Decrease in the height of the intervertebral discs. Intervertebral disc - norm and pathology

A decrease in the height of the intervertebral discs of the lumbar spine is currently a fairly common pathology. Everyone knows that the human spine plays the role of a load-bearing axis. It supports the entire human body, and thanks to the intervertebral discs, it performs a shock-absorbing function. It protects the spinal cord from injury. The spine consists of separate parts - the vertebrae.

The causes of the appearance of pathology

Intervertebral discs are located between the individual parts of the spine, which perform the amortization function. They consist of the following parts:

• nucleus - fibrous tissue with a cartilaginous structure;
• a ring made of tendon-like tissue.

For all its functionality, intervertebral discs have no vessels in the structure. Therefore, they get their nutrients from the tissues around them. And if these tissues for some reason cease to receive nutrition, then the intervertebral discs "experience hunger." The parts of the spine are connected to each other directly by the nucleus of the disc. And with limited admission nutrients:

1. 1 Disc tissue is dehydrated.
2. 2 The intervertebral discs become fragile and lose their height.

And if the process of tissue nutrition is not restored, then the cartilaginous tissues of the disc harden and in appearance resemble bone tissue. This process is called osteochondrosis (spondylosis). But such a disease can be caused by another reason - mechanical squeezing of the disc. This happens with injuries of the spine, with unbearable loads.

Several pathology options are possible:

1. 1 Protrusion - if there is no damage to the annulus fibrosus.
2. 2 Hernia of the intervertebral disc - if such violations lead to the destruction of the ring and displacement of the ring outside of it.

What can happen after a decrease in the height of the intervertebral discs?

• At the third stage, the destruction of the disc ring continues and a hernia is formed. At this stage of the lesion, the disc is less than half the norm. At this time, appear:
• At the second stage, the annulus fibrosus changes. At this stage, the nerve endings are already restrained (this leads to pain). Blood and lymph outflows are already disturbed, and the height of the intervertebral disc is less than the norm by a quarter.
• First stage. Slight inconvenience (discomfort). Basically, they happen only in the morning, over time, the person "paces". At this stage, a doctor is rarely consulted.

1. 1 scoliosis is the bending of the spine in one direction or another;
2. 2 kyphosis - the formation of a hump;
3. 3 lordosis - backward bending of the spine.

• The fourth stage is the last stage in the spinal deformity. At this stage, there is a shift and compaction of the damaged vertebrae. This is a painful process. Patients feel severe sharp pain when walking, joint mobility is minimized. The disc height is already less than half of the norm. At this stage of the development of the disease, it is possible to establish the patient's disability.

Lumbar osteochondrosis is manifested by the following symptoms:

1. 1 With bending and sudden movements, lower back pain. Causes discomfort and uncomfortable posture while sleeping. Violent pain in the lumbar spine in the morning.
2. 2 Pain in the hip joint and lower limb. At this time, areas with numbness and burning are formed. The patient experiences pain in the legs, and sometimes lumbago.

Prevention and treatment of the disease

Prevention of lowering the height of the intervertebral discs is quite simple:

1. 1 It is necessary to eat properly and in a balanced manner.
2. 2 Wellness gymnastics is very important for the prevention of disease.
3. 3 It is necessary to maintain the water balance in the body. To do this, you need to drink at least 2 liters of water per day. Water helps to maintain the correct metabolism in the human body.
4. 4 Control the weight being lifted - do not lift anything heavy.
5. 5 It is necessary to protect yourself from injury, stress and hypothermia.
6. 6 Be sure to periodically undergo a preventive examination of the spine.

How is lumbar osteochondrosis treated? After a thorough examination of the patient by a neurologist, various examinations and tests are prescribed: X-ray, MRI, CT, etc.

The prescribed treatment is aimed at relieving pain in the patient, relieving the nerve roots from pinching.

And among other things, treatment is aimed at stopping the process of disc destruction.

The main methods of treatment:

1. 1 Medication.
2. 2 Manual therapy.
3. 3 Physiotherapy.
4. 4 Therapeutic gymnastics.
5. 5 Surgical intervention.

Treatment of osteochondrosis with folk remedies is as popular as folk treatment other diseases. This is due to its simplicity and low cost. Traditional medicine for the treatment of this disease offers various tinctures, compresses, rubbing. Baths of sea salt and pine needles will not interfere. These baths help restore blood circulation and relax muscles.

It is better to use complex treatment of the disease in the treatment of lumbar osteochondrosis. But it should only take place as prescribed by a doctor and under his supervision.

Injuries to the lumbar and thoracic intervertebral discs are much more common than commonly thought. They arise with the indirect impact of violence. The immediate cause of damage to the lumbar intervertebral discs is heavy lifting, forced rotational movements, flexion movements, sudden sudden straining and, finally, falling.

