Hernia nuclei pulposi
Hernia nuclei pulposi — one of consequences of osteochondrosis representing protrusion of an intervertebral disk between bodies of vertebras. Demonstrates pains, tonic muscular tension and restriction of movements in an affected area of a backbone. Can lead to a sdavleniye of spinal backs, vessels and a spinal cord. It is visualized by means of KT, MPT or a contrast miyelografiya. Treatment mainly conservative (medicamentous, LFK, massage, traction therapy). Operations on removal of disks (a diskektomiya, an endoscopic diskektomiya) are carried out according to strict indications and can cause heavy complications.
Hernia nuclei pulposi
In total in a spine column there are 24 intervertebral disks. They have the different size: the smallest — at disks of cervical department, and the biggest — at lumbar disks. In all departments disks are characterized by the same structure: the pulpozny kernel surrounded with a fibrous ring. The kernel for 90% consists of water, its consistence reminds gel. The fibrous ring is created by the fibers passing in various directions. Together components of a disk cause its elasticity, elasticity, resistance to twisting and bending. Intervertebral disks provide mobile connections between bodies of vertebras and depreciation of a backbone.
The intervertebral (intervertebral) disk normal settles down strictly between bodies of two adjacent vertebras. When it goes beyond this space, speak about a hernia nuclei pulposi. Most often hernias are formed in lumbar department, it bears the main loading at the movements and heavy lifting. The cervical department in which the difficult movements of large volume are carried out (twisting, bending) is in the second place on the frequency of formation of hernias. The age of patients for whom the hernia nuclei pulposi is diagnosed usually fluctuates within 30-50 years. When progressing the hernia nuclei pulposi can become the reason of a number of the serious investigations, ivalidiziruyushchy the patient. In this regard its timely identification and diagnostics are urgent problems of a practical vertebrologiya and neurology.
Hernia nuclei pulposi reasons
Backbone osteochondrosis acts as a major factor of development of hernias. The degenerate and dystrophic changes resulting at osteochondrosis the intervertebral disk loses water and loses the elasticity. Height of a disk decreases, it hardly maintains pressure of vertebras put upon it and is easily injured at excessive physical activities. In such situation under the influence of various adverse factors there is a shift of a part of a disk out of space limits between vertebras. The hernia nuclei pulposi begins to be formed.
More earlier development of osteochondrosis is observed at persons with anomalies of development of a backbone (wedge-shaped vertebras, a lyumbalization, merge of vertebras, Klippelya-Feyl's syndrome, etc.), dismetabolichesky diseases (diabetes, a hypothyroidism) postponed earlier spine injuries (spinal fracture, a vertebral and spinal trauma). The anomalies of development leading to uneven load of a spine column can be the reason of early osteochondrosis (for example, a dysplasia of a coxofemoral joint). Act as the factors provoking formation of hernia rise in weight, a backbone bruise, vibration, the sharp movements, long stay in a pose sitting (at the motorists working at the computer of persons, etc.), obesity, the wrong load of a spine column owing to a kifoz, a lordoz and other types of a curvature of a backbone, at violation of a bearing and work in an inconvenient pose.
Stages of formation of a hernia nuclei pulposi
At the initial stage there is an insignificant shift of a disk to 2-3 mm called by a disk prolapse. Further shift (on 4 mm and more) is designated by the term a disk protrusion. At the same time the pulpozny kernel is displaced, but settles down within a fibrous ring. Clinically demonstrate symptoms of irritation of a nearby spinal back. Further progressing of a hernia nuclei pulposi leads to a crack or stratification of the fibrous capsule of a disk and loss of a pulpozny kernel out of its limits. This state is called extrusion of a disk. At this stage the hernia nuclei pulposi can peredavlivat a spinal back and its krovosnabzhayushchy vessel, causing a radikulopatiya and a radikulomiyeloishemiya — a radicular syndrome with symptoms of loss of neurologic functions. The stage at which the dropped-out pulpozny kernel hangs down as a drop outside an intervertebral crack is designated as disk sequestration. As a rule, it leads to a rupture of the fibrous capsule and the full expiration of a kernel. At a stage of extrusion and sequestration the hernia nuclei pulposi reaches such sizes that can cause a sdavleniye of a spinal cord with development of a compression miyelopatiya.
