Even those who do not have back problems are aware of what an intervertebral hernia is, how dangerous this disease is and what discomfort it can cause. However, it does not develop out of nowhere and does not suddenly arise. It is preceded by various negative conditions associated with the structure of the spine, which then gradually develop into the intervertebral hernia itself. Dorsal disc extrusion is one of the serious stages of the development of intervertebral hernia.
Dorsal disc extrusion
What it is?
Disc extrusion is one of the stages of the formation of an intervertebral hernia, which develops against the background of rupture of the fibrous membrane. The terms “dorsal/dorsal” mean that the protrusion of the disc body occurs outward, towards the soft tissues of the back. If the pathology is not treated, then over time it will turn into a full-fledged intervertebral hernia, which will be more difficult to cope with.
Moderate midline nuclear extrusion of the L4-5 disc
The disease is characterized by the presence of ruptures in the fibrous membrane of one of the vertebral discs. The inner core of the disc partially emerges through the formed gaps. This is the last stage of development of an intervertebral hernia.
Protrusion, extrusion and hernia
On a note! As a rule, dorsal extrusion occurs in the lumbar region, since this is where the spine experiences the greatest load. This is especially true for the disc located between the L5 and S1 spinal segments. Sometimes extrusion forms in the cervical or thoracic region.
With the more well-known protrusion, the spinal disc protrudes quite a bit - up to 5 mm. But during extrusion, the protrusion is much more significant - more than 5 mm. In this case, the integrity of the fibrous ring of the disc is already compromised. With protrusion, only protrusion occurs. By the way, sometimes disc extrusion and hernia are considered synonymous.
Severity of pathology
Lumbar disc extrusion
Developing disc extrusion is the penultimate stage of destruction of the fibrous ring in osteochondrosis, which is not treated. At the first stage of the degenerative process, dehydration occurs and elasticity is lost. This is facilitated by a reduction in the volume of diffuse nutrition of the cartilage. If you take an MRI at this time, the image will show primary degenerative changes. The second stage is called protrusion, in which there is a slight decrease in the height of the intervertebral disc. At the same time, it begins to protrude beyond the vertebral bodies that it separates.
At this stage of development of osteochondrosis, patients complain of:
- severe pain caused by pressure on the radicular nerves;
- numbness of certain areas of the lower extremities;
- paresthesia and sensory impairment.
Extrusion of the spine is the final stage after which a disc herniation occurs. During extrusion, the annulus fibrosus ruptures, inside which the substance of the nucleus pulposus is located. But this location is located in such a way that exit of the corpus pulposum through the crack is not possible because compensatory fixation by the longitudinal ligament of the vertebrae has occurred. If the site of the fissure in the fibrous ring is located in a place where there is no developed ligamentous apparatus, then the extrusion stage does not develop and a hernia appears immediately.
If the MRI image shows that extrusion of the intervertebral disc is developing, you need to contact a vertebrologist as soon as possible to prescribe comprehensive, comprehensive treatment. In this situation, the patient is separated from a disc herniation by the slightest tension in the muscular frame of the lower back.
Reasons for development
The human spine is a complex system of elements consisting of bone tissue - vertebrae, between which there are small, fairly soft pads - intervertebral discs. Their functions are the connection of individual vertebrae into a single system and shock absorption of the spine during body movement . In their structure, they have an external fibrous ring and an internal nucleus pulposus.
The structure of the vertebra and intervertebral disc
The discs of the spine experience serious stress every day. And in the absence of rest or when the already heavy load increases, their outer shell can bulge, going beyond the spine. The danger of this condition is that as a result of these processes pinching of nerve endings can occur. This can lead not only to back pain, but also to various problems with internal organs and even paralysis of the limbs.
Corrective corset for the spine
The main reasons for the formation of disc extrusion:
- rachiocampsis;
- age-related changes;
- osteochondrosis;
- spondylosis;
- disruption of metabolic processes in tissues, which causes the disc to dry out;
- excessive stress on the back;
- excess weight;
- injuries.