Injuries to the thoracic intervertebral discs more often occur with a direct impact or impact in the area of ​​the vertebral ends of the ribs, transverse processes in combination with muscle tension and forced movements, which is especially often observed in athletes when playing basketball.

Injuries to the intervertebral discs are almost not observed in childhood, occur in adolescence and adolescence, and especially often in people 3-4 decades of age. This is explained by the fact that isolated injuries of the intervertebral disc often occur in the presence of degenerative processes in it.

What causes damage to the intervertebral discs?

The lumbosacral and lumbar spine is the area where degenerative processes develop most often. The most common degenerative processes are the IV and V lumbar discs. This is facilitated by the following some anatomical and physiological features of these discs. It is known that the IV lumbar vertebra is the most mobile. The greatest mobility of this vertebra leads to the fact that the IV intervertebral disc is under significant stress, most often it is traumatized.

The emergence of degenerative processes in the V intervertebral disc is due to the anatomical features of this intervertebral joint. These features consist in the discrepancy between the anteroposterior diameter of the bodies of the V lumbar and I sacral vertebrae. According to Willis, this difference ranges from 6 to 1.5 mm. Fletcher confirmed this by analyzing 600 x-rays of the lumbosacral spine. He believes that this discrepancy in the sizes of these vertebral bodies is one of the main causes of degenerative processes in the V lumbar disc. This is also facilitated by the frontal or predominantly frontal type of the lower lumbar and upper sacral facets, as well as their posterior-external slope.

The above anatomical relationships between the articular processes of the I sacral vertebra, V lumbar and I sacral spinal roots can lead to direct or indirect compression of these spinal roots. These spinal roots have a significant length in the spinal canal and are located in its lateral grooves, formed in front by the posterior surface of the V lumbar intervertebral disc and the body of the V lumbar vertebra, and behind by the articular processes of the sacrum. Often, when degeneration of the V lumbar intervertebral disc occurs, due to the inclination of the articular processes, the body of the V lumbar vertebra not only descends downward, but also shifts posteriorly. This inevitably leads to a narrowing of the lateral notches of the spinal canal. Therefore, so often there is a "disco-radicular conflict" in this area. Therefore, the most common phenomenon of lumbar ischialgia with the interest of the V lumbar and 1 sacral roots.

Ruptures of the lumbar intervertebral discs occur more often in men doing manual labor. They are especially common among athletes.

According to V.M.Ugryumov, ruptures of degenerated intervertebral lumbar discs occur in middle-aged and elderly people, starting from 30-35 years. According to our observations, these injuries also occur at a younger age - at 20-25 years old, and in some cases even at 14-16 years old.

Intervertebral discs: anatomical and physiological information

Intervertebral disc, located between two adjacent surfaces of the vertebral bodies, is a rather complex anatomical formation. This complex anatomical structure of the intervertebral disc is due to a kind of complex of functions it performs. The intervertebral disc has three main functions: the function of firmly connecting and holding adjacent vertebral bodies near each other, the function of the half-joint, which ensures the mobility of the body of one vertebra in relation to the body of another, and, finally, the function of a shock absorber, which protects the vertebral bodies from constant trauma. The elasticity and firmness of the spine, its mobility and ability to withstand significant loads are mainly determined by the state of the intervertebral disc. All these functions can be performed only by a full-fledged, unchanged intervertebral disc.

The cranial and caudal surfaces of the bodies of two adjacent vertebrae are covered with cortical bone only in the peripheral regions, where the cortical bone forms the bony edge - the limbus. The rest of the surface of the vertebral bodies is covered with a layer of a very dense, peculiar spongy bone, called the endplate of the vertebral body. The bone marginal edging (limbus) rises above the endplate and, as it were, frames it.

The intervertebral disc consists of two hyaline plates, an annulus fibrosus and a nucleus pulposus. Each of the hyaline plates tightly adheres to the endplate of the vertebral body, is equal to it in size and is, as it were, inserted into it like a clock glass turned in the opposite direction, the rim of which is the limbus. The limbus surface is not covered with cartilage.

It is believed that the nucleus pulposus is the remnant of the dorsal notochord of the embryo. Chord in the process of evolution is partially reduced, and partially transformed into the nucleus pulposus. Some argue that the nucleus pulposus of the intervertebral disc is not a remnant of the notochord of the embryo, but is a full-fledged functional structure that replaced the notochord in the process of phylogenetic development of higher animals.

The nucleus pulposus is a gelatinous mass consisting of a small number of cartilaginous and connective tissue cells and fibrous intertwining swollen connective tissue fibers. The peripheral layers of these fibers form a kind of capsule that delimits the gelatinous core. This nucleus turns out to be enclosed in a kind of cavity containing a small amount of fluid, resembling a synovial one.

