It is important to be competent in the treatment of intervertebral hernia, and to know not only how to relieve pain, but also how to keep the spine as healthy as possible, to understand what absolutely should not be done when back pain occurs in order to avoid complications, and also to know what needs to be done in the event of back pain. mandatory.

Intervertebral hernia is one of the common and potentially dangerous diseases, since during its development, damage to the spine occurs in the immediate vicinity of the nerve roots and spinal cord, through which nerve impulses pass from all organs to the brain. This is the cause of complications that can lead to limitation of movements, disruption of vital organs, and sometimes to paralysis.

Intervertebral hernia often occurs in people of working age (20-50 years), condemning them to temporary disability, and sometimes to disability!

Military Medical Academy named after. CM. Kirov, St. Petersburg;

biophysicist, full member of the Academy of Medical and Technical Sciences Fedorov V.A.

What is an intervertebral hernia? Stages

Intervertebral hernia is a disease that is caused by destructive changes in the tissues of the intervertebral disc located between the vertebrae. The intervertebral disc, thanks to its structure, acts as a kind of shock-absorbing pillow, providing springiness to the spine, softening and absorbing shock loads when walking, running, jumping, etc.

The intervertebral disc consists of a nucleus pulposus with a gel-like consistency, and a fibrous ring around it, which holds this gel inside. The function of depreciation is performed nucleus pulposus, which (in an adult) is 70% water. It also contains carbohydrates that have the ability to quickly bind and “give” water.

When there is a load on the spine (for example, when walking), the nucleus pulposus flattens and decreases in size up to 2 times, as water is pushed out of it. When the load is reduced, water returns to the core, it restores size and shape.

Intervertebral hernia, as a rule, is preceded by degenerative changes in the fibrous ring: it loses its density (its structure becomes looser, gaps appear between the fibers, ruptures of individual fibers occur without compromising the integrity of the entire ring).

As damage develops in the annulus fibrosus, the nucleus pulposus begins to move from the center of the disc to the periphery.

There are several stages of hernia development:

1. Disc prolapse- slight displacement of the nucleus (by 2-3 mm), the fibrous ring moves outward, but its integrity is not compromised;
2. Protrusion disk– displacement of the nucleus pulposus by 4 mm or more;
3. Disc extrusion or prolapse(actually, a hernia) - a violation of the integrity of the fibrous ring with the release of the nucleus pulposus into the spinal canal;
4. Disc sequestration– the nucleus pulposus loses connection with the vertebrae, fragments and moves along the spinal canal.

Symptoms of intervertebral hernia

The main symptom of intervertebral hernia is pain, and it is pain that makes people see a doctor. Often back pain can simply be muscle pain unrelated to pressure on the nerve root.

As a rule, pain occurs suddenly and intensifies with movement in the corresponding segment of the spine. The lumbar region is most often affected, as it is subject to the greatest stress. Less commonly - thoracic; when a hernia occurs in this section, patients often complain of very severe pain, reminiscent of a feeling of “a stake in the back”.

However, pain does not always accompany a hernia, especially in the early stages of its occurrence.

Symptoms of intervertebral hernia vary depending on the direction in which the protrusion and prolapse of the nucleus pulposus occurs.

The disease occurs in close proximity to the spinal cord and the roots extending from it, so other symptoms associated with impaired conduction of nerve pathways may also be observed:

• decreased skin sensitivity;
• decreased muscle tone in the limbs and deterioration of movements in them;
• weakening of tendon reflexes (involuntary movements of the limbs when a tendon is struck, for example, under the kneecap);
• disruption of internal organs; for example, with a hernia in the lumbar region, bowel function is affected, Bladder, reproductive organs;
• dizziness, memory loss, changes blood pressure- with a hernia in cervical spine.

In some cases, intervertebral hernia may develop heavy complications, such as:

• Radiculopathy (radicular syndrome, outdated name - radiculitis) associated with pressure from the hernia on the nerve root.
• Spinal cord compression caused by a narrowing of the spinal canal by a hernia, tissue swelling, impaired blood supply, and, sometimes, direct mechanical compression.
• Compression of the artery supplying the spinal cord- acute or gradually increasing - leading to the death of nerve cells.
• Clamping of the veins that drain blood from the spine, which leads to severe swelling and compression of the spinal cord.

All these complications are fraught with disruption of the spinal cord and muscle atrophy (shrinkage). With complications of a hernia in the lumbar region, they may suffer internal organs, fecal and urinary incontinence and impotence may occur. In extreme cases, the kidneys and other vital organs may fail, and if the vessels in the cervical region are compressed, the blood supply to the brain may be disrupted and death may occur.

One of the most dangerous complications is cauda equina syndrome - compression of a bundle of nerve fibers, originating at the level of the first lumbar vertebra. This can lead to immediate development of paralysis of the lower extremities, failure of the pelvic organs and death of the patient.

Destructions in the fibrous ring are not quickly restored, so when a hernia occurs, the main load falls on the back muscles. Intervertebral discs weakened by a herniation do not secure the vertebrae well. The body cannot allow damage to such a vital organ as the spinal cord, located in the spinal column, therefore muscles begin to work hard center the spinal axis. The muscles also try to compensate for the lack of shock absorption that the intervertebral disc(s) previously provided. Untrained muscles do not center the spinal canal well, especially if there are already other problems in the spine () or the muscles were not previously trained due to a sedentary lifestyle. Even a small load can cause complications. The most dangerous are shocks and sudden movements.

Effective measures No. 1. Maximum protection from additional overloads muscles and spine:

Muscles experience enormous stress in new conditions. The presence of pre-existing problems in the spine () and the hernia itself can seriously impair their functioning, since nutrition and transmission are disrupted nerve impulses. The muscles may simply not be prepared, as they were previously untrained due to a sedentary lifestyle. In this situation it often occurs muscle spasm. Due to muscle spasm, blood vessels are pinched, muscle cells stop receiving adequate nutrition and die, and connective tissue grows in their place. Adhesions and scars occur - all this leads to poor posture. This creates conditions for the development of repeated cases of the disease (relapses) and the emergence of new foci of damage.

Due to increased work, muscle tissue cells die faster. An excess of dead cells can also occur due to the fact that the nucleus pulposus, when leaking out, compressed the vessels, and the affected area was deprived of nutrition. The body's reaction to such an accumulation of dead cells is edema(a necessary measure for cleaning fabrics). However, edema compresses nearby vessels, impairs muscle nutrition, and cell death progresses. But the main problem is that dead cells are excreted only with lymph through lymphatic vessels, and the movement of lymph is ensured, in turn, by the contractile activity of the muscles (even at rest). When the muscles are already overworked, Tothe circuit closes: To relieve edema, active lymph flow and muscle activity are needed, but the muscles are already overloaded and, due to edema, are deprived of nutrition and cannot recover.

Swelling increases especially quickly during prolonged lying down, for example, during sleep, since overall muscle activity is reduced and is not enough to ensure sufficient lymph flow to cleanse the tissues in the affected area. Therefore, it is better to avoid bed rest. During the day, it is advisable not to lie down for a long time or take fixed positions for a long time. It is much more beneficial to move - but with caution so that new painful sensations do not arise. It is advisable to interrupt night sleep every 3 hours for 15 minutes to walk or do exercises while lying in bed.

It is necessary to improve the nutrition (blood supply) of the back muscles. The muscles need resource replenishment so that they can cope with the new load of supporting the spine in conditions of a hernia.

The root cause of the development of intervertebral hernia

As already mentioned, an intervertebral hernia begins to develop due to the fact that the fibrous ring, which forms part of the intervertebral disc, becomes flabby, loose, and the nucleus pulposus along with the disc begins to “float out”. This is caused by a lack of nutrition to the intervertebral disc. Why is it getting worse?

In children and adolescents, the intervertebral discs receive nutrition and oxygen directly from the vessels that are suitable for them, which, however, cease to function by the age of 18-20. In an adult, the nutrition of the discs (as well as the removal of waste from the cells) is carried out by diffusion - “pushing” substances through microscopic channels in the cartilage covering the vertebral body.

A necessary condition for the delivery of nutrients, oxygen and water through cartilage to the cells of the intervertebral disc (as well as vertebrae) is coordinated and dynamic work of the back muscles and disc:

• Only with physical stress is sufficient blood flow created to fully nourish the spine, and lymph flow and venous outflow are provided to cleanse the tissues of cartilage, vertebrae, and intervertebral discs from dead cells.
• It is during movement that pressure changes occur in the spine itself, which ensures the “suction” and “extrusion” of substances in the nucleus pulposus.

It follows from this that the intervertebral disc begins to gradually deteriorate long before a hernia occurs for three main reasons:

• muscles do not work dynamically, that is, we are talking about about physical inactivity (sedentary lifestyle),
• the muscles do not work coherently, which indicates.
• the muscles and disc are exposed to excessive stress that exceeds the current capabilities of the body (professional sports, exhausting or excessive physical work, professional destructive factors, etc.).

Physical inactivity

A sedentary lifestyle is dangerous because:

The spinal muscles relax and do not provide sufficient flow of blood, nutrients and oxygen to the vertebrae.