Trauma is one of the reasons for the formation of disc extrusion
Stages of development of intervertebral disc herniation
Over time, the intervertebral discs begin to wear out, lose their original qualities, their anatomical shape changes and protrusions form in the spine. Under the influence of injuries, excessive physical exertion or viral and infectious diseases, metabolic disorders, the membrane of the disc begins to crack and rupture. A gelatinous substance penetrates into the resulting “holes”, forming a hernia. For some time, the protrusion is restrained by the longitudinal ligament, but its efforts gradually weaken.
Conventionally, the development of a herniated disc can be divided into four stages, each of which has its own distinctive symptoms and requires slightly different treatment for a herniated disc. And each subsequent phase becomes more difficult to heal.
Spinal disc prolapse
At this stage of the development of the disease, the intervertebral disc protrudes beyond the permissible dimensions by 2-3 mm without rupture of the membrane. Age-related degenerative processes in the body, metabolic disorders, and low physical activity lead to the disc gradually dehydrating, losing its elasticity, and becoming soft and loose. At the same time, the axial load on the spine does not decrease, but rather increases with increasing body weight (for example, if a person is prone to obesity).
Impaired blood supply to the discs, lack of nutrients and fluid gradually causes cracking of the cartilage shell. Such pathological changes can be caused by osteochondrosis, poor posture, spondylosis and other diseases. The sensations at this stage of the disease largely coincide with the symptoms of osteochondrosis: a slight aching pain after strong physical exertion, rapid fatigue and a periodic feeling of discomfort. Such pathologies do not cause severe pain, so at this stage patients rarely seek advice from a spinal hernia treatment clinic.
Intervertebral disc protrusion
At this phase of the disease, protrusion of the disc occurs 4-15 mm beyond the anatomical dimensions. Under the influence of axial loads, the nucleus pulposus gradually shifts from its natural position and begins to put pressure on the fibrous membrane. With every movement, with the slightest physical exertion, the pressure increases, stretching the walls of the ring.
Finding weak areas in the surface, the nucleus pulposus can no longer be restrained by ligaments and forms a protrusion of the intervertebral disc, the treatment of which is already quite dangerous to delay or ignore. The disc shell is not yet damaged and a person may not feel severe pain, especially if the blood vessels or nerve roots are not touched (not pinched).
If the tumor compresses the nerve, then the location of the pain and symptoms of the disease depend on the location of the lesion in the spine. This may be pain in different parts of the back, radiating to the limbs, weakness of the arms or legs, numbness of the fingers or a feeling of coldness in them, sensitivity disorders.
Treatment of protrusion of the cervical spine is often accompanied by surges in blood pressure, headaches, dizziness and disturbances in visual and auditory functions. This is due to compression of the cervical arteries and nerve endings.
Protrusion of a hernia in the lumbar region is often accompanied by lumbodynia or, as the common people call it, radiculitis. This area is dangerous due to disturbances in the functioning of the internal organs of the small pelvis.
Extrusion of intervertebral discs
Disc extrusion is characterized by rupture of the annulus fibrosus and release of gelatinous substance. As a rule, the moment of rupture coincides with the moment of a sharp axial load on the spine in combination with torsion. This could be lifting weights or a sharp turn of the body, an unsuccessful fall or incorrectly performed exercises in the gym, hypothermia, a cold, or simply stress.
Patients usually remember the moment of rupture of the shell ring and the exit of the cartilaginous core quite well. It's like a lumbago in the back, a sharp pain, then gradually subsiding, limited mobility of the pathological area, muscle spasm and swelling of soft tissues.
In most cases (approximately 90%), treatment of lumbago occurs in the lumbar spine. This is explained by its greatest mobility and at the same time load. After the severe local pain subsides, it begins to spread to the buttocks and then along the back of the leg. Limitation of motor capabilities is often accompanied by lameness and neurological pathologies (decreased sensitivity, numbness, etc.), treatment of sciatic nerve entrapment.