The annulus fibrosus consists of dense connective tissue bundles located around the gelatinous nucleus and intertwined in various directions. It contains a small amount of interstitial substance and single cartilage and connective tissue cells. The peripheral bundles of the annulus fibrosus are closely adjacent to each other and, like Sharpey fibers, are introduced into the bony edging of the vertebral bodies. The fibers of the annulus fibrosus, located closer to the center, are located more loosely and gradually pass into the capsule of the gelatinous nucleus. Ventral - the anterior part of the annulus fibrosus is more durable than the dorsal - posterior.

According to Franceschini (1900), the annulus fibrosus of the intervertebral disc consists of concentrically arranged collagen plates and undergoes significant structural changes... In a newborn, the collagen lamellar structure is poorly expressed. Up to 3-4 years of life in the thoracic and lumbar regions and up to 20 years in the cervical region, collagen plates are located in the form of quadrangular formations surrounding the disc nucleus. In the thoracic and lumbar regions from 3-4 years, and to the cervical - from the age of 20, the transformation of primitive quadrangular collagen formations into elliptical occurs. Subsequently, by the age of 35 in the thoracic and lumbar regions, simultaneously with a decrease in the size of the disc nucleus, collagen plates gradually acquire a pillow-like configuration and play a significant role in the amortization function of the disc. These three collagen structures are quadrangular - elliptical and cushion-shaped - replacing each other, are the result of mechanical action on the nucleus pulposus of the disc. Franceschini believes that the core of the disc should be viewed as a device designed to convert vertically acting forces into radial ones. These forces are critical in the formation of collagen structures.

It should be remembered that all elements of the intervertebral disc - hyaline plates, nucleus pulposus and annulus fibrosus - are structurally closely related to each other.

As noted above, the intervertebral disc, in conjunction with the posterior-external intervertebral joints, participates in the movements carried out by the spine. The total range of motion in all segments of the spine is quite significant. As a result, the intervertebral disc is compared with a semi-joint (Luschka, Schmorl, Junghanns). The nucleus pulposus in this semi-joint corresponds to the articular cavity, the hyaline plates correspond to the articular ends, and the annulus fibrosus corresponds to the articular bursa. The nucleus pulposus in different parts of the spine occupies a different position: in the cervical spine, it is located in the center of the disc, in the upper thoracic vertebrae - closer to the front, in all other parts - on the border of the middle and posterior thirds of the anteroposterior diameter of the disc. With the movements of the spine, the nucleus pulposus, which is able to move to some extent, changes its shape and position.

The cervical and lumbar discs are higher in the ventral region, and the thoracic discs are higher in the dorsal. This, apparently, is associated with the presence of the corresponding physiological curves of the spine. Various pathological processes leading to a decrease in the height of the intervertebral discs cause a change in the size and shape of these physiological curves of the spine.

Each intervertebral disc is somewhat wider than the corresponding vertebral body and, in the form of a roller, stands somewhat forward and to the sides. Anteriorly and laterally, the intervertebral disc is covered by the anterior longitudinal ligament, which extends from the lower surface of the occipital bone along the entire anterior-lateral surface of the spine to the anterior surface of the sacrum, where it is lost in the pelvic fascia. The anterior longitudinal ligament is firmly adhered to the vertebral bodies and freely spreads over the intervertebral disc. In the cervical and lumbar - the most mobile parts of the spine, this ligament is somewhat narrower, and in the thoracic it is wider and covers the anterior and lateral surfaces of the vertebral bodies.

The posterior surface of the intervertebral disc is covered by the posterior longitudinal ligament, which starts from the cerebral surface of the occipital bone body and extends along the entire length of the spinal canal to the sacrum, inclusive. Unlike the anterior longitudinal ligament, the posterior longitudinal ligament does not have strong connections with the vertebral bodies, but freely spreads over them, being firmly and intimately connected with the posterior surface of the intervertebral discs. The portions of the posterior longitudinal ligament passing through the vertebral bodies are narrower than the portions associated with the intervertebral discs. In the area of ​​the discs, the posterior longitudinal ligament expands somewhat and is woven into the annulus fibrosus of the discs.

