroid function;
- Passive lifestyle;
- Monotonous movements in the spine for a long time.
Under the influence of all predisposing and causative factors, the intervertebral disc begins to lose its elasticity, density and strength. It leaves the liquid, microelements and nutrients necessary for normal functioning. As a result, the wall of the intervertebral disc begins to bulge (from the Latin “prolapse” - prolapse) and extend beyond the vertebra. The annulus fibrosus still retains its integrity and remains intact.
Diagnostics
A doctor's consultation begins with a survey and examination. If there is a suspicion of the development of an intervertebral hernia, the rheumatologist prescribes an examination. It could be:
- MRI;
- CT;
- X-ray of the spine.
MRI diagnostics
The main method for diagnosing dorsal intervertebral hernia, like others, is MRI. It is preferable to conduct magnetic resonance imaging in closed-type tomographs, since they provide the most complete information about the condition of the spine. As a result of the examination, it becomes clear not only the cause of the patient’s condition, but also the exact type and size of the dorsal hernia.
Classification
The main types of intervertebral disc prolapse according to the location of the pathology:
- Posterolateral prolapse – protrusion of the disc occurs on the side of the spinal canal;
- Central prolapse (median) - protrusion occurs in the direction of the spinal canal, towards the center of the vertebral bodies;
- Anterolateral prolapse – protrusion of the disc occurs in the direction of the spinous processes and the anterior ligament of the spine, outward;
- Lateral prolapse (lateral) - protrusion of the disc occurs outside the spine, on one side of the vertebra.
According to the localization of the process, disc prolapses are divided into:
- Prolapse in the cervical spine;
- Prolapse in the thoracic region;
- Prolapse in the lumbar region.
Development mechanism
Intervertebral hernia refers to degenerative-dystrophic pathology of the spinal column. Its formation is mediated by vascular and metabolic disorders that accompany local overload. First, the amount of mucopolysaccharides and proteoglycans in the nucleus pulposus decreases, causing the disc to lose fluid and become less elastic.
Continued trophic disorders provoke damage to the fibrous capsule - microcracks appear in it, and the adhesion of the fibers is disrupted. As a result, such areas become thinner and less durable. Experiencing pressure from the nucleus pulposus, the capsule stretches and then ruptures, allowing the disc substance to pass into the spinal canal.
As the hernial protrusion grows, it compresses neighboring structures: nerves and blood vessels. This, in turn, aggravates trophic disorders, contributing to the progression of the process and the appearance of symptoms of the disease.
In addition to the intervertebral disc, the osteoarticular and muscular-ligamentous apparatus is affected, since degenerative-dystrophic pathology covers all structures of the spine.
Treatment of prolapsed intervertebral disc
Treatment of prolapse is exclusively conservative and helps the patient to completely get rid of further progression of the pathology.
Drug treatment
- Chondroprotectors: Mucosat, Teraflex, Chondroxide. They eliminate the main cause of the disease, restore damaged cartilage and eliminate the processes of its destruction. The course of treatment is individual and depends on the patient’s age, the effect of predisposing factors on him and the speed of recovery processes.
- Biogenic stimulants: Aloe, FiBS, Plazmol, etc. Accelerate metabolic and restoration processes, trigger natural tissue repair mechanisms.
- Vitamins: Multi-tabs, Neurobion, etc. Improve the body's protective properties, normalize metabolism, nerve transmission and improve blood circulation.
Physiotherapeutic treatment
Physiotherapy is the main method of treating this stage of the formation of an intervertebral hernia. Each of these measures allows you to normalize metabolic processes, accelerate blood flow through the vessels, restore the transmission of nerve impulses, relax muscle fibers, and increase the distance between the affected vertebrae. The main methods of physiotherapeutic treatment of intervertebral disc prolapse:
- Acupuncture;
- Massage;
- exercise therapy;
- Mud baths;
- Hydrogen sulfide baths;
- Spinal traction.
Detailed description of the medical procedure for removing a herniated disc
Surgery to remove a lumbar disc (discectomy) is the removal of a disc that has fallen out of place and is compressing a nearby nerve root. Removing the prolapsed disc relieves pressure on the nerve and relieves pain. The operation is usually performed under local anesthesia. During the operation, an incision is made over the site where the disc prolapsed.
Then the damaged disc is removed (discectomy) in whole or in part, possibly with part of the vertebra (laminectomy). The roots of the nerves are checked to ensure there is no longer pressure on them. Bone grafting is sometimes used to support the spine. The bone for grafting is taken from another place in the body (for example, from the pelvic bones). This procedure requires an additional incision where the bone is harvested.
The need for fixation depends on the number of damaged vertebrae, the location of the problem disc and other factors. As a rule, at the end of the operation, the surgeon inserts a drainage tube into the surgical wound and removes it a day after the operation or earlier, depending on the decrease in the amount of discharge. At the end of the operation, the surgeon sutures and bandages the surgical wound.
Prevention
In order to avoid the occurrence of intervertebral disc prolapse and its further development into a disc herniation, it is necessary to fulfill a number of conditions and rules:
- If you experience any complaints in the area of the spinal column, do not self-medicate;
- Fighting physical inactivity (if you have a sedentary job, take active breaks, walk to work, etc.);
- Strengthen the muscular frame of the back (gymnastics, exercises, exercise machines);
- Monitor posture from childhood;
- Eat according to nutritional technologies, consuming all the necessary minerals, proteins and fats.