It is already quite difficult to ignore such symptoms and any sane person will no longer delay visiting a doctor. At this stage of the disease, as a rule, surgical intervention is not required, but conservative treatment of a spinal hernia is prescribed. Therapy is aimed at relieving pain, relieving swelling and muscle spasms, and eliminating compression of the nerve roots.
Further treatment consists of prescribing the patient a special course of therapeutic exercises, physiotherapy, swimming, and sometimes traction (traction) of the spine. For each specific case and specific patient, a different complex is selected, and self-medication is not only undesirable, but in most cases it is dangerous. Improving the condition of the muscle corset and gentle stretching of the ligamentous apparatus will prevent relapses and the formation of new intervertebral hernias.
At the same time, much in treatment depends on the patient’s self-awareness and desire to recover. After completion of therapy, the person himself will need to do exercises, exercise therapy, review the routine and intensity of physical activity, and avoid injuries and movements that provoke the condition of the hernia.
Sequestration of herniated discs
Sequestration of herniated intervertebral discs is the most difficult and unpleasant stage of the disease. It is characterized by the separation of part of the hernial protrusion from the main disc. Not associated with living and functioning fibers, a piece of the disc quickly dies, forming a foreign body in the tissues that causes purulent inflammatory processes. It’s even worse when a hernia has formed in the spinal canal and the sequester compresses and inflames the spinal cord.
The consequences of such a pathology can be the most unpleasant (up to complete immobilization of the limbs and the inability to move independently). Sequestration is accompanied by severe back pain, tissue swelling, stiffness at the site of the hernia, disruption of the internal organs, neurological problems, etc.
As a rule, such cases rarely respond to conservative treatment and require immediate surgical intervention.
The cost of removing a herniated disc, or rather a separated piece, is quite high, but inaction at this stage can have dire and irreversible consequences. At the same time, surgery is always considered as an extreme and necessary treatment measure if there is at least some hope of recovery using non-surgical therapy. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr
Symptoms
The presence of dorsal disc extrusion is characterized by a number of symptoms, which, if noted, a person should definitely consult a doctor. Signs of pathology development:
- feeling of sharp pain in a certain place of the spinal column;
- shooting pain in the buttock or lower limb;
- appearance of lameness (not in all cases);
- muscle numbness;
- the skin begins to lose sensitivity.
Back pain
On a note! Disc extrusion is not always accompanied by pain and may not even have obvious symptoms. Often the pathology is diagnosed completely by accident. Pain occurs when the nerve roots are compressed.
Depending on where the extrusion is located, the symptoms of the disease also change. If there is extrusion in the cervical region, pain will occur in the back of the head or in the arms, especially if you sit in one place for a long time (for example, at the computer). But the symptoms are felt most strongly if the pathology forms in the lumbar region.
An example diagram of disc extrusions when interpreting a CT scan of the spine. On the left – foraminal extrusion (hernia) with compression of the dural sac; in the middle – foraminal extrusion with compression of the nerve root, on the right – sequestered disc herniation (sequestration is marked with an asterisk “*”)
Table. Classification of disc extrusions.
Symptoms of dorsal disc protrusion
At the initial stage of the disease, the patient does not experience any discomfort. Occasionally there is a feeling of stiffness or aching pain at the location. Consequently, no therapeutic measures are carried out, and the condition begins to worsen. Dorsal protrusion will manifest itself as follows:
- If the cervical spine is affected, headaches and dizziness, jumps in blood pressure, and a feeling of “pulse” in the head.
- When the intervertebral discs of the lumbar region change, there is limited movement, severe pain when bending, weakness of the lower extremities.
- With protrusion of the thoracic region - a feeling of constriction, a feeling of numbness in the arms, pain that can be easily confused with heart pain.
Dorsal protrusion is one of the types of protrusion. A characteristic feature is the protrusion of tissue precisely towards the spinal cord.
Diagnosis of pathology
The presence of extrusion can be detected by conducting an examination using instrumental methods. But before this, the doctor collects a detailed medical history in order to make at least a preliminary diagnosis. He interviews the patient and tries to obtain information about the nature of the pain, its location, etc. He may also use the palpation method to identify painful areas.