The gelatinous nucleus of the intervertebral disc, due to its turgor, exerts constant pressure on the hyaline plates of the adjacent vertebrae, trying to distance them from each other. At the same time, the powerful ligamentous apparatus and the annulus fibrosus tend to bring the adjacent vertebrae closer together, opposing the nucleus pulposus of the intervertebral disc. As a result, the size of each individual intervertebral disc and the entire spine as a whole is not a constant value, but depends on the dynamic balance of the oppositely directed forces of the nucleus pulposus and ligamentous apparatus two adjacent vertebrae. So, for example, after a night's rest, when the gelatinous nucleus acquires maximum turgor and largely overcomes the elastic traction of the ligaments, the height of the intervertebral disc increases and the vertebral bodies move apart. In contrast, by the end of the day, especially after a significant backbone load on the spine, the height of the intervertebral disc decreases due to a decrease in the turgor of the nucleus pulposus. The bodies of the adjacent vertebrae approach each other. Thus, during the day, the length of the spinal column either increases or decreases. According to A.P. Nikolaev (1950), this daily fluctuation in the size of the spinal column reaches 2 cm. This also explains the decrease in the height of the elderly. A decrease in the turgor of the intervertebral discs and a decrease in their height lead to a decrease in the length of the spinal column, and, consequently, to a decrease in the height of a person.

According to modern ideas, the safety of the nucleus pulposus depends on the degree of polymerization of mucopolysaccharides, in particular hyaluronic acid. Under the influence of certain factors, depolymerization of the basic substance of the core occurs. It loses its compactness, becomes denser, fragmented. This is the beginning of the degenerative dystrophic changes intervertebral disc. It was found that in degenerative discs there is a shift in the localization of neutral and pronounced depolymerization of acidic mucopolysaccharides. Consequently, subtle histochemical techniques confirm the idea that degenerative-dystrophic processes in the intervertebral disc begin with subtle changes in the structure of the nucleus pulposus.

The intervertebral disc of an adult is in approximately the same conditions as the articular cartilage. Due to the loss of their ability to regenerate, insufficient blood supply (Bohmig) and a large load on the junior vertebral discs due to the vertical position of a person, aging processes develop in them rather early. The first signs of aging appear already at the age of up to 20 years in the area of ​​thinned sections of the hyaline plates, where hyaline cartilage is gradually replaced by connective tissue cartilage, followed by its dissociation. This leads to a decrease in the resistance of the hyaline plates. At the same time, the above-mentioned changes in the nucleus pulposus occur, leading to a decrease in its cushioning effect. With age, all these phenomena progress. Dystrophic changes in the annulus fibrosus are added, accompanied by its tears even under normal loads. Gradually: this is joined by degenerative changes in the intervertebral and costal-vertebral joints. Moderate osteoporosis of the vertebral bodies develops.

In pathological conditions, all the processes described in various elements of the intervertebral disc develop unevenly and even in isolation. They appear ahead of time. Unlike age-related changes, they are already degenerative-dystrophic lesions of the spine.

In the opinion of the absolute majority of authors, degenerative-dystrophic lesions in the intervertebral disc arise as a result of chronic overload. At the same time, in a number of patients, these lesions are the result of an individual acquired or constitutional inferiority of the spine, in which even the usual daily load is excessive.

A more in-depth study of the pathological morphology of degenerative processes in discs in recent years has not yet introduced fundamentally new facts into the concept of degenerative processes that was described by Hildebrandt (1933). According to Hildebrandt, the essence of the ongoing pathological process is as follows. Degeneration of the nucleus pulposus begins with a decrease in its turgor, it becomes drier, fragmented, and loses its elasticity. Biophysical and biochemical studies of the elastic function of the discs made it possible to establish that in this case the collagen structure of the nucleus pulposus is replaced by fibrous tissue and the content of polysaccharides decreases. Long before the disintegration of the nucleus into separate formations, other elements of the intervertebral disc are also involved in the process. Under the influence of the pressure of adjacent vertebrae, the nucleus pulposus, which has lost its elasticity, is flattened. The height of the intervertebral disc decreases. Parts of the disintegrated nucleus pulposus are displaced to the sides, they bend outwardly the fibers of the annulus fibrosus. The fibrous ring becomes loose and torn. It was found that with a vertical load on the disk in the modified disk, the pressure is significantly lower than in the normal one. At the same time, the annulus fibrosus of a degenerated disc experiences 4 times more stress than the annulus fibrosus of a normal disc. The hyaline plates and the adjacent surfaces of the vertebral bodies are constantly traumatized. The hyaline cartilage is replaced by fibrous cartilage. Tears and cracks appear in the hyaline plates, and sometimes whole sections of them are rejected. Defects in the nucleus pulposus, hyaline plates and annulus fibrosus merge into cavities that cross the intervertebral disc in different directions.

Symptoms of damage to the lumbar discs

Symptoms of injuries to the lumbar intervertebral discs fit into various syndromes and can vary from minor, sudden pain in the lumbar region to the most severe picture of complete transverse compression of the cauda equina elements with paraplegia and dysfunction of the pelvic organs, as well as a whole range of vegetative symptoms.

