Hernia nuclei pulposi of cervical department
Hernia nuclei pulposi of cervical department — a degeneration and a prolapse for borders of intervertebral space of a cervical intervertebral disk. Clinically demonstrates pain in the nadplechya and a hand irradiating in fingers, weakness and a gipesteziy hand, a syndrome of a vertebral artery. It is diagnosed mainly by results of MRT of cervical department of a backbone. Conservative therapy consists of anti-inflammatory and miorelaksiruyushchy medicines, kortikosteroidny blockade, a kinezioterapiya, physical therapy, massage, medical tractions. Surgical treatment usually comes down to removal of the struck disk and stabilization of a backbone.
Hernia nuclei pulposi of cervical department
The hernia nuclei pulposi of cervical department meets rather often. On prevalence takes the second place after a hernia nuclei pulposi of lumbar department. Most often hernias are formed in disks between the fifth and sixth, between the sixth and seventh cervical vertebras. More seldom — between the fourth and fifth, it is extremely rare between the seventh cervical and the first chest vertebras. Considering prevalence of cervical hernias, rather young age of the diseased (on average 30-50 years), the risk of heavy vascular complications, this pathology remains a pressing problem of clinical neurology, a vertebrologiya and orthopedics.
Disks of cervical department of a backbone have smaller diameter, than chest and lumbar therefore also hernias in this department of the smaller size. However narrower vertebral channel and the reduced space for an exit of backs from a spinal cord cause emergence of clinical symptomatology even at a small protrusion of a disk. Feature of cervical department is passing from two parties along bodies of vertebras of vertebral arteries. In this regard the hernia nuclei pulposi of cervical department is shown not only neurologic, but also vascular disorders.
Reasons of hernia of cervical department
Formation of a hernia nuclei pulposi is connected with the degenerate processes happening in a disk owing to which it loses elasticity. Chronic traumatizing at the raised load of cervical department or a sharp spine injury (a backbone bruise, an incomplete dislocation of a cervical vertebra) is led to formation of cracks of a fibrous ring of a disk, an exit of a part of a disk out of limits of intervertebral space, and further — to a prolapse of a pulpozny kernel.
Degenerate changes of intervertebral disks are, as a rule, connected with osteochondrosis, but can be caused by a cervical spondilez, spondiloartrozy, backbone tuberculosis, inadequate load of cervical department at anomalies of development of a backbone (Klippelya-Feyl's syndrome, a wedge-shaped vertebra, assimilation of the Atlas), violation of a bearing, cervicothoracic scoliosis, obesity. Various dismetabolichesky processes in an organism arising at diabetes, alcoholism, smoking, genetically determined exchange diseases act as the factors promoting a degeneration of disks.
Clinical symptoms of a hernia nuclei pulposi are caused by a sdavleniye it a spinal back, substance of a spinal cord, a vertebral artery. In the first two cases there are neurologic symptoms (pain, motive deficiency and sensitive frustration), in the third — a syndrome of a vertebral artery. The last can become the reason of the repeated tranzitorny ischemic attacks (TIA), chronic ischemia of a brain in the vertebro-bazilyarny pool with formation of distsirkulyatorny encephalopathy.
Symptoms of hernia of cervical department
At initial stages of cervical hernia the painful and vertebral syndromes connected with irritation of a spinal back on education level of hernia act as its main manifestations. Originally pain syndrome can have periodic character, is provoked by turns and a ducking. Then pain is transformed to a constant, amplifies at the movements by the head. It is localized in a neck, a shoulder and a hand from the formed hernia, is followed by paresteziya and a sleep of a hand. At the movements in cervical department so-called "lumbago" - the acute pain going from a neck to brush fingers is possible.
The painful impulsation causes reflex development of the musculotonic changes making a vertebral syndrome. The arising increase in a tone of paravertebralny muscles of cervical department and other muscles of a neck leads to restriction of mobility and aggravates a current of a pain syndrome. Tonic reduction of muscles on the party of defeat causes emergence of a reflex wryneck.
Over time the sdavleniye hernia of nervous fibers of a spinal back leads to violation of carrying out on them nervous impulses — the radicular syndrome appears. There is a weakness in a hand which is followed by decrease in a tone of muscles (sluggish monoparesis). Paresteziya are replaced by essential decrease or full loss painful and other types of sensitivity in a zone of an innervation of the squeezed back.