MRI of the spine. Tomogram
After making a preliminary diagnosis, the patient is usually sent for magnetic resonance imaging. This is the most accurate way to identify disc extrusion and determine its type. The patient may also be referred for a CT scan. Radiography is rarely used. It will not be able to demonstrate changes in the disc; it will only show changes in the spinal column itself, which will not always provide enough information to make a diagnosis.
Treatment
Treatment of extrusion is usually carried out conservatively, that is, without surgical intervention, but with the use of medications, physiotherapy, massages and exercise therapy. The most commonly used methods are manual therapy and electric current therapy. Doctors prescribe NSAIDs as medications to relieve inflammation and eliminate pain. Sometimes blockades are made directly to the affected area.
How is dorsal disc extrusion treated?
Medicines prescribed by a doctor may include chondroprotectors, analgesics, and glucocorticosteroids. And among physiotherapeutic procedures, acupuncture is especially popular.
On a note! Treatment of the pathology is long-term. It can go on for weeks, or even months. It depends on many factors.
Surgical treatment is usually used only if the pathology continues to progress even with the use of all conservative methods or is already significant in size and causes serious discomfort. The operation is called a discectomy - in this case, the protrusion is removed through an incision, thereby reducing the pressure on the nerve roots.
Endoscopic discectomy
discoplasty can also be performed . It is done under local anesthesia. The disk warms up well under the influence of the laser, but is not destroyed. When heated, cartilage tissue grows and the affected disc is restored. True, full recovery does not occur immediately after the procedure, but is achieved within about six months.
Classification
There are several types of classification of this pathology depending on its location or type. It is necessary to know this when prescribing treatment and additional procedures, such as gymnastics, massage, physiotherapy. The most common classifications are by the location of the affected disc or discs and by the location of the nucleus exit.
Localization
To determine the location of the damaged disc or discs, a notation system is used in which a letter indicates the part of the spine, and a number indicates the number of the vertebra whose disc is damaged. That is, the damage can be localized in one of the following areas:
- Cervical (vertebrae C1 to C7);
- Thoracic (vertebrae D1 to D12);
- Lumbar (vertebrae L1 to L5);
- Sacral section.
The approximate localization of the process is established based on symptoms and manual examination at the stage of the first consultation with a doctor, since instrumental studies must be prescribed to clarify the diagnosis. And you need to know which area of the spinal column to examine.
Exit site of the nucleus pulposus
Compression of the spinal disc occurs in different directions. Depending on this, the nucleus pulposus shifts in the ring in one direction or another. The ring rupture occurs precisely in this place. Thus, there may be several options for placing the gap.
- Lateral extrusion – can be of left or right localization. A condition in which the nucleus pulposus extends beyond the disc on one side of the spinal column;
- Dorsal extrusion - with it, the nucleus protrudes away from the spinal cord, squeezing the soft tissues of the back adjacent to the spine;
- Central extrusion is one of the most unfavorable variants of its development, as it is characterized by severe compression of the nervous tissue of the spinal cord. After all, the nucleus exits precisely towards the brain canal.
Depending on these types, surgery to treat a hernia may differ. Some diagnostic methods and conservative treatment will also differ slightly.
Possible complications after surgery
If the doctor recommends surgery, then, of course, you need to agree. However, it is important to remember possible risks and complications, since any surgical intervention in the spine is a great stress for the body. For example, there is a risk of infection of the disc or spinal canal. In the first case, you will have to use antibiotics to cope with it. If the infection has affected the spinal cord canal, doctors will recommend another operation, after which you will still have to take antibiotics.
The spinal canal is a container for the spinal cord, its roots and vessels
It is also important to remember that even after a successful operation, the risk of relapse of the disease is present. As a rule, extrusion reappears within the first 1.5 months after surgery.
Surgery for dorsal hernia
If conservative therapy does not produce positive results within 1–3 months, patients are advised to consult a neurosurgeon and determine whether there are indications for surgical treatment. It is carried out when:
- sequestered hernias;
- severe neurological disorders;
- loss of control over urination and defecation (often caused by a dorsal median disc herniation of L5–S1 measuring significantly more than 0.5–0.6 cm);
- decreased quality of life.