The main complaint of the victims is sudden pain in the lumbar spine after lifting a weight, a sudden movement or, less often, a fall. The victim is unable to take a natural posture, unable to carry out any movements in the lumbar spine. Scoliotic deformity often develops sharply. The slightest attempt to change the position causes increased pain. These pains can be local, but can radiate along the spinal roots. In more severe cases a picture of acute paraparesis can be observed, which soon turns into paraplegia. There may be acute urinary retention, stool retention.

Objective examination reveals the smoothness of the lumbar lordosis up to the formation of angular kyphotic deformity, scoliosis, contracture of the lumbar muscles - a symptom of "reins"; restriction of all types of movements, an attempt to reproduce which increases pain; pain when tapping along the spinous processes of the lower lumbar vertebrae, reflected ischialgic pains when tapping along the spinous processes, soreness of the paravertebral points, pain on palpation of the anterior spine through the anterior abdominal wall; increased pain when coughing, sneezing, sudden laughter, straining, with compression of the jugular veins; the inability to stand on toes.

The neurological symptoms of lumbar disc injury depend on the level of disc injury and the degree of involvement of the spinal cord elements. As noted above, with ruptures of the disc with massive loss of its substance, monoparesis, paraparesis and even paraplegia, a disorder of the function of the pelvic organs can occur. Severe bilateral symptomatology indicates massive prolapse of the disc substance. If the IV lumbar root is interested, hyposthesia or anesthesia in the buttock, outer thigh, inner surface of the foot can be detected. In the presence of hyposthesia or anesthesia on the back of the foot, one should think about the interest of the V lumbar root. The loss or decrease in superficial sensitivity along the outer surface of the lower leg, the outer surface of the foot, in the region of the IV and V fingers suggests that the first sacral segment is interested. Often observed positive symptoms tensile (Kernig's, Lasegue's symptoms). There may be a decrease in Achilles and knee reflexes. In case of damage to the upper lumbar discs, which is much less common, there may be a decrease in strength or loss of function of the quadriceps femoris muscle, sensitivity disorders on the anterior and inner thighs.

Diagnosis of damage to lumbar discs

Of great importance in recognizing injuries of intervertebral discs is the X-ray method of investigation. X-ray symptomatology of injuries of the intervertebral lumbar discs is actually the X-ray symptomatology of lumbar intervertebral osteochondrosis.

In the first stage of intervertebral osteochondrosis ("chondrosis" according to Schmorl), the earliest and most typical X-ray symptom is a decrease in the height of the intervertebral disc. At the beginning, it can be extremely insignificant and is caught only by comparative comparison with neighboring disks. It should be remembered that the most powerful, "highest" disc normally is the IV intervertebral disc. At the same time, the straightening of the lumbar spine is detected - the so-called "string" or "candle" symptom, described by Guntz in 1934.

During this period, the so-called X-ray functional tests are of great diagnostic value. The functional X-ray test is as follows. X-rays are taken in two extreme positions - in the position of maximum flexion and maximum extension. With a normal, unchanged disc, at maximum flexion, the height of the disc decreases in front, with maximum extension, at the back. The absence of these symptoms indicates the presence of osteochondrosis - it indicates a loss of the amortization function of the disc, a decrease in turgor and elasticity of the nucleus pulposus. At the moment of extension, there may be a posterior displacement of the body of the overlying vertebra. This indicates a decrease in the function of keeping the disc of one vertebral body relative to the other. The posterior displacement of the body should be determined by the posterior contours of the vertebral body.

In some cases, high-quality radiographs and tomograms can reveal a prolapsed disc.

There may also be a "spacer" symptom, consisting in the uneven height of the disc on the anteroposterior radiograph. This unevenness consists in the presence of a wedge-shaped deformation of the disc - at one edge of the vertebral bodies, the intervertebral cleft is wider and gradually narrows in a wedge-shaped direction towards the other edge of the bodies.

With a more pronounced X-ray picture ("osteochondrosis" according to Schmorl), the phenomena of sclerosis of the end plates of the vertebral bodies are observed. The appearance of sclerosis zones should be explained by reactive and compensatory phenomena on the part of the corresponding surfaces of the vertebral bodies arising from the loss of the amortization function of the intervertebral disc. As a result, the facing surfaces of two adjacent vertebrae are exposed to systematic and constant trauma. Edge growths appear. Unlike marginal growths in spondylosis, marginal growths in intervertebral osteochondrosis are always located perpendicular to the long axis of the spine, emanate from the limbus of the vertebral bodies, can occur in any part of the lnmbus, including the back, never merge with each other and appear against the background lowering the disc height. Retrograde stepped spondylolisthesis is often observed.

