Modern methods of treatment of sequestered herniated discs
The Sequestered herniation of the spine is a violation of the integrity of the intervertebral disc with the release of nucleus pulposus into the lumen of the spinal canal. The disease significantly reduces the physical and emotional quality of life.
Sequestered disc herniation in 10% of cases of all patients with spinal osteochondrosis is a common cause of disability. Timely and adequate treatment of sequestered hernias of the spine returns patients the ability to work and health.
The Most vulnerable to the formation of disc herniation are the cervical areas (L4-L5, L5-S1) and lumbar spine. They include the physiological curvature (kyphosis and lordosis), which allows us to walk upright and hold the vertical position of the body.
The disease is accompanied by pathological changes in sensory and motor division of the nervous system. The herniated disk is formed gradually. Sequestration hernia is the final stage, after the protrusion and extrusion.
The Localization of sequestered disc herniation in relation to the vertebral column may be: anterior, lateral, median or combination.
causes of sequestered hernias
Due to the lack of its own blood vessels, the disk receives nutrients by diffusion (merge substances). The main role played by the adjacent muscular structure. During muscle tension (excessive physical stress), triggers degenerative changes of the water Department. Fibrous ring loses water and vitamins, it decreases its height, there are cracks.
Sequestration of hernia occurs in the following cases:
- osteochondrosis (genetic predisposition, a history of long-term illness, frequent exacerbations, poor treatment, and so on)
- anatomic defects of development;
- microelementosis (lack or excess of trace elements and minerals in the human body);
- excess weight, physical inactivity, poor diet;
- the static, dynamic loads on the spine.
To Provoke the deterioration of the patient with the further development of the sequestered herniation of L4-L5, L5-S1 and other vertebrae of the lumbar spine can:
- lifting weights
- incorrect tilts and squats;
- emotional stress.
The Clinical picture depends on the localization and direction of the herniation. Sequestered herniation of the spine (lumbosacral spine, L4-L5 and L5-S1) has several distinct manifestations:
- pain syndrome (constant pain, aggravated by changing the position of the torso, from the waist (along the nerve) radiating to the posterolateral thigh, anterolateral area of lower legs, sole of foot, toes);
- limitation of active movements (disturbed gait or the patient is unable to move independently, to further develop paresis and paralysis);
- sensitivity (in addition to pain, patients concerned about the feeling of numbness in the foot, the sole, toes);
- changes of the muscles (for a long period of poor circulation and nerve root compression, reduces the volume of the foot; the muscles get thin, and then atrophy);
- autonomic disorders (autonomic autonomic dysregulation leads to dryness, or rash of the skin sore feet, changing local temperature of the skin);
- disorders of the pelvic organs (urination, defecation);
- aseptic inflammation (dropped out of the ring pulpous nucleus, irritating muscles and bone tissue, causing swelling and inflammation; may develop osteomyelitis with lesion of the vertebra)
- defense of the muscles of the spine (in the projection of lesion focus is determined by the reflex contraction of muscle fibers in response to irritation of the spine, palpable "cushions" of the muscles)
- reduction or loss of tendon reflexes (knee, ankle);
- is flattened lumbar lordosis (normal in the lumbar region has a curvature inwards).
Sequestered disc herniation diagnosed by standard clinical, laboratory and instrumental methods:
- neurological exam
- General and biochemical blood analysis, urine analysis;
- MRI (positron emission) tomographyof the spine or specific Department (allows you to determine the location of the hernia, its direction, size, degree of damage to the fibrous ring, the condition of adjacent structures)
- electromyography (defines a Central or peripheral lesion of the conduction of the nerve impulse in muscle fibers).
Supervision and treatment of the patient with disc herniation exercises a neurologist. If the patient has a long history of degenerative disc disease of the spine, it is observed as an outpatient in the clinic by place of residence.
This phase of treatment consists of different areas:
- Medical therapy
- non-Steroidal anti-inflammatory drugs (diclofenac, nimesil, xefocam, Nise, and others) – struggling with inflammatory phenomena in the lesion;
- Diuretics (furosemide, hydrochlorothiazide and others) – appoint short courses at the beginning of treatment to relieve swelling of compressed tissues;
- b Vitamins (thiamine, pyridoxine, milgamma, combilipen and others) – improve the conductivity of the nerve fiber
- Muscle relaxants (mydocalm and others) – spazmirovannuû relax the muscles;
- of Vascular and nootropic therapy (Actovegin, trental, pentoxifylline) improves blood circulation and power delivery in the microvasculature;
- Anticonvulsants (carbamazepine, are, Finlepsin and others) – reduce the phenomenon of neuropathic pain;
- Chondroprotectors (a derivative of chondroitin sulfate) – saturated cartilage related molecules.
- Novocaine blockade.
- physical therapy
This includes magnetic therapy, ultrasound, diadynamic currents at the point the shaft or through the vascular technique, currents D'arsonvalya, traction and others.
Acupuncture is performed by a qualified technician, pain relieved on 3-4 procedure. Physiotherapists do not recommend simultaneous use of electrotherapy and acupuncture.
- physiotherapy (physical therapy), massage (including Eastern medicine), manual therapy, vacuum therapy.
Physical therapy may be used in the subacute period of the disease, in rehabilitation after surgery. In the acute phase of disease are shown only sparing manual therapy.
There is a manual method of vertebronevrologii (I. M. Danilov created over 10 years ago). Based on the effects on the musculo-ligamentous apparatus of the spine. Redistribution of internal and external load and pressure (reduced internal increases external). Due to the set position, the drive starts to receive nourishment, improves blood circulation and restores the lost functions. Prolonged treatment, up to 9-14 months.
If, during the first 2-3 weeks, the patient noted a positive trend, then surgical treatment may be postponed.
With the deterioration of the clinical picture of disc herniation hospitalization is shown. The surgery, when shown the removal of the entire disk or its part, decides the doctors neurologists, neurosurgeons, traumatologists.
- Microsurgery microdiscectomy (removal of disc herniation under the microscope, minimally invasive, reduces the compression of the spinal cord);
- nucleoplasty Percutaneous (minimally invasive intervention is performed under local anesthesia and constant x-ray control in two projections; puncture needle is inserted through the electrode, which resembles the cold plasma; as a result of hardening of the disk, it reduces the sequestration);
- Endoscopic removal of a hernia (surgical access is not more than 7 mm; performed spinal microscope, leaves no scars, can be performed under local anesthesia);
- Prosthetics (held in conjunction with the discectomy; for the transplant used part of the bone of the patient, donor or artificial (titanium) prostheses;
- Foraminotomy, laminotomy (removal of the handle or portion of the vertebrae that compresses the spinal cord, disrupting its power)
- Restoration of the intervertebral discs (autologous cartilage; during surgery discectomy, the cartilaginous tissue is incubated and propagated, and after 3-4 months the patient sits native cartilage tissue grown in vitro).
recovery and prevention
Rehabilitation direction in the treatment of patients is reduced to the appointment of therapeutic physical training, physiotherapy and psychotherapy qualified.
Clinical supervision of a neurologist on a residence, courses of maintenance therapy, a healthy lifestyle, exercising in the pool, getting rid of excess weight, correct diet, Spa treatment 1-2 times a year will help you to feel great.
Education of sequestration is an extreme degree of manifestation of spinal hernia. This condition requires immediate treatment. Dropped the core of the disc can move up and down along the spinal column that can lead to unpredictable consequences. The effectiveness of treatment, especially after surgery, largely depends on the proper and long term rehabilitation. Be careful!