Hernia nuclei pulposi symptoms
At the beginning of the formation hernia of an intervertebral disk often has a latent current. Then there are pains in that department of a backbone where hernia is localized. Originally pains have stupid tranzitorny character, amplify at static and dynamic loading, completely pass in a prone position. The patient tries to spare a sick zone of a spine column, limiting the movements in it. In parallel with a pain syndrome musculotonic tension on the respective site of the paravertebralny area develops.
In process of increase in hernial protrusion increase of painful and musculotonic syndromes, restriction of movements is noted. Pain accepts constant character, can remain in a prone position. Muscular tension is more expressed from an arrangement of hernia and can provoke a backbone distortion that creates additional load of it and aggravates clinical manifestations. At further progressing of hernia of an intervertebral disk complications develop. In some cases hernia has a subclinical current and demonstrates only at emergence of the last.
The hernia nuclei pulposi can have a number of clinical features depending on department of a backbone in which it is localized. So, the hernia nuclei pulposi of cervical department is followed by neck pains and a reflex muscular wryneck; can be complicated by a syndrome of a vertebral artery. The hernia nuclei pulposi of chest department often imitates clinic of somatic diseases (stenocardia, stomach ulcer of a stomach, sharp pancreatitis); it is capable to provoke dyspepsia, intestines dyskinesia, swallowing difficulty, fermental insufficiency of a pancreas. The hernia nuclei pulposi of lumbar department is shown by symptoms and lyumboishialgiya, complicates walking and inclinations of a trunk.
Hernia nuclei pulposi complications
The radicular syndrome arises at impact of hernia on a spinal nerve, close to it. The radicular syndrome can have landmark development: in the beginning symptoms of irritation of a back, and then loss of its functions are observed. In the first case the intensive pain syndrome described by patients as "lumbago" or "blow by electric current", provoked by the movements in the struck department of a backbone is characteristic. In a zone of an innervation of a back paresteziya are noted. Loss of functions of a back leads to emergence in the field of its innervation of muscular weakness and hypotonia, decrease in sensitivity. Over time sluggish paresis with muscular atrophies, fading of tendinous reflexes and trophic frustration develops.
The Diskogenny miyelopatiya is formed when the formed hernia causes narrowing of the vertebral channel and a sdavleniye of spinal substance. First of all motive function suffers. At the level of defeat peripheral paresis develops. Then loss of sensitivity and a sensitive ataxy joins. At hernia of lumbar department pelvic frustration are possible. As a rule, in the beginning manifestations of a miyelopatiya have unilateral character. Without performing the corresponding treatment the changes arising in a spinal cord become irreversible, and the created neurologic deficiency is not subject to the return development.
The syndrome of a vertebral artery arises if hernia of cervical department squeezes the vertebral artery passing along the side surface of bodies of vertebras. It is shown by dizzinesses, a vestibular ataxy, ear noise, tranzitorny scotomas and fotopsiya, faints. Can serve as the reason of passing violations of brain blood circulation (TIA) in the vertebro-bazilyarny pool.
Diagnosis of a hernia nuclei pulposi
Initial displays of hernia of an intervertebral disk of a malospetsifichna are also similar to clinic uncomplicated backbone osteochondrosis hernia. The X-ray analysis of a backbone allows to diagnose osteochondrosis, a curvature of a backbone, anomaly of its development, etc. pathology of bone structures. However the hernia nuclei pulposi on roentgenograms is not visible. It is possible to suspect hernia of such cases on persistent character of a pain syndrome and its progressing. During diagnostics the neurologist and a vertebrolog need to differentiate hernia of an intervertebral disk from a miozit, a pleksit, Shmorl's hernia, a spondiloartroz, a hematoma and a tumor of a backbone.
Tomographic techniques of a research — backbone MPT and KT allow to find hernia. And MRT of a backbone is more informative as it gives the best visualization of myagkotkanny structures. By means of MRT it is possible not only "to see" hernia, to establish its localization and a stage of process, but also to define extent of narrowing of the vertebral channel. In the absence of a possibility of carrying out a tomography, "hernia nuclei pulposi" can be applied to confirmation of the diagnosis a contrast miyelografiya.