1. Due to lack of movement in the spine, the diffusion (passage) of nutrients, oxygen and water through the cartilage to the discs is impaired. As a result, cells die and the nuclei pulposus are dehydrated.
2. Due to the deterioration of lymph flow, dead cells begin to accumulate in the vertebrae and discs, preventing recovery.
3. With sedentary work (lifestyle), an indispensable condition in the prevention and treatment of the disease is a constant micro change in the “sedentary” posture itself. This is necessary so that different muscle groups work, and not the same ones, since otherwise they will be overstrained. This change is achieved when sitting on a swinging (dynamic) support. A person intuitively changes his posture to ensure a stable position on a chair. Accordingly, the groups of working muscles constantly change.

6 reasons why you should include phonation in the treatment of intervertebral hernia:

1. Phonation promotes cleansing tissue in the damaged area of ​​the spine from dead cells and breakdown products due to stimulation of lymph flow. And this is a necessary condition for recovery.
2. Happening blood flow stimulation, due to which the nutrition of muscle cells, vertebrae, and spinal cord improves. Also transport of nutrients and water into the cartilage plate and intervertebral discs is activated, which is necessary for the nutrition of their cells and elasticity.
3. Improves the outflow of venous blood from the affected area, which reduces swelling and compression of the spinal cord, nerves and blood vessels.
4. Improving the conduction of impulses along nerve fibers, which was proven by studies carried out at the Moscow Regional Research Clinical Institute. As a result, the functioning of neuromuscular shock absorption systems is restored and the development of recurrent cases of the disease is prevented.
5. Phonation improves kidney function, which helps restore the water-electrolyte balance of the blood and improve the functioning of all muscles. The work of the adrenal glands is also stimulated and the production of hormones that activate regenerative processes in the body increases.
6. Spinal phonation promotes the release of the original stem cells, which can be transformed into any functional tissue (including cartilage). RF patent No. 2166924.

It is important that phonation helps get rid of pain- the effectiveness of the method was proven by a study conducted as part of the preparation of T. I. Yakushina, candidate of medical sciences. Of the 52 patients with osteochondrosis and hernia, in 45 people (86.5%), the use allowed:

• reduce pain and relieve muscle spasms on the 4th day of treatment
• restore skin sensitivity in 7-8 days;
• improve physical activity on days 10-11.

Dynamics of pain syndrome as a result of vibroacoustic influence

The diagram shows the dynamics of pain reduction, which was observed during treatment using phonation with the " " device.

The effectiveness of treatment using different methods of physical influence

Note: VAV - vibroacoustic impact; VAV+IR - vibroacoustic and infrared influence using the " " apparatus; Magnet - magnetic influence.

There is a possibility that your attending physician may not know about this new modern treatment method (phonation) and the corresponding devices, therefore, before going to your appointment, we suggest printing out information about contraindications and methods of treating intervertebral hernia.

Hernia of the spine, or intervertebral hernia– a disease in which deformation of the intervertebral disc occurs, rupture of its outer part and protrusion of the inner part beyond the limits vertebral body.

Worldwide, intervertebral hernia is diagnosed annually in 150 people per 100,000 population. Statistics show that the prevalence of the disease has tripled in recent years.

In most cases, pathological changes develop in the lumbar spine. 48% of intervertebral hernias are detected between the last lumbar vertebra (fifth) and the sacrum. 46% - between the fourth and fifth lumbar vertebrae.

Intervertebral hernias in the cervical spine are much less common. IN thoracic region- rarely. According to statistics, this disease is the most common cause of acute back pain.
Every year in the United States, 200,000 surgical procedures are performed for herniated discs. In Germany, about 20,000 patients are operated on every year.

Anatomy of the spinal column and intervertebral discs

The human spinal column consists of vertebrae - bones of complex shape, total of which on average is 33. Each vertebra consists of two parts: a massive oval or bean-shaped body and an arch attached to it at the back. The vertebral bodies are mounted on top of each other in the form of a column. The arches also connect to form the spinal canal, the receptacle for the spinal cord. At the junction of the vertebral arch and its body there are notches. When the notches of the overlying and underlying vertebrae are combined, lateral openings are formed - through them the nerve roots emerge from the spinal canal.

Sections of the spinal column:

• Cervical consists of seven small vertebrae. Has high mobility. The first cervical vertebra articulates with the occipital bone of the skull.
• Thoracic region represented by 12 vertebrae connected to the ribs. They are part of the chest and are rigidly fixed. Mobility in this part of the spine is very low. This is one of the reasons that osteochondrosis, intervertebral hernias and other pathologies rarely develop here.
• Lumbar. Consists of five large vertebrae. Has high mobility. Takes on the heaviest loads compared to the cervical and thoracic regions. The last, fifth, lumbar vertebra connects to the sacrum.
• Sacrum. Consists of five vertebrae that are fused into one bone.
• Coccyx. Includes 3 to 5 small vertebrae.

The bodies of adjacent vertebrae are connected to each other by intervertebral discs.

Intervertebral disc- a fibrocartilaginous formation that acts as a lining between the vertebral bodies.

The structure of the intervertebral disc:

Functions of intervertebral discs:

• ensuring normal mobility of the spinal column
• intervertebral discs connect the spinal column into a single whole
• spring function - shock absorption while walking, jumping, etc.

Facts about intervertebral discs:

• The total height of all intervertebral discs is about 1/3 of the height of the spinal column.


• The size of the intervertebral discs depends on the size of the vertebrae, so they vary in different segments of the spine. For example, the average diameter of a lumbar vertebra is 4 cm, and its height is from 7 to 10 mm.


• The boundary between the annulus fibrosus and the nucleus pulposus is best expressed in boys and girls. With age, it gradually wears off, and the nucleus pulposus becomes denser.


• A person's height varies throughout the day. In the evening we are 2 cm lower than in the morning. This is due to a change in the height of the intervertebral discs: they “flatten” a little under prolonged loads associated with the vertical position of the body.


• If you compress a normal healthy intervertebral disc, its height can decrease by a maximum of 1 - 2 mm. But you can “stretch” it by 3–5 mm.


• Normally, the intervertebral discs may protrude slightly beyond the vertebral bodies. This usually occurs in the anterior direction, and the size of the protrusion does not exceed 3 mm.


• In total, there are 23 intervertebral discs in the human body.


• The term “displaced intervertebral disc” is sometimes used. This is not entirely true. The intervertebral disc is tightly connected to the vertebral bodies, and is strengthened in front and behind by strong ligaments. It cannot shift, that is, leave its normal location.

Reasons for the development of intervertebral hernia

• Degenerative changes in the vertebrae and intervertebral discs. Often, intervertebral hernia is a complication of osteochondrosis.
• Previous spinal column injuries: vertebral compression fractures, subluxations.
• Increased load on the spinal column: constant work sitting or standing in a monotonous position, improper carrying of heavy objects, excessive physical exercise, overtraining in athletes.
• Sedentary lifestyle.
• Infectious diseases, in which the spinal column is affected.
• Excess body weight.
• Congenital anomalies of the spine. If the vertebrae have an irregular shape, then the load on the intervertebral discs increases, and hernial protrusions are more easily formed.
• Action of vibration. Most often this is due to industrial hazards. Under the influence of vibration, the structure of the intervertebral disc is disrupted and it becomes weakened.
• Incorrect posture, scoliosis.

Types of intervertebral hernias

Classification of intervertebral hernias depending on the degree of protrusion:
Classification of intervertebral hernias depending on the direction of the hernial protrusion:
Classification of intervertebral hernias depending on the affected segment of the spine:

• lumbar intervertebral hernia– occur in most cases, many doctors encounter almost exclusively them in their practice
• cervical intervertebral hernia- much less common
• thoracic intervertebral hernia- extremely rare occurrence

