What is a foraminal disc herniation: symptoms, diagnosis and treatment

Foraminal hernia.
In patients with intervertebral hernias, the foraminal form of pathology is diagnosed in approximately 10% of cases. This is the name for right-sided or left-sided displacement of the nucleus pulposus without violating the integrity of the fibrous ring. The result of protrusion is pinching of the spinal roots and the appearance of acute symptoms. The patient complains of constant or episodic pain, stiffness, and decreased sensitivity. Treatment of foraminal intervertebral disc herniation can be conservative, but more often doctors resort to surgical intervention.

Description of the disease

Foraminal hernia differs from ordinary disc displacement by intense symptoms that manifest themselves even at the initial stage of the pathology. This is due to its localization in the area of ​​the spinal roots. Any, even the slightest, awkward movement leads to acute pain due to pinching of sensitive nerve endings.

The hernial protrusion forms gradually. First, the disc extends beyond the spinal canal by 2 mm, and then the size of the protrusion is already 4-6 mm. At this stage, only the nucleus pulposus is displaced, but it does not go beyond the boundaries of the fibrous ring. Such a small protrusion already provokes irritation of the nearby spinal root.

Over time, under the influence of dynamic loads, the fibrous capsule delaminates, cracks, and the nucleus pulposus falls outside of it. A foraminal hernia compresses not only the nerve endings, but also the blood vessels that supply it with nutrients. This is the reason for the radicular syndrome that appears at this stage - a set of symptoms of impaired neurological functions.

Types of foraminal hernia

Pathological protrusion is most often observed in those parts of the spine that are most susceptible to static and dynamic loads. Therefore, a foraminal hernia almost always clinically manifests itself in the neck or lumbar region. The strong adhesion of the thoracic vertebrae to the ribs and minor loads even during intense sports training explain the rare detection of herniated protrusion of the thoracic intervertebral discs in patients.

Foraminal disc herniation L5-S1

This disc protrusion occurs at the border of the fifth lumbar and first sacral vertebrae. Foraminal hernia of this location ranks first in the number of diagnosed displacements of intervertebral discs. The reason is the load on the lumbosacral region even in a lying position. The formation of a hernia is caused by the structural feature of the longitudinal ligaments located in this area. In contrast to the anterior one, there is a narrowing of the posterior connective tissue cord in the direction of the first sacral vertebra. The posterior ligament does not securely fix the fibrous ring, which leads to its displacement.

Foraminal disc herniation L4-L5

This form of hernial protrusion is detected when the nucleus pulposus of the disc, located between the 4th and 5th lumbar vertebrae, is displaced. The segments of this department are quite large, as they are designed to withstand heavy loads throughout the day. The spinal canal is narrow, so lumbar hernia is characterized by pronounced neurogenic symptoms. The situation is aggravated by the lack of supporting structures that could stabilize the discs and vertebral bodies. This function is performed only by the muscular frame. If it is weakened due to a sedentary lifestyle or impaired trophism, then protrusion of the disc occurs quite quickly.

Foraminal disc herniation C6-C7

This is the name for protrusion of the nucleus pulposus of the intervertebral disc, localized between the 6th and 7th cervical vertebral bodies. One of the most frequently diagnosed and difficult to treat conservatively types of hernias. In addition to neurogenic clinical manifestations, there is a high probability of vascular symptoms. When visiting a doctor, the patient complains not only about pain in the neck, but also about surges in blood pressure and impaired coordination of movements. These specific symptoms are provoked by compression of the protrusion of the vertebral artery, which supplies oxygen and nutrients to the brain.

Recovery after endoscopic foraminotomy

Special care for the postoperative wound is not required - it is enough to change the bandage yourself once every 2-3 days.
After spinal surgery, you should not lift heavy objects for a while. The patient needs correction of motor habits. Recommendations for recovery will be given by the attending physician, and they should be followed for the period indicated by the neurosurgeon. In general, the patient can return to normal life the very next day after endoscopic foraminotomy. However, we recommend going back to work no earlier than after 2 weeks, provided that it does not involve physical labor. You can start physical work in 1-1.5 months. It is recommended to avoid long-term stress of the same type on the spine, to engage in swimming and regular walking of 3-4 km. Neurosurgeon, doctor of the highest category, candidate of medical sciences.
Sciences Meredzhi Amir Muratovich for performing a unique operation for foraminal and extraforaminal spinal stenosis with Bertolotti syndrome! Bertolotti syndrome is a fairly rare spinal anomaly in which the fifth lumbar vertebra is completely or partially fused with the sacrum. The patient's situation was complicated by stenosis and required surgical intervention. For the first time in the world, such a complex intervention was performed not by the traditional “open” method with the installation of implants, but by a minimally invasive endoscopic method.

