What are the characteristics of the extrusion of the intervertebral disc
The Dorsal (back) extrusion – initial step for the formation of intervertebral hernia. When this pathology is torn fibrous ring (peripheral connective tissue sheath) and the inner content of the vertebral disc (the nucleus pulpous) begins to protrude outward, partially longitudinal ligament is fixed.
Effect of extrusion on herniation of the spine
Hernial protrusion towards the formation passes 3 stages:
- Prolapse – prolapse of the intervertebral disc beyond the functional segment of 2-3 mm, without rupture of the fibrous ring.
Occurs on the background of degenerative changes in the spine (a blood disorder). However, due to the lack of nutrients and fluids in the intervertebral disc appears full of cracks and the mobility of nucleus pulposus decreases.
- Protrusion – protrusion of from 4 to 15 mm;
When the damaged wall of the disc protrudes beyond the functional segment, there comes the second stage of formation of a hernia – a protrusion. When it is displaced intervertebral disc beyond the vertebral 3-4 mm.
- Extrusion – rupture of the annulus fibrosus and a minor loss of nucleus pulposus to the outside (hanging drop).
When torn fibrous ring and nucleus pulpous at 3-4 mm beyond the wall of the vertebral disc extrusion occurs. It can be called the initial stage of herniation, as a pulpous nucleus is irritating a nerve root.
In this situation, a strong compression of the nerves does not occur, since the formation of constrained longitudinal ligament of the spine. More dangerous exclusively at the level of l5-s1, which often leads to compression of the sciatic nerve.
causes of loss of vertebral disc
The Most frequent reasons of loss of intervertebral disc is degenerative condition (degenerative disc disease, scoliosis, spondylosis of the spine). When them disturbed blood circulation and delivery of nutrients to the anatomical structures of the intervertebral segments.
Traumatic injuries of muscular-ligamentous apparatus also lead to the formation of intervertebral extrusion.
When excessive physical activity often occurs in the extrusion segment L5-S1 (between lumbar and sacral spine). This segment is subjected to maximum cushioning the load when walking in comparison with other divisions of the vertebral column.
Symptoms of disc extrusion
Often extrusion of the intervertebral disc occurs without obvious clinical symptoms. Only if intervertebral disc protrusion compresses the nerve roots, pain appears. The degree of severity depends on the location of the protrusions.
Cervical extrusion may be accompanied by pain in the upper limbs and the back of his head.
In the lumbar prolapsed intervertebral disc is more severe syndromes and is accompanied by:
- Pain along the length of pinched nerve;
- Localized pain with compression of spinal nerves
- Numbness of the thighs;
- Tingling in the lower extremities.
Sharp pain attack during extrusion, as a rule, is not observed. Pathology is not characterized by large bulging disc in the spinal-cord region, as in hernia.
The Emergence of aching pain in the lower extremities accompanied by numbness of the toes and painful sensation in the lower leg area.
To Diagnose the condition the doctor more often have neurologic manifestations:
- the Appearance of local pain during digital examination feeling the axis of the spine;
- Numbness in thigh and lower extremities;
- Absence of the Achilles and patellar reflex.
Upon detection of the above symptoms, the doctor prescribes an MRI, which can be traced to the structural features of extrusion and its location.
we should also highlight the piriformis syndrome that occurs when subligamentous (subglottic) the loss of the intervertebral disc in the segment L5-S1 without destruction of the fibrous ring. Through this area passes the sciatic nerve, which goes from the pelvis to the lower limb.
Symptoms of herniated disk are somewhat different in young and older people. Young men seldom observed extrusion of L5-S1, because they have cartilage more durable.
Degenerative changes of the spine at a young age are less common than in the elderly. Modern teenagers often observed extrusion of the cervical spine due to improper landing behind a school Desk. It is characterized by syndromes such as dizziness, headache, numbness of the upper extremities due to compression of the nerve roots.
In the elderly because of the defeat of segment l5-s1 there are often "top pain" on the gothe sciatic nerve (upper thigh, posterior surface of the tibia). On their background, observed violations of sensitivity, numbness of the thigh.
Essentials of diagnosis bulging between the vertebrae
Exclusively and its symptoms can be identified:
- With the help of computer (CT) or magnetic resonance imaging (MRI) after implementation of cuts in the area of pain. For a more accurate assessment of the nature of protrusions, a contrast dye injected into the spinal canal;
- Discography to evaluate the structure loss (protrusion, extrusion, herniation). To implement the contrast is injected directly into the intervertebral disc;
- Neurological determination of nerve conduction is necessary in cases of suspected syndrome of compression.
Peculiarities of the treatment based on the results of the diagnosis
With a small amount of extrusion (up to 5 mm) TOOOreatment is carried out at home. To address pathology doctors prescribe physical therapy and spinal traction.
If the size of protrusion on the results of magnetic resonance investigations exceed 8 mm, you must also outpatient treatment. Operational measures these dimensions of education are not shown.
Dimensions of the protrusions to 12 mm require hospitalization for the decision of a question on tactics of treatment of the disease. If the symptoms of the disease does not disappear after the application of conservative methods, will require urgent surgery. It is also when the emergence of a syndrome "a horse tail" (compression of the sacral nerve plexus protrusion of the cartilaginous disc in l5-s1).
If the extrusion is greater than 12 mm, outpatient therapy is rarely used (in the absence of lesions of the cauda equina). Such treatment is dangerous rapid development of paralysis of the lower limbs, therefore, should be applied only after a thorough examination of the person.
Approaches to the treatment of a slipped disc at the level l5-s1 are completely different. Only with protrusion of the intervertebral disc 1-2 mm, you can assign anti-inflammatory drugs, but in the absence of a syndrome "a horse tail".
With protrusion of 5-6 mm required surgery to prevent paralysis (immobilization) of the lower limbs.
If you exclusively often prescribed:
- Physiotherapy in combination with a set of strengthening exercises helps to strengthen the muscle corset back, eliminate inflammatory syndrome in soft tissue;
- non-Steroidal drug group NSAIDs. Without them it is almost impossible to eliminate pain syndrome arising from compression of a nerve root by a prolapsed intervertebral disc at the level l5-s1 or in the overlying divisions of the lumbar spine;
- When lumbago (severe pain with restriction of spinal mobility) are assigned to narcotic drugs;
- Steroid epidural anesthesia (injection of medication into the epidural space of the spinal cord) reduce inflammation, reduce pain.
With the ineffectiveness of conservative methods exclusively can be removed surgical intervention (spinal fusion and discectomy). Spinal fusion is often performed when fusion between the vertebrae at the level of l5-s1. This pathology is often congenital. On its background increases the likelihood of exclusively.
A Discectomy is surgery that is characterized by low invasiveness. When her access to the damaged division is provided using surgical endoscopes. The tools allow you to remove the dead tissue and cauterize the defect of the fibrous ring.
In conclusion, it should be noted that in most cases, to avert extrusion into the hernia of the spine helps normalize weight and proper diet and a therapeutic exercise.