Surgical treatment of dorsal disc herniation L5–S1 or any other can be carried out using different methods:
- puncture surgery (nucleoplasty and hydroplasty);
- endoscopic surgery;
- microdiscectomy.
Shaboldin A.N.
microsurgically removes a herniated disc. Which one is optimal for a particular patient is decided individually by neurosurgeons. If the operation involves the removal of a significant part of the nucleus along with the fibrous ring, the patient will be offered the installation of a special Barricaid mesh to prevent recurrence of the hernia in the same place.
In cases where it is necessary to remove the entire affected disc, it must be replaced with a fully biocompatible and highly functional M6 endoprosthesis. If this is not possible for one reason or another, neurosurgeons will likely recommend transpedicular fixation.
M6 intervertebral disc prosthesis
In both cases, there is no recurrence of the hernia at the same level, since the disc itself has been removed, but there remains a possibility of its formation at other levels of the spine if the patient does not follow the doctor’s recommendations and does not change his lifestyle.
Nucleoplasty
Puncture surgery involves reducing the volume of the nucleus pulposus by destroying part of it with laser energy, radio waves, cold plasma or liquid pressure. The instrument is inserted through a pinpoint puncture of soft tissue, the size of which does not exceed a few millimeters.
The method using liquid pressure is recognized as one of the most effective and safe, since it does not involve the risk of overheating of surrounding tissues and provides a high degree of control over the volume of intervention performed. It is called hydroplastic.
SpineGet hydronucleoplasty device
But the use of puncture surgery methods is only possible for dorsal disc herniation measuring up to 0.7 mm. Moreover, if the patient does not change his usual lifestyle, continues to spend a lot of time in a sitting position or, on the contrary, performs too hard physical work, a hernia can form again either in the same spinal motion segment or in another.
Endoscopic surgery
A gentle method of surgical treatment of dorsal hernia, used when it is located in a narrow place of the spinal canal or is large in size. Unlike nucleoplasty and hydroplasty, the operation is performed under general anesthesia and requires hospitalization for one day.
Shaboldin A.N. endoscopically removes a herniated disc
At the same time, it is quite low-traumatic, since all manipulations are also performed through pinpoint punctures of soft tissues. A thin port (hollow tube) is installed through which, under a video camera, the herniated disc is removed. Intraoperative risks are insignificant, since access to the affected intervertebral disc is provided through the use of a shaver.
Microdiscectomy
Microdiscectomy is an open, but low-traumatic operation, performed through an incision of about 2 cm. It is performed under general anesthesia and allows you to remove almost any hernia, including sequestered ones.
Remote disc herniation
In particularly difficult cases, some patients may require a rather traumatic operation - laminectomy. This operation involves access to the spine through a large incision, but allows you to carefully examine all anatomical structures and solve a complex of problems in this area. As a result, not only the entire disc, but also part of the vertebra may be removed.
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.
How to treat spinal diseases?
Step 1. It is recommended to contact a trainer involved in physical therapy. Sometimes this type of physical activity helps not only to heal, but also to prevent the development of back diseases altogether. Working with a trainer is necessary at first - it is important to learn how to perform the exercises correctly. Then you can study at home on your own.
Contact a trainer
Step 2. You can take medications prescribed by your doctor. It is important to remember that you cannot prescribe medications yourself - they may have contraindications.
Take medications if necessary
Step 3. In some cases, it is necessary to wear a back support corset. However, before purchasing this device, it is also important to consult a specialist.
Use a corset
Supportive corset for the spine
Step 4. Massage therapy is also a good therapy option. You should find a good massage therapist and take a course.
Massotherapy
Step 5. In case of severe pain, you can ask your doctor for an appointment for a blockade.
Blockade
Step 6. In any case, it is important to visit a specialist’s office, get advice on treatment, and discuss any concerns regarding back health.