Symptoms of a herniated disc

Location of intervertebral hernia	Characteristic symptoms
Cervical spine	Headache. Associated with compression of nerve roots and vertebral arteries(large arteries that run along the cervical spine on the right and left). Most often the whole head hurts. Sometimes the pain affects only the occipital or temporal region. Neck pain. Associated with compression of the herniated nerve roots. Usually bothered in the early stages of the disease. In some cases, they can occur when the size of the hernial protrusion is from 1 mm. Dizziness. It is a sign of compression of the vertebral artery. Weakness, increased fatigue. They are a consequence of insufficient oxygen supply to the brain. Also caused by compression of the vertebral artery. Sudden increases in blood pressure. The vessels that run near the cervical spine contain many nerve endings. Many of them are involved in regulating blood pressure levels. When they are irritated by a hernial protrusion, electrical impulses enter the brain, triggering reflexes, leading to vasospasm and increased pressure. In some cases, this can lead to strokes. The nerve roots that arise from the cervical spinal cord include sensory and motor nerves. When they are compressed, the following symptoms are noted: Pain in shoulder, arm. Weakness of the arm and shoulder muscles. Unpleasant sensations: numbness, “crawling”, tingling. Pale skin, increased sweating. With severe compression of the cervical segment of the spinal cord by a hernial protrusion, severe paralysis develops.
Lumbar spine	Lumbago– sudden appearance acute pain in the lower back during physical activity or heavy lifting. The pain is tearing, stabbing, shooting in nature. Associated with a sharp prolapse of the intervertebral disc and irritation of the nerve endings that are located in the fibrous ring. A reflex is triggered, as a result of which the tone of the lumbar muscles greatly increases. The patient freezes in a monotonous position, cannot straighten his back and turn around. This manifestation of herniated intervertebral discs lumbar region most often occurs in men aged 30–40 years. Sciatica (sciatica)– irritation of the sciatic nerve due to pinching of the spinal roots by a hernial protrusion. There is pain, burning, tingling and numbness that spreads from the lower back down the back of the leg. These symptoms usually occur on one side, according to the position of the intervertebral hernia. Prolonged pain in the lumbar region. Can last up to several months. They have an aching, pulling, burning character. Pelvic organ dysfunction. Incontinence or, on the contrary, urinary retention. Defecation disorder. In men, the disease may be accompanied by impotence. Compression of motor nerves in the spinal roots: weakness of the leg muscles, decreased tone, decreased reflexes (detected during examination by a neurologist). Compression of sensory nerves in the spinal roots: decreased skin sensitivity, unpleasant sensations in the form of tingling, numbness, “crawling sensation.” These symptoms may involve the thigh, lower leg, foot, groin area, or buttock area. Compression of the nerves in the spinal roots that regulate blood vessels, sweat glands and other autonomic functions. It manifests itself in the form of pale skin, increased sweating, and the appearance of white or red spots. Spinal cord compression and damage: paralysis (complete lack of movement) and paresis (partial lack of movement) in the legs.
Thoracic spinal column	Backache. Usually localized between the shoulder blades at the location of the hernia. May spread to the chest, neck, lower back, shoulders, arms. Intensifies during deep breaths and exhalations, sneezing, coughing. Often has a girdling character. Stomach ache. A rare situation when pain spreads to the abdominal area. Requires careful diagnosis to exclude other diseases. Symptoms Associated with Spinal Cord Compression: below the site of injury, paresis and paralysis develop, sensitivity decreases or is completely lost.

Spinal cord compression is the most severe complication of an intervertebral herniation of any location. This usually occurs with posterior hernias. They protrude into the spinal canal, which contains the spinal cord, and compress it. The processes of sensory nerves that go up to the brain and the processes of motor neurons that go down to the organs are compressed. Depending on the degree of compression, either complete paralysis and loss of sensitivity occurs, or paresis (partial paralysis) with partial loss of sensitivity below the location of the hernia.

Diagnosis of intervertebral hernias

Medical examination

If there are complaints and symptoms characteristic of an intervertebral hernia, the patient is examined by a neurologist or orthopedist.

Points that make up a medical examination:

• Questioning the patient. The doctor finds out when the pain first appeared, what provokes it, what its nature is, where it occurs, how long it usually lasts, and what other symptoms occur.
• Inspection and palpation of the back and neck: assessment of the condition of the spine, posture, identification of pain points in the spinal column.
• Assessment of movements and muscle strength, skin sensitivity.
• Reflex assessment.
• Conducting functional tests: the patient is asked to walk around the room, sit down, tilt his head and body, raise his leg while lying down, etc.

After a medical examination, a preliminary diagnosis is established and an examination is prescribed.

Radiography

Typically, X-rays are taken in frontal and lateral projections (full face and profile). This diagnostic technique does not allow identifying the hernia itself, since the intervertebral discs are not visible on radiographs. But it is possible to detect the causes of the development of intervertebral hernia: vertebral injuries, their deformations, congenital anomalies.

Indications: a study is prescribed for all patients with suspected intervertebral hernia to confirm or exclude pathological changes in the vertebrae.

Contraindications:

• pregnant women;
• patients with intense bleeding.

CT scan

Efficiency and information content

Computed tomography is an x-ray technique that allows you to obtain clear layer-by-layer images of any area of ​​the body, including the spinal column. The images show the intervertebral discs quite clearly, their condition can be assessed and small hernias can be identified. CT makes it possible, like radiography, to assess the condition of the vertebrae and detect the causes of the hernia.

Indications: Computed tomography is prescribed to patients with suspected intervertebral hernia in order to identify the disease and its causes.

Contraindications:

• pregnant women and young children;
• patients in serious condition;
• patients whose body weight exceeds 150 kg;
• mentally ill people with inappropriate behavior;
• patients suffering from claustrophobia - fear of closed spaces (during a CT scan a person is in a confined space).

All contraindications are relative. If urgently necessary, the study can still be carried out.

Despite its sufficient information content, computed tomography is better suited for assessing the condition of bones than soft tissues and intervertebral discs. Currently, when doctors suspect intervertebral hernias, they prefer magnetic resonance imaging (MRI).

Invasive CT myelography

A test in which a contrast agent is injected into the space around the spinal cord, followed by a CT scan. This allows you to assess the degree of compression of the spinal cord by the herniated disc. Invasive CT myelography is performed only in hospitals.

Indications: identifying the degree of compression of the spinal cord during intervertebral hernias, identifying disturbances in the outflow of cerebrospinal fluid.

Contraindications:

• all contraindications typical for conventional computed tomography;
• individual intolerance to contrast media.

Magnetic resonance imaging

Information content and efficiency

Magnetic resonance imaging is ideal for diagnosing intervertebral hernias and assessing the condition of the spinal cord and other soft tissues. All anatomical formations are clearly visible on the resulting images. But when it is necessary to assess the condition of the vertebrae, MRI is inferior to computed tomography.

Indications: using MRI, you can accurately diagnose an intervertebral hernia, assess its position, size, and degree of compression of the spinal cord.

Contraindications:

• any metal implants inside the patient’s body (since a powerful electromagnetic field is created during MRI);
• pacemakers, electric ear prostheses;
• the presence of an Ilizarov apparatus and other metal structures.

Advantages of magnetic resonance imaging over computed tomography in the diagnosis of intervertebral hernias:

• high information content of the method;
• The patient's body is not affected by X-ray radiation.

Treatment of intervertebral hernia

Interesting facts about the treatment of intervertebral hernias:

• Typically, intervertebral disc protrusion within 3 mm is not accompanied by any symptoms and does not lead to complications. This condition is considered to be within normal limits.
• Sometimes intervertebral hernias are detected accidentally during a computed tomography or magnetic resonance imaging scan. There are no symptoms of dysfunction. In these cases, the patient also most often does not need treatment.
• According to statistics, in most cases with intervertebral hernia, all symptoms disappear 6 weeks after the first attack, and remission occurs. There are scientific studies confirming spontaneous recovery after 24 weeks. In this regard, there are not always indications for surgical treatment of the disease.

Drug treatment of intervertebral hernia

Main purpose of application medicines for intervertebral hernia – pain reduction.

Drugs	Description
: Diclofenac (synonyms: Diclogen, Voltaren, Ortofen) Meloxicam (syn.: Movalis) Ketorol	They have analgesic and anti-inflammatory effects. They are used as prescribed by a doctor in the form of tablets, injections, ointments. Use of Diclofenac: In tablets 0.025 and 0.05 g: 2 – 3 times a day, one tablet. When the intensity of pain decreases - 0.025 g 3 times a day. The general course of treatment is usually 5 – 6 weeks. With injections, the effect occurs faster. Diclofenac is administered intramuscularly at a dosage of 0.075 g 1–2 times a day. Treatment is continued for no more than 2–5 days. Ointment: rub into the skin 2–4 times a day in an amount of 2–4 g. Application of Meloxicam: Take 0.0075 g in tablets once a day. Injections (Movalis): administer 7.5–15 mg once a day. The duration of treatment is as prescribed by the doctor. Application of Ketorol: In tablets: take one tablet 0.01 - 0.03 g every 6 - 8 hours. For injections: administer intramuscularly 1 ampoule (1 ml) of a 3% solution every 6 to 8 hours. Duration of treatment as prescribed by the doctor. Application of Analgin: In tablets: 1 tablet (0.5 g), no more than 4 tablets per day for an adult. For injection: administer intramuscularly 1 ampoule (1 ml) of a 50% solution. No more than 4 ampoules per day for an adult.
Ointments based on adrenal hormones - glucocorticoids: The most powerful: Chalcinonide Dermovate Strong drugs: Cutivate Flucinar (Sinaflan, Sinalar) Lorinden (Locacorten); Triacort Fluorocort (Polcortolone ointment) Esperon Elokom Lokoid (Laticort) Sikotren Alupent Celestoderm-B (Betnovate) Medium strength drugs: Ultralan Dermatop Prednisolone ointment Deperzolon Weak drugs: Hydrocortisone	Glucocorticoids (corticosteroids) are medications that have powerful anti-inflammatory and analgesic effects. Prescribed for herniated intervertebral discs, accompanied by severe pain and severe inflammation. Use of corticosteroid ointments: Treatment usually starts with weaker drugs. If they do not have the desired effect, then move on to more powerful ones. The ointment is rubbed into the skin in the affected area in a small amount 1 – 2 times a day.

Self-medication can lead to undesirable and serious consequences. All medications must be used strictly as prescribed by the doctor.

How to perform therapeutic exercises for a herniated spine?