Vollniar (1957) described a "vacuum phenomenon" - an X-ray symptom, which, in his opinion, characterizes degenerative-dystrophic changes in the lumbar intervertebral discs. This "vacuum phenomenon" consists in the fact that at the anterior edge of one of the lumbar vertebrae on the roentgenogram, a slit-shaped enlightenment the size of a pinhead is determined.

Contrast spondylography. Contrast methods of X-ray examination include ppeumomyelography and discography. These methods of investigation can be useful when clinical and routine radiographic findings cannot accurately represent the presence or absence of disc damage. At fresh damage discography of intervertebral discs is of greater importance.

Discography in the cases shown provides a number of useful data that complement clinical diagnosis. Puncture of the disc allows you to clarify the capacity of the disc cavity, cause provoked pain that reproduces the increased pain attack usually experienced by the patient, and, finally, obtain a contrasting discogram.

Puncture of the lower lumbar discs is performed transdurally, according to the technique proposed by Lindblom (1948-1951). The patient is seated or placed in a position with the maximum possible correction of the lumbar lordosis. The patient's back is arched. If the puncture of the disc is performed in a sitting position, then the forearms bent at the elbows rest against the knees. The interspinous spaces are carefully determined and marked with a solution of methylene blue or brilliant green. The operating field is treated twice with 5% iodine tincture. Then the iodine is removed with an alcohol napkin. The skin, subcutaneous tissue, interspinous space are anesthetized with 0.25% novocaine solution. A needle with a mandrel for a lumbar puncture is inserted as in a lumbar puncture. The needle passes through the skin, subcutaneous tissue, superficial fascia, supraspinous and interspinous ligaments, posterior epidural tissue and posterior wall of the dural sac. Remove the mandrel. CSF dynamic tests are carried out, CSF pressure is determined. Cerebrospinal fluid is taken for examination. The mandrin is reintroduced. The needle is advanced anteriorly. Guided by the patient's sensations, the direction of the needle is changed. In case of contact of the needle with the elements of the cauda equina, the patient complains of pain. If you feel pain in the right leg, you should pull the needle a little and hold it to the left, and vice versa. The anterior wall of the dural sac, the anterior epidural tissue, the posterior longitudinal ligament, and the posterior portion of the annulus fibrosus of the intervertebral disc are punctured. The needle falls into the cavity. The passage of the posterior longitudinal ligament is determined by the patient's reaction - complaints of pain along the spine up to the occiput. The passage of the annulus fibrosus is determined by the resistance to the needle. In the process of performing a puncture of the disc, one should be guided by the profile spondylogram, which helps to navigate in choosing the right direction for the needle.

Determination of the disc capacity is carried out by injecting physiological saline solution through a needle into the disc cavity using a syringe. A normal disc allows 0.5-0.75 ml of liquid to be injected into its cavity. A larger number indicates a degenerative disc change. If there are cracks and ruptures of the fibrous ring, then the amount possible introduction fluid is very large, as it flows into the epidural space and spreads in it. By the amount of injected fluid, one can roughly judge the degree of disc degeneration.

The reproduction of the provoked pain is carried out by a somewhat excessive administration of the solution. By increasing the intradiscal pressure, the injected solution enhances or causes compression of the root or ligaments and reproduces more intense pain characteristic of this patient. These pains are sometimes quite significant - the patient suddenly cries out from the pain. Asking the patient about the nature of the pain allows you to decide whether this disc corresponds to the cause of the patient's suffering.

Contrast discography is carried out by injecting a cardiotrast or hepac solution through the same needle. If the contrast medium goes freely, it should not be injected more than 2-3 ml. Similar manipulations are repeated on all questionable disks. The most difficult to puncture the V disc located between the V lumbar and I sacral vertebrae. This is due to the fact that the bodies of these vertebrae are located at an angle open anteriorly, due to which the gap between them behind is significantly narrowed. Usually, the puncture of the V disc takes more time than the puncture of the overlying ones.

It should be borne in mind that radiography is performed no later than 15-20 minutes after the injection of a contrast agent. At a later date, contrasting discography will not work, since the cardiotrast will dissipate. Therefore, we recommend that you first puncture all the necessary discs, determine their capacity and the nature of the provoked pain. The needle is left in the disk and the mandrin is inserted into it. Only after the needles have been inserted into all the required discs should the contrast medium be quickly injected and the discography done immediately. Only in this case are discograms of good quality obtained.

Only three lower lumbar discs can be punctured by the transdural route. Above is the spinal cord, which excludes transdural puncture II and I of the lumbar discs. If it is necessary to puncture these discs, the epidural approach suggested by Erlacher should be used. The needle is inserted 1.5-2 cm outward from the spinous process on the healthy side. It is directed upward and downward, whip from the posterior-external intervertebral joint into the intervertebral foramen and inserted into the disc through the gap between the root and the dural sac. This disc puncture method is more difficult and requires skill.

