The intervertebral discs are flexible spacers between the vertebrae. The main function of the discs is depreciation shock, inevitably. In the spine while running, walking, lifting weights The outer fiber ring and a gelatinous nucleus pulposus, which is located in the central part of the disc: each disc is made up of two layers. Fiber ring is a very strong bond, which has a fibrous structure and connects together the two vertebrae. Nucleus pulposus, which is due to their structure, the central element of the damping plate.
The mechanism of disc herniation is to break the fiber ring, accompanied by the release of a substance outside of the nucleus pulposus plate. If you break the fiber ring semicircle facing the spinal canal, the nucleus pulposus material goes into it, which can cause compression of the neural structures.
Causes
Although described isolated cases of disc herniation in children, in most cases, the disease occurs in people 25-45 years old. With age, developed disc degenerative changes, which lead to a decrease in hydrophilicity of the nucleus pulposus, which helps reduce the incidence of disc herniation in the elderly vozrasta.Simptomy
If a rise in the pressure disc can briefly breaking the fiber ring occur to form a hernia. For example, a fall from a ladder, a direct blow to the back break lead to the formation of the vertebrae and herniated disc. Such a herniated disc is called post-traumatic.
When lifting heavy weights off the floor, as there. A marked increase in the pressure inside the disc In most cases there is a rupture disc by repetitive microtrauma and degenerative disc changes. To such a change can break disk very slight increase intradiscal pressure. Pain in the extremities with herniated two reasons. First, the herniated disc in the spinal canal compression of the nerve roots and spinal cord. Secondly, the nucleus pulposus material is a chemical stimulation of the nerve tissue, contributes to the local inflammatory reaction. As a result of compression, and the development of inflammation is impaired function of the nerve root, which is manifested by pain, numbness of the limbs and sometimes the weakness of certain muscles.
If herniated disc back pain may be completely absent! But often patients reported back pain caused by rupture of a richly innervated ring. The most common symptoms of herniated disc are:
· Pain that radiates into the arm or leg
· Numbness of the limbs
· Weakness of certain muscles
· Reduced tendon reflexes
With participation of the different roots of the above symptoms occur in different areas. Given the topography of the area, the doctor may be able to determine the level at which there was a break with the development of the intervertebral disc hernia.
Diagnosis herniated disc begins with a detailed investigation of the complaints, history and physical examination, the patient. The doctor will ask in detail about the location and nature of the pain, the presence of reducing skin sensitivity and muscle weakness. Certainly asked about the presence of abnormal urination and defecation. The presence of these symptoms shows compression of the nerve roots that innervate the pelvic organs and is an indication for emergency surgery.
Additional methods of testing can be ordered spine radiography. In this study, only visualized bony structures, so that identifying the X-ray can not herniated. However, doing x-rays eliminates another disease whose symptoms are similar to the symptoms of a slipped disc.
Currently, the most accurate method for the diagnosis of herniated disc is a magnetic resonance imaging (MRI). This method is safe and very informative. Currently, the diagnosis of herniated disc MRI is almost completely supplanted the practice of research methods such as myelography and computed tomography.
Treatment
The presence of disc prolapse does not mean that the inevitable surgery. In many cases, the herniated disc is not to be operated on. The method for treating a patient based has certain symptoms. If simtomatika expressed, and the more there is a tendency to worsen, then you need to remove a hernia surgery. If the symptoms do not pronounced with a positive progress, effective medical therapy. Many people with confirmed disc herniation on MRI disturb her symptoms completely disappeared within a few weeks or months.
Surgical treatment Surgical treatment
Observation: In the case of "soft" symptoms, patients do not require treatment. They were medical monitoring used, established "expectant management."
Mode: If the pain compliance recommended bed rest for a few days. In what is necessary to achieve a progressive activation of the patient, which provides short walks, and a series of simple exercises to perform.
Pain Management: Depending on the severity of the pain to bother you, use different drugs. With low levels of pain sufficiently effective pain relievers such as acetaminophen, ibuprofen, Analgin. If the average intensity of the pain, the need for such a potent non-steroidal anti-inflammatory drugs such as diclofenac ksefokam, ketorol, Ketonal etc. In case of pain for a few days can be ordered narcotic drugs (Tramal, promedol, Nubain, etc.)
Epidural steroids. In cases of severe pain injection of glucocorticoid hormones (diprospan, Kenalog) are performed in the epidural space. This method of treatment for patients with herniated disc is only effective about half the time.