Before performing a complex of gymnastics for intervertebral hernia, you should consult a doctor. Incorrectly selected exercises and excessive loads can lead to additional disc displacement and worsening of the patient’s condition.

What exercises to do for a herniated cervical spine?

An approximate set of exercises for a herniated disc in the cervical region:

• Starting position – standing, feet shoulder-width apart. Tilts the head to the right and left.
• Starting position – sitting on a chair, with a straight back. Tilt your head forward and backward (do this with caution!).
• Starting position – sitting on a chair with a straight back. Turns the head right and left.

Purpose of the exercises: stretch the muscles, eliminate excessive muscle tension, prevent the herniation from pinching the nerve roots.

Frequency of performing a set of exercises: daily, at least once a day.

Number of repetitions: start with 5 repetitions, in the future their number can be increased.

What exercises to do for a herniated lumbar spine?

An approximate set of exercises for intervertebral hernia in the lumbar region:

• Starting position: lying on your back, hands at your sides. Tighten and then relax your abdominal muscles several times. The degree of muscle tension can be controlled by placing your hand on your stomach.


• Starting position: lying on your back, legs straight, arms extended at your sides. Raise your pelvis and body above the floor. Stay in this position for 10 seconds.


• Starting position: lying on your back, legs slightly bent. bend right leg in the knee and try to pull it towards the body, while simultaneously placing your left hand on it and preventing bending. Then repeat the same for the left leg and right arm.

Purpose of the exercises: strengthen the muscles of the lower back, relieve their excessive tone, improve the mobility of the spinal column, prevent herniation of a nerve root.

Frequency of execution: daily, start with 10 repetitions, then increase.

Massage is an effective additional method of treating intervertebral hernias. It should be carried out only in the subacute period, when there is no severe acute pain, as prescribed by a doctor.

Purposes of massage for intervertebral hernia:

• decline muscle tension;
• improvement of blood circulation in the intervertebral discs and surrounding tissues;
• pain reduction;
• acceleration of patient rehabilitation;
• reducing the risk of the disease becoming chronic.

General rules of massage for intervertebral hernia:

• all manipulations must be carried out only by a specially trained specialist;
• a light relaxing massage is performed, including mainly stroking, rubbing, and gentle kneading;
• any rough techniques are avoided, the patient should under no circumstances feel pain;
• the first session does not last long, during which the massage therapist acts as gently and carefully as possible;
• during subsequent sessions the strength and duration of the impact increase;
• during a massage of the neck and shoulder girdle, the patient lies on his stomach, resting his forehead on his folded hands;
• it is permissible to massage the neck in a position where the patient is sitting with his arms and head resting on the table;
• massage of the back and chest is performed while lying on the stomach, while a special pillow is placed under the patient’s chest;
• The lumbar massage is performed while lying on the stomach, with the patient’s legs slightly bent and a cushion placed under the shins: this helps reduce tension in the lumbar muscles.

Indications for massage for intervertebral hernias: as part of complex therapy in the subacute period, during rehabilitation.

Contraindications:

• the beginning of the acute period of the disease, severe pain;
• pustular lesions and tumors on the skin;
• general serious condition patient;
• increase in body temperature more than 38⁰C.

What traditional methods exist for treating spinal hernia?

Before using traditional methods of treating intervertebral hernias, you must consult with your doctor. Self-medication can lead to aggravation of the patient’s condition and negative consequences.

Massage with honey

Ingredients:

• fir oil;
• 100 g of any honey;
• mummy in a small amount (1 tablet);
• any warming cream.

Mode of application:

• Mix honey and mumiyo until smooth.
• Rub your back with fir oil.
• Take honey mass. Drive into the skin at the affected area with light slaps.
• After completing the procedure, remove any remaining honey from the skin using a dry towel.
• Rub the affected area with warming ointment. Wrap up.

Rubbing with oils based on medicinal plants

Oils of comfrey roots, birch leaves, and St. John's wort help relieve pain and improve tissue restoration if rubbed into the skin at the location of the intervertebral hernia daily.

Rubbing with cinquefoil tincture

Ingredients:

• cinquefoil root – 100 g;
• sweet clover grass – 100 g;
• elecampane root – 100 g;
• seeds of steppe hemlock, unripe, - 150 g.

Mode of application:

• mix all the listed components in a three-liter jar, fill with vodka;
• leave for 3 weeks;
• rub the location of the intervertebral hernia daily.

Horse fat compress

Mode of application:

• freeze a small amount of horse fat;
• cut the fat into thin shavings, place them on a piece of cellophane of the required size, cover with cotton fabric;
• wait until the fat warms up and melts;
• apply the resulting compress to the affected area, wrap yourself up;
• the pain subsides within about an hour;
• To consolidate the effect, wear for 1 – 2 days.

Which sanatorium is better to relax in with a spinal hernia?

Rehabilitation of patients with intervertebral hernias should be carried out in sanatoriums where there are appropriate programs, specialists, and equipment.

Several specialized sanatoriums exist in the Moscow region:

• Sanatorium "Udelnaya". Offers full boarding with five meals a day. In terms of price level it belongs to economy class. The level of service is rated by many operators as average.
• Rublevo-Uspensky medical and health complex (health complex "Sosny"). Has high ratings from operators. We offer middle class and comfort class service. Excellent organization of leisure time, a lot of entertainment, but prices are quite high.
• Boarding house "Zarya". Offers full boarding, three meals a day. Service - comfort class. The operators have high ratings. The price level is approximately average.
• Sanatorium "Kashirskie fontanelles". Full boarding with three meals a day. It ranks slightly above average among operators. We offer middle class and economy service. The price level is quite high.
• Sanatorium "Valuevo". Belongs to the comfort class. The level of service and prices are average. The operators' ratings are above average.

When choosing a sanatorium for the treatment of intervertebral hernia, you should first of all study the available programs and see where they are the most comprehensive. It is worth consulting with your doctor.

Physiotherapy for intervertebral hernias

Method	Description	How is it used?
Diadynamic currents	Diadynamic current is direct current with low voltage. Effects of diadynamic currents: decreased excitability of nerve endings; improvement of tissue nutrition; improved blood circulation; pronounced analgesic effect. This type of current is widely used for diseases accompanied by pain in the spinal column, including intervertebral hernias.	Methodology of the procedure: Electrodes are placed on the skin in the affected area and current is supplied to them. The procedure is accompanied by a slight tingling and burning sensation, redness of the skin in the area of ​​treatment. : as prescribed by the attending physician, usually about 6 – 10 sessions. Indications: intervertebral hernias, accompanied by severe pain, in the subacute period. Contraindications: acute inflammatory process; skin diseases, ulcers on the skin in the affected area; significant increase in body temperature, fever; hypertensive crisis (sharp increase in blood pressure); increased bleeding.
Acupuncture (acupuncture)	The method is based on the introduction of thin needles into the skin at special reflexogenic points. The procedure has an analgesic effect, improves blood flow and tissue nutrition. Today, the effectiveness of acupuncture for intervertebral hernias has not been fully proven. Some researchers claim that patients receiving this type of treatment do not show significant improvement compared to those taking a placebo.	During the session, the specialist uses special thin metal needles. They are injected into the skin at special reflexogenic points located in strictly defined places. The number of procedures is determined individually by the attending physician. Acupuncture has virtually no contraindications. Needles should not be placed on areas of the skin affected by inflammatory and pustular processes.
Electrophoresis	Electrophoresis - introduction medicines through the skin using an electric current. Currently most often used papain and caripain(enzymes of plant origin) having the following effects: restoration of damaged tissues; improved nutrition and blood circulation; help reduce hernial protrusion.	Methodology: Two electrodes are applied to the patient’s skin in the affected area: one of them is supplied with an electric current with a plus sign, and the other with a minus sign. One of them is marked medicinal substance, which penetrates the skin under the influence of an electric field. During the procedure, the parameters of the electric current are adjusted so that a slight tingling sensation is felt on the patient’s skin. Duration of the procedure: 15 minutes. Total duration of treatment: 10 days, as prescribed by a doctor. Indications: intervertebral hernia in the subacute stage (when there are no acute severe pain). Contraindications: malignant tumors of various organs and systems; severe cardiac dysfunction; acute inflammation or infection of the skin at the site of exposure; skin diseases: eczema, psoriasis, etc.; high temperature, fever; increased bleeding; individual intolerance to drugs used during electrophoresis; skin damage at the site of exposure: wounds, burns.

Other methods of treating intervertebral hernias without surgery:

• Manual therapy. A system of manipulations that is carried out by a specialist and is aimed at eliminating intervertebral hernia. Usually 2 to 10 sessions are required. If you decide to resort to this treatment method, you should first consult with your doctor and find an experienced chiropractor.
• Kinesitherapy. Treatment using movements that the patient performs with the participation of a doctor. You can consider kinesitherapy as a type of physical therapy. This technique is aimed at normalizing muscle tone, restoring normal blood circulation, and increasing tissue regeneration. Improvement occurs after 12 sessions. Usually the course is repeated 2 - 3 times.
• Hirudotherapy. Treatment with leeches. Their saliva contains biologically active substances that promote the resorption of prolapsed disc fragments and improve blood circulation in the affected area.
• Cryotherapy. Low temperature treatment. Liquid nitrogen is placed on the affected area. Thanks to the action of cold, blood circulation in the tissues improves.
• Osteopathy. A relatively young and somewhat controversial area of ​​medicine. Using light movements and pressure, the doctor eliminates pathological changes that contribute to the development of an intervertebral hernia.