Possible reasons

The main cause of the formation of a foraminal hernia is progressive osteochondrosis. This degenerative-dystrophic pathology occurs against the background of gradual destruction of the intervertebral discs of one, and sometimes several vertebral segments. The disc loses its ability to retain moisture, cracks, thickens and becomes thinner. Therefore, when neighboring vertebrae put pressure on it, the nucleus pulposus protrudes. Most often, the development of osteochondrosis is provoked by the following pathological conditions:

• developmental anomalies of the spinal column - Klippel-Feil syndrome, wedge-shaped vertebrae, lumbarization, vertebral fusion;
• dysmetabolic diseases - hypothyroidism, adrenal gland dysfunction, diabetes mellitus;
• previous spinal injuries - fractures, compression, spinal cord injuries.

Hernial protrusion is caused by congenital or acquired anomalies that provoke improper distribution of loads on the vertebrae and vertebrae. These are dysplasia, kyphosis, scoliosis, lordosis, flat feet.

In older people, dehydration of cartilage occurs due to the natural aging of the body and a slowdown in regeneration processes. Provoking factors also include a sedentary lifestyle, increased physical activity, high body weight, an unbalanced diet, and smoking.

Characteristic symptoms

The main danger of a foraminal hernia is the development of radicular syndrome. At the initial stage, only moderate pain is observed, and at the final stage, loss of functions of the spinal roots is noted. The intensity and specificity of clinical manifestations depend on the location of the foraminal hernia.

The severity of pain in the affected spinal segment increases gradually as the size of the protrusion increases. It becomes constant and bothers a person even at night. Muscle tone increases as a protective reaction of the body in response to pain. Skeletal muscle tension is usually noted on the side of the displacement of the nucleus pulposus. It can be so strong that it provokes a distortion of the spine. This causes a disruption in the distribution of loads and an exacerbation of symptoms.

Diagnostic methods

The initial clinical manifestations of foraminal hernia are very similar to the symptoms of osteochondrosis not complicated by displacement of the intervertebral disc. Therefore, the primary diagnosis is made on the basis of constant pain, the severity of which quickly increases. A neurologist or vertebrologist needs to rule out myositis, plexitis, spondyloarthrosis, malignant or benign neoplasms.

When diagnosing a hernia, radiography is not informative, since the protrusion is not visualized in the resulting images. But the signs of osteochondrosis are clearly visible, which become the main cause of nuclear displacement.

Osteochondrosis of the cervical spine on x-ray.

Foraminal hernia can be detected using MRI or CT. Instrumental studies make it possible to establish the localization of the protrusion, its size and shape, and the degree of narrowing of the spinal canal. If the patient has contraindications for CT or MRI, then myelography with contrast is prescribed.

Consequences

When diagnosing a foraminal hernia, doctors exclusively recommend surgery . If the patient refuses, he will be prescribed a course of drug therapy. As practice shows, after treatment with pills and injections, people still come for surgery.

For dorsal foraminal hernia, delaying treatment is not recommended . It progresses quickly, noticeably worsening the state of health. Lack of adequate therapy can cause deterioration in the functioning of the lower extremities. Depending on whether the patient has a left- or right-sided protusion, atrophy of the patient’s left or right leg is possible.

There is no point in delaying the treatment of foraminal hernia, as it progresses quite quickly

In some cases, it is even possible that a paraforaminal hernia may compress the anterior artery running in the spinal canal. This leads to poor blood circulation and lack of oxygen. As a result, the patient may have a heart attack, which will cause paralysis.

Treatment options

Unlike other forms of hernial protrusion, foraminal pathology does not respond well to conservative therapy. A course of painkillers, exercise therapy, and physiotherapeutic procedures are most effective at the initial stage of the disease. If the pain intensity does not decrease within several months of conservative treatment, surgery is performed. Surgical intervention is indicated immediately when complications arise.

Drug therapy

Severe pain is relieved by parenteral administration of non-steroidal anti-inflammatory drugs (NSAIDs) with the active ingredients ketoprofen, diclofenac, meloxicam. If they are ineffective, glucocorticosteroids Diprospan, Dexamethasone, Triamcinolone with anesthetics in the form of drug blockades can be used. Pain of moderate severity is eliminated by taking NSAIDs in tablets - Ibuprofen, Naproxen, Celecoxib.