Further increase in the sizes of cervical hernia involves a compression not only a back, but also a spinal cord with development of a diskogenny miyelopatiya. Sdavleny a vertebral artery it is shown by dizzinesses, a headache, a vestibular ataxy, tranzitorny disorders of sight (a fotopsiya, scotoma, decrease in visual acuity), noise in ears and easy relative deafness, vegetative violations, developing of faints at sharp turn by the head, the drop-attacks, TIA.
The hernia nuclei pulposi of cervical department depending on the level of an arrangement can have a variable clinical picture. At hernia of the disk C4-C5 shoulder pain and weakness of muscles prevails. At hernia of the C5-C6 level weakness is noted in a biceps and razgibatel, the sleep and paresteziya in a brush thumb is characteristic. Hernia of C6-C7 is followed by decrease in muscular force in a triceps and razgibatel of fingers, the pain going on the back surface of a hand to a tip of a middle finger. Hernia of C7-T1 is shown by weakness when tightening a brush in a fist, pain and paresteziya irradiate in a little finger.
Diagnosis of hernia of cervical department
At initial stages (a disk protrusion) in the presence only of painful and vertebral syndromes it is difficult to doctor to suspect formation of cervical hernia of clinic. In such cases carry usually out a backbone X-ray analysis which can reveal symptoms of osteochondrosis, a spondiloartroz, etc. pathological changes of bone structures of a spine column. It is possible to visualize cervical hernia by means of backbone MPT or KT. As the indication for their performance existence of muscular weakness in a hand or clinic of a syndrome of a vertebral artery acts. Earlier in such cases used a contrast miyelografiya. Now safer and informative method of diagnostics is backbone MRT. MRT is better than KT allows to visualize myagkotkanny structures of a backbone, gives fuller information on the size of hernia and extent of narrowing of the spinal channel.
Electrophysiological researches (EMG, ENG, ENMG) give the chance to reveal the neural nature of defeat and to determine its level. For assessment of a condition of a vertebral artery REG with functional tests, duplex scanning or UZDG of vertebral arteries is carried out. The differential diagnosis is carried out with a humeral pleksit, a plechelopatochny periartroz, a cervical pleksit, a cervical miozit, an infectious miyelopatiya at the cervical level.
Treatment of hernia of cervical department
Conservative therapy of cervical hernia and restoration after its surgical treatment can be carried out by joint efforts of the neurologist, orthopedist, a vertebrolog, the manual therapist, massage therapist, a kinezioterapevt. In the sharp painful period resolvents (an ibuprofen, , , to meloksika, etc.), local introduction of corticosteroids (a hydrocortisone, a diprospan), miorelaksant are appointed (a tolperizona a hydrochloride). From the first days neurometabolic pharmaceuticals, first of all group B vitamins are applied. Knocking over of a pain syndrome and reduction of an inflammation are promoted by use of an electrophoresis, UVCh, magnetotherapy and fonoforez.
For the purpose of reduction of pressure upon the struck intervertebral disk application of soft manual therapy or traction therapy is possible. Traction of cervical department of a backbone is performed by means of Gleason's loop in a sitting position. Decrease in intensity of a musculotonic syndrome is promoted by use of techniques of miofastsialny massage and reflexotherapy. At a syndrome of a vertebral artery in addition appoint vascular (, ) and nootropic (piracetam, ) means.
In the beginning diseases need to be provided rest of cervical department of a backbone. For this purpose carrying a collar of Shants is widely applied. However it is fraught with bystry development of an atrophy of muscles of a neck while creation of the powerful muscular corset keeping anatomical structures of cervical department of a backbone in normal situation acts as the main guarantee of recovery and prevention of further progressing of a disease. This problem is solved by means of a kinezioterapiya which includes performance under observation of the doctor of LFK or kineziolog of individually picked up exercises of LFK and occupation on special exercise machines.
Surgical treatment of cervical hernia has to is carried out according to strict indications and with extra care. Development of the considerable neurologic deficiency which is not decreasing against the background of conservative therapy, the expressed narrowing of the vertebral channel, the sdavleniye of a vertebral artery leading to ischemia of tissues of brain can be the cause for operation. Surgical treatment, as a rule, means the radical removal of hernia (a diskektomiya or a mikrodiskektomiya) added with the operations fixing a backbone (intervertebral fixing of a keydzhama, a mezhtelovy spondilodez, etc.). Low-invasive interventions (punktsionny laser vaporization, an endoscopic mikrodiskektomiya, intra disk electrothermal therapy) can be applied only at the small sizes of hernia when also conservative ways of treatment are in most cases effective.