Surgical treatment of intervertebral hernia

Indications for surgical treatment of intervertebral hernia:

• severe pain that does not go away for a long time, despite conservative treatment;
• severe neurological disorders: decreased sensitivity, muscle tone and strength, paralysis and paresis;
• urinary incontinence, impotence in men (if it is caused by compression of the spinal cord herniation).

Recently, many scientific studies have appeared proving that intervertebral hernias are prone to self-healing without surgical intervention. Therefore, indications for surgery are being reduced. At the same time, a number of clinics strive to operate on as many patients as possible, since the operation has a very high cost.

In such a situation, the patient can be advised to find a good doctor whom he can trust and who will clearly explain whether surgery is necessary in a particular case or, perhaps, it is worth holding off and waiting for the hernia to resolve without intervention.

Types of surgical interventions for intervertebral hernias:

• Classic laminectomy– an open operation in which part of the intervertebral arch is removed and the spinal canal is opened. Quite a complex and traumatic operation. After it, the patient requires a long recovery period. Today it is used less and less.
• Microsurgery. It is carried out using miniature instruments under high magnification. Allows you to remove almost any type of intervertebral hernia. During the operation, the surrounding tissues are minimally damaged.
• Endoscopic surgery. It is performed without an incision, through a puncture. Less traumatic. Today, several endoscopic techniques have been developed. Their advantage is that the patient can get out of bed and walk on the day of surgery.
• Intervertebral disc replacement. The damaged disc is completely removed and an artificial implant is placed in its place. Techniques are being developed that could completely restore damaged disks.

What is a blockade for a spinal hernia?

Therapeutic blockade for spinal hernia is a procedure aimed at pain relief and muscle spasm relief. Simply put, a blockade is an injection of anesthetics (novocaine, lidocaine, etc.). The analgesic effect of this procedure can last from half an hour to 3 weeks, depending on the characteristics of the body and the technique of performing the blockade.

Therapeutic effect of the blockade:

• rapid pain relief – relief occurs within 1-2 minutes;
• elimination of muscle spasms that increase pain;
• relieving inflammation, especially with the administration of corticosteroids;
• reducing swelling of soft tissues, which causes pinching of nerve fibers.

When blocking, the following are used:

• Anesthetics – 0.5% novocaine solution or 1% lidocaine;
• Anesthetics + corticosteroids - a mixture of hydrocortisone (50-75 mg) and 0.5% novocaine (up to 100 ml).

When anesthetizing the nerve roots, 10-20 ml of the drug is administered per injection. When administering drugs into the spinal canal, the volume can reach 300 ml.

Types of blockades:

Indications for spinal blockade:

• radiculopathy – painful pinching of the spinal cord roots due to protrusion and intervertebral hernia;
• severe pain caused by prolonged muscle spasm near the hernia;
• pain associated with compression of the spinal cord by posterior hernias.

Contraindications:

• infection of the spine;
• fever;
• mental illness;
• weakness;
• bleeding disorders;
• renal and liver failure;
• tendency to convulsions;

Disadvantages of the blockade:

• Paravertebral blockade only anesthetizes the superficial muscles. Its effect may be short-term. Ineffective for large hernias or compression of the spinal cord.
• The blockade may need to be repeated (up to 3-5 times), which increases the risk of complications.

The blockade can cause a number of complications:

• Allergic reactions to the administered medications. Occurs due to individual intolerance to drugs.
• Phrenic nerve palsy can develop with a blockade near the 5th cervical vertebra. Manifested by hiccups, uncontrolled movements of the diaphragm, shortness of breath, and breathing problems.
• Infections– develop due to violation of asepsis during the procedure. With an epidural block, pathogenic bacteria enter the spinal canal, which can lead to an infectious lesion of the spinal cord. With paravertebral blockade, there is a risk of developing phlegmon or abscess.
• Damage to blood vessels. The medicine enters the bloodstream, which may cause a burning sensation and pain. In severe cases, anaphylactic shock develops, which requires emergency medical attention.
• Spinal cord injury occurs when manipulation is carried out carelessly. Symptoms: paresis and paralysis of muscles, impaired sensitivity and a feeling of numbness in the limbs, urinary incontinence and involuntary bowel movements.
• Bladder disorders- manifests itself in the release of a small amount of urine. Disruption of innervation leads to stretching of the bladder wall, which does not contract enough to empty completely.
• Penetration of drugs into the subarachnoid space(between the soft and arachnoid membranes of the brain and spinal cord). Manifestations: headache and impaired respiratory rate.

Blockade at spina bifida– a quick and effective way to get rid of pain. However, an experienced doctor should make a decision about it, taking into account the possible risks.

How does recovery occur after spinal hernia surgery?

Surgeries have recently been prescribed to fewer and fewer patients. This is due to the fact that significant success has been achieved in conservative treatment and the fact that recovery after surgery for a spinal hernia is a rather lengthy and labor-intensive process. Rehabilitation can take more than 6 months and requires patience, perseverance and strict adherence to the instructions of the rehabilitation doctor from the patient.

Modern technologies make it possible to reduce the postoperative period to a minimum. In some cases, the patient can walk on the same day. However, this does not mean that rehabilitation should be taken lightly. After all, its task is to consolidate the results of the operation and prevent the development of complications.

Stages of the recovery period:

1. Early postoperative period– elimination of pain. Lasts 2-3 weeks. The first few days will have to be kept in bed to prevent early postoperative complications. The main goals of this period are to eliminate pain and swelling of the spinal root. The condition can be alleviated by taking medications: antibiotics, non-steroidal anti-inflammatory drugs.
2. Late postoperative period– restoration of range of motion and self-care skills. Lasts up to 2 months. At this time, physical and psychological adaptation to new opportunities occurs. Goal: erase pathological stereotypes and movements that have taken root during periods of acute pain. Rehabilitation is carried out using massage, therapeutic exercises and physiotherapy.
3. Long-term postoperative period– restoration of the functions of the spine and strengthening of the muscular-ligamentous apparatus that provides its support. This period lasts for the rest of your life. Its goals are to strengthen the back muscles and prevent the appearance of new hernias. Indicated: physical therapy and treatment in sanatoriums treating the musculoskeletal system.

Means used to restore the spine

• Medications taken as prescribed by a doctor. The dose is determined based on the gender, age and condition of the patient.
  • Nonsteroidal anti-inflammatory drugs(Nise, Dikloberl) eliminate pain and reduce swelling of the nerve root. Duration of treatment is up to 4-6 weeks.
  • Antibiotics(Cefoxitin, Cefotetan) before surgery and for 12-18 hours after surgery - to prevent purulent complications.
  • B vitamins(Neuromultivit, Milgamma) accelerate the restoration of nerve fibers. Duration of use – up to 4 weeks.
  • Anticholinesterase drugs(Prozerin, Neuromidin) eliminate numbness and weakness in the lower extremities. Helps restore sensitivity and motor functions of the affected limbs. Course 1-3 months.
  • Chondroprotectors(Alflutop, Structum) promote the restoration of cartilage tissue of the intervertebral disc. Duration of treatment is up to 3 months. If necessary, the course can be repeated after 2-5 months.
• Physiotherapeutic procedures. 10-20 procedures per course.
  • Magnetotherapy– exposure to a magnetic field reduces pain, swelling and inflammation. Can be used at an early stage to accelerate the healing of postoperative wounds. Allowed already on the second day after surgery.
  • Laser therapy– laser radiation is used to accelerate tissue regeneration, heal postoperative wounds, restore disc connective fibers and improve the condition of nerve fibers.
  • UHF– ultra-high frequency electromagnetic fields eliminate the infiltrate formed after surgery and prevent the development of infection. Used to accelerate wound healing in the early postoperative period on days 3-5.
  • Electrical muscle stimulation– under the influence of electrical impulses, involuntary muscle contraction occurs and blood circulation in the affected area improves. There should be no visible muscle contraction during the procedure. In this case, it does not put stress on the intervertebral joints, so it can be used 1-2 days after the sutures are removed.
  • Amplipulsetherapy– has an analgesic effect, helps restore damaged nerve fibers and cartilage tissue, improves muscle nutrition and helps strengthen them. Helps restore muscle function after paresis or paralysis caused by a hernia. Prescribed 10-14 days after surgery.
  • Diadynamic therapy– treatment with pulsed electric current has an analgesic effect, stimulates nutrition and strengthening of muscles, restores muscle sensitivity and has an analgesic effect. Prescribed in the late postoperative period, 2-3 weeks after surgery.
  • Electrophoresis with lidase– the medicine is injected under the skin using a weak electric current of galvanic origin. The drug itself improves the condition of cartilage tissue and prevents the development of scars that can disrupt the functioning of the spine. Treatment is recommended in the late period, 1.5 months after surgery.
  • Ultrasound with traumeel has an anti-inflammatory and absorbable effect. Homeopathic ointment is introduced into the tissues using ultrasound and improves the functioning of the spine.
• Massage– allowed in the late and long-term postoperative period 3 weeks after surgery. It is prohibited to impact the operated area of ​​the spine. Only performed by a specialist. Different types of massage are used:
  • manual;
  • vacuum;
  • spot.
• Physiotherapy(physical therapy). Classes with a trainer begin 1.5 months after surgery. The doctor individually selects a set of exercises based on the location of the hernia, health status and age of the patient. The first classes are carried out only under the supervision of a doctor. In the future, you can train at home, without increasing the number of repetitions and strictly following the methodology. If pain occurs, you should stop doing the exercises.
• Manual therapy- only allowed post-isometric relaxation in the long-term postoperative period. This is a gentle technique aimed at relaxing muscles. Active exposure is unacceptable - it can worsen the condition.
• Mechanotherapy– exercises on orthopedic simulators under the strict supervision of a doctor. Loads must be strictly dosed.
• Reflexology– impact on reflex points relieves pain and improves the functioning of nerve fibers. During the rehabilitation period the following is used:
  • acupuncture - inserting needles into reflex points;
  • acupressure – acupressure;
  • thermopuncture - cauterization with wormwood cigars;
  • electropuncture – exposure to electric current.
• Mechanical unloading of the spine. The use of corsets limits the mobility of the spine in the operated segment until the muscles are strong enough to fix it. Corsets are extremely important for preventing recurrent hernias. The most commonly used:
  • semi-rigid corset;
  • Shants collar;
  • fixing belt.
• Spa treatment. The most effective procedures:
  • radon baths;
  • mud therapy;
  • swimming;
  • underwater massage.