Finally, the disc can also be punctured with an external approach suggested by de Seze. To do this, a needle 18-20 cm long is injected 8 cm outward from the spinous process and directed inward and upward at an angle of 45 °. At a depth of 5-8 cm, it abuts against the transverse process. It is bypassed from above and the needle is advanced deeper to midline... At a depth of 8-12 cm, its tip rests against the lateral surface of the vertebral body. X-rays are used to check the position of the needle and make corrections until the needle enters the disc. The method also requires known skills and takes longer.

There is another possibility to perform a puncture of the disc during the operation. Since the intervention is performed under anesthesia, in this case it is only possible to determine the capacity of the disc cavity and produce contrast discography.

The character of the discogram depends on the changes in the disc. The normal discogram appears as a round, square, oval slit shadow located in the middle (anteroposterior projection). On the profile discogram, this shadow is located closer to the posterior, approximately at the border of the posterior and middle third of the anteroposterior disc diameter. In case of damage to the intervertebral discs, the nature of the discogram changes, the Shadow of contrast in the area of ​​the intervertebral space can take on the most bizarre forms up to the release of contrast iodine in the anterior or posterior longitudinal ligaments, depending on where the annulus fibrosus has ruptured.

We resort to discography relatively rarely because more often on the basis of clinical and radiological data it is possible to make a correct clinical and topical diagnosis.

Conservative treatment of injuries of the lumbar intervertebral discs

In the vast majority of cases, damage to the lumbar intervertebral discs can be cured by conservative methods. Conservative treatment of damage to the lumbar discs should be carried out in a comprehensive manner. This complex includes orthopedic, medication and physiotherapy treatments. Orthopedic methods include resting and unloading the spine.

The victim with damage to the lumbar intervertebral disc is put to bed. It is a misconception that the victim should be laid on a hard bed in a supine position. For many victims, this forced position causes increased pain. On the contrary, in some cases there is a decrease or disappearance of pain when laying the injured in a soft bed, allowing significant flexion of the spine. Often, the pain disappears or decreases in the lateral position with the thighs brought to the abdomen. Therefore, in bed, the victim must take the position in which the pain disappears or decreases.

Unloading of the spine is achieved by horizontal position of the victim. Some time later, after the acute phenomena of the former injury have passed, this unloading can be supplemented by constant stretching of the spine along an inclined plane with the help of soft rings for the armpits. To increase the tensile force, additional weights can be used, suspended from the victim's pelvis using a special belt. The size of the weights, the time and degree of stretching are dictated by the victim's sensations. Rest and unloading of the injured spine last for 4-6 weeks. Usually during this period pain disappears, the rupture in the area of ​​the fibrous ring heals with a strong scar. In later periods after the former injury, with more persistent pain syndrome, and sometimes in recent cases, it is more effective not to constant stretching, but to intermittent stretching of the spine.

There are several different techniques for intermittent spinal stretching. Their essence boils down to the fact that within a relatively short period of 15-20 minutes, with the help of weights or dosed screw thrust, the stretching is brought to 30-40 kg. The magnitude of the tensile force in each individual case is dictated by the patient's physique, the degree of development of his muscles, as well as his sensations during stretching. The maximum stretch lasts for 30-40 minutes, and then gradually reduces to pet over the next 15-20 minutes.

Stretching of the spine with the help of a dosed screw rod is carried out on a special table, the platforms of which are spread along the length of the table with a screw rod with a wide thread pitch. The victim is secured at the head end of the table with a special bra, worn on chest, and on the leg - with a belt behind the pelvis. When the leg and head platforms diverge, the lumbar spine is stretched. In the absence of a special table, intermittent stretching can be carried out on a regular table by hanging weights by the pelvic belt and a bra on the chest.

Underwater spinal stretching in the pool is very useful and effective. This method requires special equipment and equipment.

Drug treatment damage to the lumbar discs consists in oral administration of medicinal substances or their topical application... In the first hours and days after injury, with severe pain syndrome, drug treatment should be aimed at relieving pain. Analgin, promedol, etc. can be applied. Good healing effect provide large doses (up to 2 g per day) of salicylates. Salicylates can be administered intravenously. Novocaine blockades in various modifications are also useful. A good analgesic effect is provided by injections of hydrocortisone in an amount of 25-50 mg into the paravertebral pain points. Even more effective is the introduction of the same amount of hydrocortisone into the damaged intervertebral disc.