Laminectomy and discectomyTraditional methods of surgical treatment of herniated discs is to perform a laminectomy and discectomy. In the literal translation of the term "Laminectomy" means the removal of the vertebral arch, and the term "discectomy" - the removal of the disc. This is. By skin incision in the midline back over the area where the disc herniation done Subsequently subjecting the back surface of vertebrae, referred Paravertebralmuskulatur. During the operation, the level used by the correct choice of surgery to control electro-optical X-rays. For an overview of the contents of the internal vertebral canal and the possibility of manipulation performed removal of the vertebral arch. Next, the surgeon may carefully remove the affected nerve root aside consideration of the disc. In recognition of the nucleus pulposus material to break through the fibrous ring and within the spinal canal, carefully remove. This decompression and termination chemical irritation of the nerve root. Next, using were miniature instruments have been removal of the remainder of the nucleus pulposus of the intervertebral disc. This is to ensure that reduce in the future, the risk of recurrence. After major surgery operation phase stitched wound in layers.
MikrodiskekomiyaIn recent years, the most popular improved modification of the traditional discectomy. This process is called microdiscectomy. Microdiscectomy advantage is less traumatic surgery, faster recovery period. Incision 3-5 cm in length over the region broken disc performed. To inspect the contents of the spinal canal is not removing the vertebral arch and partial vykusyvanie yellow tape, is in the intervertebral foramen is maintained. For visualization of the surgical field, while in the area of the spinal canal using one operating microscope. This process is less risk of damage neural structures, the stability is not affected vertebral motor segment.
Endoscopic DiscectomyFitted after the introduction into clinical practice of the endoscope with a special camera, it was a revolution in surgery, were designed and tested dozens of new minimally invasive procedures. By endoscopic disc surgery endoscope into the damaged drive through tiny incision (0.5 cm) was introduced. In this case, the surgeon can see on the video display screen the interior of the plate, under the control of special tools remove nucleus pulposus formulation material. This process is much less traumatic than microdiscectomy, and the risk of major complications will destroy everything. The surgery is performed under local anesthesia. The very next day, the patient can be discharged from the hospital.
Currently, the meniscus tear in most cases, arthroscopic surgery, and for many years the "gold standard" is the removal of the gallbladder by laparoscopic method. However, in the era of endoscopic neurosurgery operations only at the beginning. But maybe in a few years, endoscopic spine surgery is routine.
Complications of the actual herniated disc
Cauda equina syndromeThe most dangerous complication of hernia is the development of cauda equina syndrome. This disease occurs when the compression of the large fragment of the nucleus pulposus in the spinal canal of the nerve roots that innervate the pelvic organs. Severe compression of the nerve can lead to permanent impairment of their function. As a result, the patient can not control urination and bowel movements, which create serious problems. Fortunately, cauda equina syndrome, rare. In case of violation of the pelvic organs in herniated need for urgent surgery to irreversible damage to neural structures and the development of persistent neurological symptoms prevent.Operative complicationsDuring operation,As with any surgical removal of herniated disc is a risk. Operative Complications of anesthesia and complications directly related to the surgery itself was added. Complications may occur when the removal of a disc herniation:Nerve damage
A herniated disk is in close proximity to the nerve roots. So, if a hernia, inadvertent damage to the nerve roots emerge. In this case, the patient after surgery for a long time weakness and numbness of the limbs are saved.
Rupture of the dura materThe dura mater covers the spinal cord and nerve roots primary sections, forming a sealed bag filled with cerebrospinal fluid (CSF). If you remove a hernia in a fraction of the dura mater. If the gap surgeons, then the plastic dura is seen and dura heals soon. At break unnoticed leakage of cerebrospinal fluid through the opening. This leads to lower intracranial pressure and the occurrence of headache for a few days or weeks after the operation. Moreover, the gap increases the risk of complications from Dura meningitis, in which the infection occurs in the spinal fluid. In most cases, a spontaneous rupture sealing Dura unnoticed by the formation of scar tissue.
PostoperativeEarly postoperative complications occurred in the first days after surgery. These include infectious complications (suppuration of postoperative wounds, pneumonia, urinary tract infections, etc.), the development of deep vein thrombosis of the lower extremities.
Late complications occur after several months or even returning years after surgery, and include herniated disc, degenerative process in the operated disc accelerates the onset of pain, nerve root compression caused by scar tissue.
CompletionA herniated disc is a complication of osteoarthritis, often bring great trouble ill. Modern development of neurosurgery led to the widespread use of high-tech methods of instrumental analysis of the revision of many established views on the treatment strategy for these patients. Conservative treatment is indicated in patients with a "soft" form of the disease on MRI in detecting small herniated disc. When a strong pain, muscular weakness, pelvic disorders, and in case of failure of the conservative treatment for 3 weeks shows the surgical procedure. In the currently preferred minimally invasive surgery (endoscopic discectomy and microdiscectomy). Operational risk in these transactions is minimal, and the recovery period is only a few days.
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