During the rehabilitation period, it is necessary to take into account the basic rule: do not be overzealous and take initiative. Overexertion causes recurrent hernias in 40% of operated patients. Patients should also remember that maintenance procedures will have to be done throughout their lives.

During the rehabilitation period, patients must strictly follow the doctor’s recommendations and take precautions:

• avoid hypothermia;
• do not lift weights exceeding 2 kg in each hand;
• avoid monotonous work and prolonged stay in one position;
• avoid injury;
• avoid intense training;
• do not make sudden movements in the spine, bending to the sides;
• refuse manual therapy and osteopathy;
• refusal of certain sports - horse riding, wrestling and other martial arts, jumping.

What complications can there be after surgery for a herniated disc?

In recent years, surgery for intervertebral hernia has been prescribed much less frequently than before, given the high likelihood of postoperative complications. According to statistics, over 50% of operated patients encounter complications of varying complexity.

Possible complications after surgery for a herniated disc:

Early complications

• Bleeding. Possible during and after surgery. Damage may be the cause blood vessel. If the postoperative suture begins to bleed or a hematoma forms around it, you must urgently seek medical help.
• Complications after anesthesia– individual intolerance to one of the components of anesthesia. May manifest as nausea, vomiting, and prolonged weakness after anesthesia.
• Chronic pain. The pain does not decrease after surgery and may increase over time. This is due to a surgeon error or damage to nerve fibers before surgery.

Long-term complications

• Blood clots. Blood clots often form in the vessels of the lower extremities. This occurs due to the activation of the blood clotting system during surgery. In the future, there is a risk of their tearing off and thromboembolism (blockage of heart vessels), which can cause myocardial infarction.
• Damage to the membranes of the spinal cord. Injury to the dura dural membrane results in the release of cerebrospinal fluid into the surrounding tissue. May manifest as headaches and pain in the area of ​​injury.
• Wound spinal cord. Its damage may be due to a surgeon’s error, the formation of edema or a rough postoperative scar. Such an injury can cause paralysis in lower areas of the body.
• Spinal nerve damage– leads to loss of sensitivity and loss motor function(muscle paralysis) in the segment for which this nerve was responsible.
• Repeated herniated discs. During the operation, the integrity of the disc is compromised and the muscular support of the spine is weakened. With improper rehabilitation, there is a high risk of the formation of new, rapidly progressing hernias. They may appear in the old place or in neighboring intervertebral discs.
• Scar changes– the growth of coarse connective tissue at the site of intervention can disrupt movement in this segment of the spine. In addition, a keloid scar can compress a nerve root, causing the same symptoms as a herniated disc.

Some unscrupulous “specialists” recommend surgical treatment even for protrusions and small hernias. They often convince that the operation will prevent the hernia from enlarging, which is not true. Therefore, if you are offered surgery, be sure to consult with 1-2 more specialists. Remember that there are not many indications for surgery.

What can be the consequences of a herniated disc?

The consequences of a herniated disc are most often associated with damage to the nerves extending from this segment of the spine. According to statistics, complications occur with large untreated hernias in 7-10% of patients.

Consequences of a spinal hernia:

1. Cauda equina syndrome. The cauda equina is a bundle of nerve fibers that innervates the lower limbs and pelvic organs. The syndrome occurs when nerves are compressed at the level of the first lumbar vertebra. It includes the following violations:

• severe lower back pain spreading to one or both legs;
• numbness and tingling in the perineum and inner thighs;
• decreased tone of the intestinal and bladder sphincters leads to incontinence;
• weakness of the muscles of the lower legs: the legs become “wobbly”, a flopping, unsteady gait appears;
• absence of knee and ankle reflexes.

2. Paresis and paralysis upper limbs . Complication of a herniated cervical spine. At the initial stage, numbness develops in the fingers, and movements become difficult. Subsequently, muscle atrophy increases, sensitivity in the upper parts of the arm decreases. The lesion can be unilateral or bilateral, depending on the size and location of the hernia.
3. Chest pain, heart pain, stomach pain– occur with a hernia of the thoracic region. Sometimes patients complain of the feeling of a belt tightening the chest. In some cases, severe pain occurs in the heart area, although examination does not reveal any pathological changes. Severe, causeless pain in the stomach, not associated with food intake, is also caused by disruption of the nerve compressed by the hernia.
4. Paresis and paralysis of leg muscles. It begins with mild numbness in the legs and decreased sensation in the feet. Further numbness and tingling spread to the legs and thighs. Swelling appears in the legs. Gradually, the leg muscles stop “obeying”. By the 4th-5th year of the disease, paralysis can spread to the rest of the leg muscles. If the hernia is localized between the 4th and 5th lumbar vertebrae, then paralysis of the foot develops, which is popularly called “slap-foot.”
5. Bladder disorders– release of a small amount of urine, which is accompanied by a feeling of incomplete emptying of the bladder, urinary incontinence. If such disorders develop acutely (within a few hours), this indicates compression of the cauda equina hernia.
6. Sexual disorders in men– decreased erection and early ejaculation may be a sign of protrusion or hernia pinching the spinal nerve roots in the lumbar region.
7. Pathologies of the genital organs in women– due to the deterioration of nervous regulation, the tone of the vaginal walls is weakened. This can lead to uterine prolapse and vaginal prolapse. Often women complain of pain in the ovaries and lower abdomen. In this case, ultrasound and other examination methods do not detect any pathological changes.
8. Pinched nerve atrophy– death of nerve fibers as a result of disruption of their blood circulation and prolonged compression of the nerve root. Causes complete paralysis of the muscles for the innervation of which this nerve was responsible.
9. Spinal cord injury– compression of the spinal cord causes paralysis of the body below the site of injury.

Why does my back hurt with a herniated disc?

Doctors have several explanations for the question: “Why does my back hurt with an intervertebral hernia?”

1. Pain is the result of a reflex reaction, which develops in several stages:

• Primary pain spasm is irritation of pain receptors caused by hypothermia, prolonged uncomfortable position, careless movement.
• A reflex contraction of the muscles supporting this area of ​​the spine is a response to primary pain.
• Prolonged muscle spasm causes new pain, which further increases muscle tone, aggravating the condition. Thus, chronic pain develops even with a small hernia.

2. Pain is the result of compression of the spinal nerve roots. In this case, the pathological process also consists of 3 components:

• The hernia increases in size and compresses the nerve root extending from this segment of the spine.
• Swelling of the tissues surrounding the nerve endings develops, which further increases the pinching.
• A spasm of the surrounding muscles occurs, in this way the body tries to reduce the range of motion of the spine and prevent further pinching of the root, which can lead to the death of nerve fibers.

If back pain does not go away within 3 days, we advise you to consult a doctor. Modern medicine proceeds from the fact that in 90% of cases, pain from a spinal hernia can be relieved with conservative therapy in 3-4 weeks. Only in 10% of patients, if treatment is ineffective, rigid corsets and surgery are prescribed.

How to prevent intervertebral disc herniation?

Prevention of intervertebral disc herniation requires not only healthy people. Compliance with these rules will help improve the condition of the spine for patients with protrusions and small hernias, as well as for those who have undergone surgery to remove a hernia.

A herniated disc is a disease of the musculoskeletal system, the occurrence of which is caused by the development of deformative processes associated with displacement of the nucleus of the intervertebral disc. As a result, the fibrous ring ruptures. It is through it that, under the influence of pressure, part of the nucleus pulposus protrudes outward. This pathology most often occurs in people in the age range from 25 to 45 years.