The hernia nuclei pulposi of cervical department which is followed by symptomatology of a sdavleniye of a vertebral artery is the indication to carrying out vascular researches: REG, UZDG of vertebral arteries. Examination is conducted, as a rule, with functional tests (turns and a ducking). Patients with hernia in chest department, depending on a clinical picture, can need consultation of the cardiologist, gastroenterologist, pulmonologist with carrying out the ECG, a survey X-ray analysis of OGK, gastroscopy etc.
Treatment of a hernia nuclei pulposi
Conservative therapy is the most preferable medical tactics at hernia of an intervertebral disk. It has complex character. The medicamentous component includes medicines for knocking over of a pain syndrome (ketoprofen, an ibuprofen, diclofenac, , to meloksika, etc.), miorelaksant for removal of a musculotonic syndrome (a tolperizon a hydrochloride), vitamin complexes (B1, B6, B12), antiedematous means, necessary for maintenance of nervous tissue. For the purpose of knocking over of an intensive pain syndrome local introduction of corticosteroids and local anesthetics in the form of paravertebralny blockade is applied. In initial stages hondroprotektor are effective (, a glycosamine and so forth).
The hernia nuclei pulposi in the sharp period is the indication for purpose of UVCh, an ultrafonoforez with a hydrocortisone, an electrophoresis. In the period of a convalescence the elektromiostimulyation, reflexotherapy, mud cure is applied to restoration of paretichny muscles. The good effect is rendered by traction therapy by means of which there is an increase in intervertebral distance and considerable reduction of load of the struck disk that provides conditions for a stop of progressing of hernial protrusion, and at initial stages can promote some restoration of a disk. Manual therapy is capable to replace extension of a backbone, but, unfortunately, in practice has big percent of complications therefore it can be carried out only by the skilled manual therapist.
The major part in treatment of a hernia nuclei pulposi is assigned to physiotherapy exercises. Both extension of a backbone, and strengthening of its muscular framework, and improvement of blood supply of the struck disk can be reached by specially picked up exercises. Regular exercises allow to strengthen so the muscles holding a backbone that the recurrence of hernia or its emergence in other departments of a spine column are practically excluded. Well course performing massage, and also swimming supplements LFK.
Surgical treatment is necessary only for those patients at whom complex application of conservative therapy was ineffectual, and the available heavy complications (the pain syndrome which is not stopped more than 1-1,5 months, a diskogenny miyelopatiya, a syndrome of a vertebral artery with TIA) tend to progressing. Considering possible postoperative complications (bleeding, damage or infection of a spinal cord, traumatizing a spinal back, development of a spinal arakhnoidit, etc.), it is not necessary to hurry with operation. Experience showed that surgical intervention is really necessary approximately in 10-15% of cases of hernia of an intervertebral disk. 90% of patients are successfully treated in the conservative way.
The decompression of the vertebral channel or removal of hernia can be the purpose of operation. In the first case the laminektomiya, in the second — an open or endoscopic diskektomiya, a mikrodiskektomiya is made. If during intervention full removal of a disk is carried out (diskektomiya), then for stabilization of a backbone installation of a B-Twin-implant or fixing of a backbone is carried out. New ways of surgical treatment are laser vaporization, intra disk electrothermal therapy. In the postoperative period the major is gradual building of motive loading with anatomic correct performance of all movements. In the recovery period LFK is obligatory.
Forecast and prevention of a hernia nuclei pulposi
Approximately at a half of patients at adequate conservative therapy in a month the hernia nuclei pulposi ceases to remind of itself. In other cases longer period varying from 2 to 6 months is for this purpose necessary, and for a complete recovery can be required up to 2 years. In "ideal" option the dropped-out pulpozny kernel resolves due to processes of a resorption, and the hernia nuclei pulposi decreases in a size. Approximately in a third of cases this process takes about a year, but can continue up to 5-7 years. The adverse forecast arises in cases is long the existing miyelopatiya. In such conditions neurologic deficiency remains even after expeditious removal of hernia and leads to an invalidization of patients.
As in most cases the hernia nuclei pulposi is the investigation of the wrong loads of a backbone, its main prevention consists in ensuring adequate functioning of a spine column. The active movements, swimming, regular gymnastics are useful to strengthening of muscles. It is necessary to avoid the wrong position of a backbone (stoop, , etc.), raisings of excessive weights, the long compelled situation, a set of excess weight.