Recovery after surgery
Surgical removal of a damaged intervertebral disc usually takes about 2 hours, but the patient will spend the same amount of time under the supervision of a specialist. This measure is required to understand and ensure that the operation was successful. After the specified time has passed, the person is transferred to a hospital.
On a note! The first day after the intervention you are not allowed to get up, sit down or move around the room. It will be possible to leave the bed for a short period of time every other day, provided that a specialist is present nearby.
Treatment methods for intervertebral hernias
For a quick recovery, doctors recommend using a support belt that will fix the lower back and entire back in the correct position, which will facilitate quick rehabilitation. Strict adherence to all rules will help speed up recovery.
- It is best to remain in a horizontal position until the drain is removed. If the pain is too strong, it is allowed to take anesthetics.
- The applied sutures must be treated regularly. They are removed two weeks after surgery. During this period, your doctor may prescribe physical therapy.
- For three weeks from the moment of intervention, the patient is prohibited from taking a sitting position. After this, you can sit down, but for no more than 10 minutes. This is necessary so that the spine gradually gets used to the loads.
- After a month, the patient will be able to begin light work that does not require excessive physical activity.
- During the first six weeks, do not engage in sports, bend over, or lift heavy objects.
How to lift weights correctly
If any difficulties arise, you should immediately consult a doctor. Complications are quite possible in the postoperative period, and they do not always appear while the patient is in the hospital. You need to visit a specialist if the patient has repeated back pain, the intervention site is swollen or red, and the body temperature has risen sharply to 38 degrees or higher. These are all warning signs that require emergency intervention.
Symptoms
Pathology of the intervertebral disc is accompanied by a clear clinical picture. Of course, the severity of symptoms depends on the stage of the process. In the early stages, the patient may not feel anything or may only notice a feeling of fatigue in the spine after exercise. Further progression of the disease leads to the development of pronounced manifestations.
Pain syndrome
The main complaint of patients with a herniated disc is pain. It appears already at the stage of protrusion, and subsequently only intensifies. The main mechanism is considered to be irritation of the nerve root, but later vascular and inflammatory factors are added. Typically, pain has the following characteristics:
- Shooting, stabbing, aching or throbbing.
- Strong, moderate or weak.
- Local or widespread.
- Radiating to the limbs, head, abdomen or chest.
- Short-term or long-term.
- Intensifies with sharp turns, bends, and lifting loads.
As a rule, pain is relieved by unloading the spinal column and taking painkillers and anti-inflammatory drugs. But with a severe hernia, conservative measures do not give the expected effect.
This leads to a significant limitation in the motor activity of patients and a decrease in their quality of life.
Vertebral syndrome
The progression of an intervertebral hernia is accompanied by a disruption of the nerve impulses of the damaged root. It contains sensory, motor and autonomic fibers that go to the muscles, skin and internal organs. Based on the location of the lesion, the following symptoms are observed in various parts of the body:
- Tingling, numbness, burning.
- Loss of various types of sensitivity.
- Increased or decreased tendon reflexes.
- Paresis or paralysis.
- Trophic changes in the skin: dryness, hair loss, discoloration.
If compression of the nerves of the cauda equina occurs, then along with these manifestations there are changes in the pelvic organs: urinary incontinence, sexual disorders, involuntary defecation. This is part of the structure of the caudal syndrome.
This development of events leads to the need to register a disability group, since the person even loses the ability to self-care.
Disruption of internal organs
As already noted, the autonomic innervation of organs is carried out using the same roots extending from the spinal cord. Therefore, hernial protrusion at the extrusion stage provokes functional disorders, which over time can lead to organic pathology. The most commonly noted signs are:
- Bloating.
- Constipation.
- Increased heart rate.
- Increased pressure.
- Dyspnea.
Such symptoms necessarily require differential diagnosis with various diseases of internal organs, because it is possible that the patient has a concomitant pathology. And in conditions of impaired nervous regulation, it will only intensify.
Thus, the development of intervertebral hernias has important features that need to be paid attention to during diagnosis and treatment. But the most important thing is to prevent the pathology from occurring, and when it has already been identified, to prevent the progression and development of complications.
SPINAL DISC HERNIA. INDICATIONS FOR HERNIA SURGERY (Doctor's recommendations)
Consequences and prognosis
The various complications of sequestration of a herniated intervertebral disc were described in detail above; it remains to name only a few that are rare:
- if a large number of small fragments of the nucleus pulposus enter the spinal canal, this can contribute to the development of autoimmune inflammation. The fact is that in the structure of the nucleus pulposus there are giant molecules - polymers containing protein compounds. The appearance of a protein where it has never been, for example, in the spinal cerebrospinal fluid during a penetrating wound, causes a pronounced immune response and the production of antibodies to one’s own cartilaginous structures. The presence of this process is an additional indication for surgery;
- Occasionally, with a penetrating injury to the dura mater, liquorrhea, or leakage of cerebrospinal fluid, occurs. This is fraught with the occurrence of an inflammatory reaction in this segment and the proliferation of fibrous tissue.
It should be firmly remembered: it is impossible to “reset” the sequestration. Replacing surgical treatment with conservative methods not only does not eliminate sequestration as a source of constant potential danger, but also lulls the vigilance of the patient, who becomes confident that he is no longer in danger. Continuing to treat it conservatively, performing various movements with a large amplitude, and not thinking about surgery, the patient, in the end, brings a complication closer: a spinal cord injury or cauda equina syndrome occurs.
With timely surgical treatment with disc replacement, all functions are fully restored, pain and manifestations of neurological symptoms are eliminated, and movements are restored in full.