The causes of hernia formation are due to the influence of external and internal factors on the spine. The main symptom of a vertebral hernia is the occurrence of severe pain in the back, mainly in the lumbosacral region of the spinal column. If you seek medical help in a timely manner, it is quite possible to cure this disease. Sometimes the problem is solved through surgery.

Description

A spinal hernia is a disease of the skeletal system, as a result of which the intervertebral discs, consisting of cartilage tissue, are deformed. They connect the vertebrae to each other. As a result of the development of pathology, a hernia is formed. The edge of the intervertebral disc acts as a hernial orifice. The hernial sac is part of it. If the spine is normal, then the nucleus pulposus is located inside the fibrous ring. In case of disturbances, the overlying vertebra begins to put pressure on the one located below, and the contents of the nucleus are pushed out. At the first stage of the formation of an intervertebral hernia, disc prolapse occurs. The integrity of the fibrous ring is preserved, and the changes are reversible.

The clinical manifestations of prolapse are quite weak, and the patient may not pay attention to them.

Among the signs indicating the development of a hernia are:

• fatigue;
• mild pain in the back;
• numbness of the skin.

Large hernias cause compression of a nearby nerve root, causing pain in the lower extremities. If the protrusions are small, then the nerve root may not be compressed. In this case, the disease can be treated. However, a hernia can become a serious problem. The advanced stage of the disease leads to damage to the nervous structures, the end result of which is often paralysis.

The symptoms of this disease cannot be ignored. Although in most cases the disease does not pose a mortal danger to people, it can cause disability for the patient or significantly reduce his quality of life.

Types of vertebral hernias

Intervertebral hernias are divided depending on their location. Hernias of the following parts of the spine are distinguished:

• cervical;
• chest;
• lumbar;
• sacral

In addition, there are the following types of pathology:

• Schmorl's hernia. It is a congenital disease. Her characteristic feature- no protrusion. Instead, there is an indentation at the site of the lesion.
• Median. The causes of the pathology are a mystery to specialists. In most cases, this disease goes away on its own. His distinctive feature is an unstable pain, the intensity of which tends to periodically increase and decrease.
• Dorsal. This is a pathology in which the disc protrudes into the spinal canal area, resulting in pinched nerve roots. Initially, pain occurs in the lumbar region, but over time the pain also affects the lower limbs.
• Sequestered. The disease develops when the integrity of the vertebral disc is violated, as a result of which the nucleus pulposus leaks into the lumen of the canal. The quality of human life with this pathology is significantly reduced. The place of its occurrence is most often the cervical and lumbar spine.

Causes

Degenerative-dystrophic changes in intervertebral discs are caused by various reasons. The following factors may influence the development of the disease:

• disruption of metabolic processes in the body;
• genetic weakness of the spine;
• chronic diseases: osteochondrosis, arthritis, scoliosis, ankylosing spondylitis and a number of others;
• improper organization of nutrition;
• injuries, bruises, dislocations;
• increased load on the spine;
• excess weight;
• elderly age;
• diabetes;
• bad habits: smoking, drinking alcohol;
• diseases of the endocrine system;
• physical inactivity;
• sedentary lifestyle.

The onset of the disease is characterized by the fact that the disc begins to gradually collapse, losing its elasticity and strength. At the same time, it is deprived of fluid, microelements and nutrients. As a result, the wall of the intervertebral disc protrudes, which extends beyond the vertebra.

Hernia during pregnancy

Herniated discis a common problem during pregnancy. During this period, a woman’s load on the spine increases, and at the same time the compression of nerve endings increases.

Treatment of the pathology in this case is necessary. The situation is aggravated by the fact that pregnant women are prohibited from using potent medications. In this case, a high-quality examination and the use of non-drug methods, including traditional treatment, are required.

In order to safely carry a child during pregnancy, it is necessary to control the situation: do not exceed the load on the spine, use a special bandage, choose comfortable shoes and follow a special diet. Expectant mothers need to perform special exercises to prevent exacerbation of the disease:

• Kegel exercises can relieve pain lower section backs. You need to slowly tense your vaginal muscles. At the same time, the hips, stomach and buttocks remain relaxed. Tension alternates with relaxation for 10 seconds, repeat 10 times.
• Arm raises - relieve pain caused by a displaced intervertebral disc. Lie on your back, bend your knees so that your feet are on the floor. Raise the pelvis while simultaneously extending the arms so that they are parallel to the spine. They stay in this position for 10 seconds, after which they lower their hands. You need to repeat the exercise 10 times.
• Leg raises - strengthen the muscles of the lower back. Lie in a horizontal position, bend your knees. Raise the pelvis, while slowly extending one leg, keeping it as straight as possible. Stay in this position for 10 seconds, then lower your leg and relax. Next, the exercise is carried out with the other leg. You need to do 10 approaches with each limb.

Treatment

Treatment of a vertebral hernia requires an individual approach and depends on the severity of the manifestations. It must be taken into account that human body has powerful potential and fairly high regeneration abilities. In many cases medical intervention can be avoided.

Patients with a vertebral hernia are prescribed bed rest. They need to avoid any physical activity, especially heavy lifting and physical exercise.

In the absence of complications, recovery occurs after a couple of months.

Patients may be prescribed painkillers and medications with an anti-inflammatory spectrum of action.

In case of spinal hernia, chondroprotectors are prescribed at the initial stage. The action of these drugs is aimed at restoring cartilage tissue and preventing its destruction. The most popular of them are Mucosat and Teraflex. To speed up metabolic processes in tissues and restore them, patients are prescribed stimulants: Aloe, Plazmol, etc. To improve functioning immune system and normalization of metabolic processes take vitamins.

Physiotherapeutic methods are widely used in the treatment of vertebral hernia. The most popular are:

• laser therapy;
• chipipase electrophoresis;
• tetracycline spinal traction;
• magnet;
• Exercise therapy, massages;
• manual therapy.

Laser removal of intervertebral hernia is an alternative to drug treatment in the absence of indications for microdiscectomy.

Manual therapy is effective at the initial stage of the disease. Using this method, it is possible to reduce pain. Before undergoing it, an MRI is mandatory. The examination is carried out to identify tumors, spinal cord injuries or other changes in the spine for which treatment is contraindicated. The method of manual therapy cannot be used for serious neurological disorders and sciatica, when pain radiates to the leg. If the hernia is localized in the cervical spine, manual therapy is also not recommended due to possible risk development of complications.

Injection of painkillers into trigger points of the spinal column is aimed at relieving back pain.

Spinal traction during hernia shows fairly high effectiveness. The technique is aimed at reducing pressure in the problem area, stimulating metabolic processes in the spine, eliminating swelling, releasing the nerve root and eliminating numbness of the extremities. The method consists of stretching muscles and ligaments using a horizontal bar.

X-ray-controlled blockades are used in cases where drug therapy has not led to the desired result. The method consists of administering hormonal and painkillers to the compressed nerve root under x-ray control. The manipulation is performed under local anesthesia. The effectiveness of the method depends on clinical manifestations diseases. In many cases, after the blockade, relief occurs. With this method, recovery can be achieved much faster.

Surgical intervention

If the hernia cannot be treated with medications, even with the use of epidural blockades, and the symptoms indicate the likelihood of irreversible consequences, it is advisable to surgical treatment. According to statistics, 10% of patients with protruding intervertebral disc undergo surgery. The indication for surgery is pain lasting 2-3 months, as well as the rapid development of neurological disorders.

The most common intervention methods are laparoscopy and microdiscectomy. The operation is performed under general anesthesia and lasts 30 minutes. Removal of a hernia occurs using special equipment that allows this to be done without injuring the nerve structures and surrounding tissues.

Traditional methods

In the treatment of spinal hernia it would be useful to use folk remedies. Products based on natural ingredients will help relieve pain. Many recipes have been repeatedly tested in practice. Here are some of them:

• Infusion of weeping herb. It is prepared as follows: you need to take a tablespoon of the roots of the tortuous loosestrife, pour a glass of boiling water and leave until it cools completely. After this, strain. Take ¼ cup 3 times a day half an hour before meals.
• Camphor oil rub. It is necessary to rub the area of ​​the body where the hernia is found with oil, then apply a cake of pine resin to the affected area, securing it with a plaster.
• Herbal decoction. With its help, you can reduce inflammation of the nerve roots and increase the body's resistance. For preparation, grass and rose hips, chamomile and linden are used. The ingredients are taken in equal parts, 1 tsp each. and pour boiling water in a volume of one liter. Take a glass a day, divided into three doses.

For a hernia of the spine, it is useful to drink a decoction of bran, do massages and take walks in the fresh air.

A herniated disc is a dangerous disease that often occurs under the guise of back pain. People are accustomed to attributing such pain to the banal consequences of hard work. According to statistics from the World Health Organization, by the age of 30, 80% of the population has it, after 40 years - already 90%, but only four out of a hundred people have it as a source of pain.

Our vertebrae consist of a compact substance on the outside and a spongy substance on the inside. The design combines strength and ductility to accommodate shock-absorbing loads such as compression from walking and jumping. Between the vertebral bodies there are elastic yellow discs that ensure rotation of the vertebrae relative to each other. A person transfers the weight of his body only on two supports (legs), which causes colossal axial loads that the vertebrae may not be able to withstand.