If the symptoms of a foraminal hernia are complicated by muscle spasms, then the muscle relaxants Mydocalm, Sirdalud, and Baklosan are included in the therapeutic regimen. To improve innervation, medications with B vitamins are prescribed - Combilipen, Neuromultivit, Milgamma.

Systemic chondroprotectors, which partially restore cartilage tissue, are advisable to use at the initial stage of hernia formation. The highest clinical effectiveness is characteristic of the drugs Artra, Teraflex, Dona.

Surgical intervention

The purpose of the operation is to remove the hernia or eliminate compression of the spinal canal, which provokes acute symptoms. For decompression, a laminectomy is performed, which involves removing part or all of the vertebral arch. Foraminal hernia can be eliminated during open or endoscopic disectomy, microdisectomy. Sometimes complete removal of damaged disks is required. Then the simultaneous installation of implants that stabilize the spinal segments is carried out.

New technologies of surgical therapy have been developed and are being successfully used. Some clinics practice valorization (removal of a fragment of the nucleus pulposus) and intradiscal electrothermal treatment.

Exercises, exercise therapy, massage

For acute pain caused by pinched spinal roots, patients are prescribed UHF therapy, electrophoresis or phonophoresis with NSAIDs, hydrocortisone, and anesthetics. 5-10 sessions of electromyostimulation and reflexology can speed up blood circulation, normalize microcirculation, and strengthen weakened muscles. You can consolidate the results from the use of pharmacological drugs with the help of magnetic therapy, laser therapy, shock wave therapy, and mud therapy.

Laser therapy is part of the treatment of spinal pathologies.

Traction (dry or underwater traction of the spine) often allows you to avoid surgical intervention. After the treatment procedure, the distance between the vertebrae increases, and the hernial protrusion stops growing. Classic, acupressure, and vacuum massage have a good effect.

The exercise therapy doctor selects exercises individually for the patient, taking into account the location of the protrusion and the stage of the pathology. In the process of regular exercise, muscles are strengthened, which allows you to reliably stabilize the spinal segments. And due to accelerated blood circulation, the trophism of cartilage tissue is significantly improved.

Treatment at home

For moderate pain, patients are treated at home. They are prescribed a course of medications, and it is recommended to wear orthopedic devices - bandages, corsets, orthoses. The patient must visit a hospital facility for physical therapy procedures. Daily training is required, which becomes an excellent prevention of the progression of the pathology.

Folk remedies are not used in the treatment of hernial protrusion. Their use is ineffective and in some cases harmful. Infringement of the spinal roots can cause aseptic inflammation. And the use of compresses and rubbing helps spread it to healthy tissues.

Advantages of endoscopic foraminotomy for stenosis

• Less trauma to the skin, blood vessels, osteochondral and soft tissues;
• The least risks - it is impossible to remain disabled after endoscopic surgery for stenosis (foraminotomy);
• Maximum controllability and accuracy - spinal surgery takes place under good visual control of an endoscope;
• Fast and comfortable rehabilitation - endoscopic foraminotomy is the best alternative to open spinal surgery;
• There is no need to install additional metal structures to stabilize the spine;
• Minimal postoperative suture - from an aesthetic point of view, this is important for patients with an individual tendency to hypertrophic and keloid skin scars.

Rehabilitation

During the rehabilitation period after surgery and completion of conservative therapy, the patient is recommended to regularly engage in physical therapy or gymnastics, swimming, yoga, and massage. Loads should be increased gradually to prevent microtrauma of the spinal structures. Medications may be prescribed to improve blood circulation and (or) strengthen the body's defenses.

Why is it worth having surgery for stenosis at the Pirogov Clinic?

• The clinic is equipped with the latest technology (Richard Wolf endoscopic set, HighSpeedDrill drill, X-ray and radiofrequency equipment), which allows spinal surgeries to be performed using minimally traumatic and or interventional methods;
• Our clinic has its own laboratory, equipped with new generation diagnostic equipment. You can take tests and undergo all examinations before neurosurgical surgery on the spine in 1 day and without queues. Accurate diagnostic results will be ready quickly, and if necessary, we can send them to you by email.
• A wide range of highly specialized medical specialists in one place;
• Affordable prices for operations for stenoses, spinal hernias and other degenerative diseases;
• Possibility of obtaining a loan or interest-free installment plan for treatment;
• Our services are available under VHI policies.

Make an appointment