With excessive overload, due to age or various back injuries, the outer wall of the disc (fibrous ring) becomes thinner, stretches and begins to bulge beyond the standard position of the intervertebral disc. This bulging is called a disc herniation. If the hernia bulges inward, towards the spinal canal, it can compress the spinal cord and nerve roots located at the damaged level. As a result, pain syndromes of varying severity, a feeling of numbness in the extremities and increased pressure occur.

Spinal herniation is a disease in which damage to the intervertebral disc occurs, its outer part ruptures and the internal substance of the disc leaks beyond the vertebral body.

Types of hernias

In the direction of protrusion:

• Posterior hernias: very dangerous because directly presses on the spinal cord canal. As a result, disturbances in the conduction of nerve impulses occur.
• Anterior hernias: the least dangerous type of the disease, does not cause lethal damage.
• Lateral hernias: located in the lateral direction from the vertebral bodies, on the right and left.
• Schmorl's hernia: the protrusion goes inside the vertebral body. Has a vertical direction.

According to the degree of protrusion:

• Protrusion – protrusion from 1 to 3 mm. It is a physiological norm and does not require active treatment.
• Prolapse – protrusion from 3 to 6 mm. At this stage, the first symptoms of the disease appear – back pain.
• Intervertebral disc herniation – size more than 6 mm. There is a rupture of the fibrous ring and significant protrusion of the disc substance.

By level of damage:

• thoracic intervertebral hernias are very rare, due to the fixation of the ribs in this section;
• cervical intervertebral hernias are an average type;
• lumbar intervertebral hernias are the most common, because The main burden falls on this department.

Causes

• Long-term and constant loads on the spine: this includes all hard work, work associated with constantly being in a monotonous position, improper carrying of bags and backpacks, excessive physical activity in athletes.
• Sedentary lifestyle – static position at the computer from 8 to 10 hours a day.
• Excess weight is overeating and as a consequence of the previous reason.
• Incorrect posture and scoliosis are directly related to lifestyle.
  Infectious diseases - some pathogens affect the spinal cord.
• Vibration exposure is a negative factor to which workers in production, as well as truck drivers, are exposed.
• Previous spinal injuries – subluxations and compression fractures.
• Congenital developmental anomalies - as a rule, they are only a trigger factor, which, in combination with lifestyle and behavior, leads to disc herniation.

As a result of rupture of the intervertebral plate, the elastic substance comes out. It puts pressure on the nerve root that runs next to the spine and causes an inflammatory reaction. As a result, pain appears at the site of the lesion, and in the limb innervated by the nerve, sensitivity and a feeling of numbness appear.

Main clinical symptoms of the disease

This table lists all the main symptoms of the disease. Based on these complaints, the doctor, when collecting anamnesis, can get a first idea about the presence of pathology, as well as the level of localization. Remember that you cannot use each symptom separately; you can only suspect a hernia if you have three or more signs.

Cervical region	Thoracic region	Lumbar
Combination of headaches with dizziness and pressure surges	Combined pain in the thoracic spine with scoliosis, less commonly kyphoscoliosis.	Isolated pain in the leg, usually localized along the back, sometimes along the front/lateral surface of the thigh to the foot
Numbness in fingers	Regular pain in the thoracic region in people when working in a forced position (machinists, doctors, carpenters, etc.)	Loss of sensation in the toes or groin area.
Local pain in the shoulder and/or arm	Disorder of defecation and urination.	Locally directed pain in the leg or foot
Unreasonable pressure surges		Persistent (more than 3 months) low back pain

Diagnostics

The protrusion cannot be seen on a regular x-ray. Magnetic resonance imaging (MRI) is considered a generally accepted method for diagnosing disc herniation. It allows you to show not only the level and localization of the hernia, but also a full picture of destructive changes in the vertebral discs, the degree of compression, infringement of nerve structures, and the presence of concomitant pathology. Usually this is enough for the surgeon to decide on the choice of treatment tactics. According to indications (presence of a pacemaker, metal structures), CT myelography is performed - an X-ray image with a contrast agent in the spinal canal.

If the protrusion is small (less than 5 cm) and does not cause severe attacks of pain, it is initially recommended to consult a neurologist for conservative therapy. For the majority of people drug treatment will be very effective in terms of pain relief.

Conservative (non-surgical) treatment methods

These methods include:

1 Rest is the simplest medicine. With its help, the depth and rhythm of breathing is restored, nervous and muscle tension is relieved. 2 Physiotherapy - heating and vibration create a feeling of comfort, allowing you to relieve tension from the muscles, thereby reducing pain. 3 Therapeutic exercise – passive and active stretching of the spine develops the deep muscles of the spine, helping to improve microcirculation in the hernia area. 4 Therapeutic blockades – allow you to relieve pain. Using a special needle, the medicine is injected into the area of ​​the compressed nerve root. There are paravertebral, epidural and pararadicular methods of drug administration. 5 Taking vitamins and anti-inflammatory drugs (Voltaren, diclofenac), muscle relaxants - act systemically, allowing you to reduce pain impulses.

Conservative treatment has a number of disadvantages. First of all, it is aimed not at eliminating the cause - a herniated disc, but at relieving inflammation of the nerve root. Many patients have contraindications to taking a large number of medications, since they have a toxic effect on the stomach, liver and kidneys, and can cause allergic reactions.

If the pain does not subside under the influence of all the above therapeutic measures within 2-4 months, then the patient requires surgical treatment!

Microsurgical operations

These are considered the global “gold standard” for the surgical treatment of intervertebral disc herniations. The operation is classified as minimally invasive. Access to the vertebra is made through a skin incision of 2-3 centimeters, without damaging the bone structures of the vertebrae. All manipulations in the spinal canal are carried out under the control of a high-precision operating microscope, reducing the risk of damage to tissue structures. By pushing back the nerve root, the surgeon removes the hernial protrusion and all its fragments in the disc cavity. The risks of this manipulation in the hands of experienced neurosurgeons are minimal. In the postoperative period, the patient may experience pain in the surgical area for several weeks.

The advantages of the technique are:

• Speed ​​of execution – from 15 to 30 minutes.
• The gentle nature of the intervention - a small incision will not restrict movement or bother you in the long-term postoperative period.
• Reduction of hospitalization time - on average, 1-2 days, after which the patient is discharged for observation.
• Versatility – one to two hernias can be operated on in one procedure.
• In cases where the hernia is small in diameter, some clinics use such a high-precision surgical method as puncture endoscopic microdiscectomy. It reduces surgical trauma to 1.5-2 cm, the risks of complications and rehabilitation time.

Video

The host of the popular program, while in the operating room, interviews a neurosurgeon who briefly describes the main symptoms and stages of surgical treatment for a herniated disc.

Nucleoplasty of the intervertebral disc

A modern minimally invasive operation that has shown a positive postoperative effect in 80% of patients over the past 10 years. The essence of the method is to insert a thin puncture needle-electrode into the cavity of the intervertebral disc to the nucleus pulposus. Cold plasma is supplied to the end of the electrode, evaporating part of the hernia volume, which is removed through the needle. As a result of the reduction in pressure, the hernia is “reduced” and the patient feels a decrease in pain in the spine right on the operating table. The full effect of treatment is assessed 2 months after surgery.

The advantages of the method are:

• The speed of execution is from 20 to 30 minutes.
• Minimal invasiveness - puncture through the skin is carried out under local anesthesia. It is aesthetic and painless. The patient monitors the progress of the operation on the screen.
• One-day operation - no hospitalization required, 1-2 hours after the procedure you can already get up and start walking.
• Versatility – one or several segments of the spine can be operated on in one procedure.

The most important measure after the intervention is early physical activity. Therefore, after a couple of hours, doctors will allow the patient to get up and start walking. The process of walking will allow you to mobilize the spine and reduce the possibility of tissue scar formation at the surgical site.

People whose jobs do not involve physical activity can begin working within a couple of weeks after surgery. However, drivers and office workers should periodically get up from their chairs so that repeated pinching of the nerves does not develop from a prolonged static position. Due to intense vibration load, production workers, loaders and athletes are prohibited from starting work earlier than 2-3 months. Physiotherapy, massage and exercise therapy help speed up the recovery process.

When discharging the patient, the professional doctor will leave recommendations for lifestyle changes that will help keep the spine in good condition for a long time:

• Reducing body weight - a person has two points of support, which already leads to age-related changes in the skeleton and excessive weight only aggravates it. Normalizing your weight will relieve your back and reduce the daily stress we experience every day.
• Strengthening the core muscles - regular exercises for the abdominal muscles, shoulder muscles and spinal extensors, posterior group thigh muscles will relieve the spine by transferring the axial load to the muscles.
• Swimming is the best way to unload the spine. It is enough just to swim 2-3 times a week for an hour.
• As with any disease, early diagnosis increases the likelihood of a favorable outcome. This fully applies to disc herniations.
• If detected at the initial stages, the doctor will have more opportunities for your healing, skillfully combining treatment methods.

Remember that your health is entirely in your hands. It depends on your desire to be healthy and happy. These tips will only help you if you start following them. Compliance with the above recommendations will allow you to live a full and active life without pain and repeated operations.

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