Intradiscal administration of hydrocortisone (novocaine solution 0.5% with 25-50 mg of hydrocortisone) is performed in the same way as discography is performed according to the method proposed by de Seze. This manipulation requires a certain skill and skill. But even paravertebral administration of hydrocortisone has a good therapeutic effect.

Of the physiotherapeutic procedures, diadynamic currents are the most effective. Popophoresis with novocaine and thermal procedures can be used. It should be borne in mind that often thermal procedures cause an exacerbation of pain, which appears to be due to an increase in local tissue edema. If the victim's health worsens, they should be canceled. After 10-12 days, in the absence of pronounced symptoms of irritation of the spinal roots, massage is very useful.

At a later date, such victims can be recommended balneotherapy (Pyatigorsk, Saki, Tskhaltubo, Belokurikha, Matsesta, Karachi). In some cases, it is useful to wear soft semi-corsets, corsets or "grace".

Surgical treatment of injuries of the lumbar intervertebral discs

Indications for surgical treatment of injuries of the lumbar intervertebral discs arise when conservative treatment is ineffective. Usually, these indications arise in the long term after the former damage and, in fact, the intervention is made about the consequences of the former damage. Such indications are considered persistent lumbalgia, the phenomenon of functional incompetence of the spine, a syndrome of chronic compression of the spinal roots, which is not inferior to conservative treatment. With fresh injuries of the intervertebral lumbar discs, indications for surgical treatment arise with an acutely developed syndrome of compression of the cauda equina with paraparesis or paraplegia, a disorder of the function of the pelvic organs.

The history of the emergence and development of surgical methods for treating injuries of the lumbar intervertebral discs is essentially history. surgical treatment lumbar intervertebral osteochondrosis.

Surgical treatment of lumbar intervertebral osteochondrosis ("lumbosacral radiculitis") was first carried out by Elsberg in 1916. Taking the dropped substance of the disc with its damage for interspinal tumors - "chondromas", Elsberg, Petit, Qutailles, Alajuanine (1928) removed them. Mixter, Barr (1934), proving that "chondromas" are nothing more than a prolapsed part of the nucleus pulposus of an intervertebral disc, performed a laminectomy and removed the prolapsed part of the intervertebral disc by trans- or extradural access.

Since then, especially abroad, methods of surgical treatment of lumbar intervertebral osteochondrosis have become widespread. Suffice it to say that individual authors have published hundreds and thousands of observations on patients operated on for lumbar intervertebral osteochondrosis.

The existing surgical methods for the treatment of disc prolapse in intervertebral osteochondrosis can be divided into palliative, conditionally radical and radical.

Palliative surgery for injured lumbar discs

These operations include the operation proposed by Love in 1939. Having undergone some changes and additions, it is widely used in the treatment of herniated intervertebral discs of the lumbar localization.

The task of this surgical intervention is only to remove the prolapsed part of the disc and eliminate the compression of the nerve root.

The victim is placed on the operating table in the supine position. Different authors use different techniques to eliminate lumbar lordosis. B. Boychev suggests placing a pillow under the lower abdomen. AI Osna gives the patient "the pose of a praying Buddhist monk." Both of these methods lead to a significant increase in intra-abdominal pressure, and therefore to venous stasis, which causes increased bleeding from the surgical wound. Friberg has designed a special "cradle" in which the victim is placed in the desired position without difficulty breathing and increased intra-abdominal pressure.

Local anesthesia, spinal anesthesia, and general anesthesia are recommended. Supporters of local anesthesia consider the advantage of this type of anesthesia to be the ability to control the course of the operation by squeezing the spinal root and the patient's response to this compression.

Lower lumbar disc surgery technique

With a paravertebral semi-oval incision, the skin, subcutaneous tissue, superficial fascia are dissected in layers. The affected disc should be in the middle of the incision. On the side of the lesion, the lumbar fascia is dissected longitudinally at the edge of the supraspinatus ligament. The lateral surface of the spinous processes, half-arcs and articular processes is carefully skeletonized. All soft tissues must be removed from them in the most careful way. With a wide powerful hook, soft tissues are pulled laterally. The half-arches are exposed, the yellow ligaments and articular processes located between them. The area of ​​the yellow ligament is excised at the desired level. The dura mater is exposed. If this turns out to be insufficient, bite off part of the adjacent sections of the half-arms or remove the adjacent half-arms completely. Hemilaminectomy is quite acceptable and justified for expanding the operative access, but it is difficult to agree to a wide laminectomy with removal of 3-5 arches. In addition to the fact that laminectomy significantly weakens the posterior spine, it is believed that it leads to limited movement and pain. Restriction of movement and pain is directly proportional to the size of lamiectomy. Careful hemostasis is performed throughout the entire intervention. The dural sac is displaced internally. The spinal root is taken aside. Examine the postero-lateral surface of the affected intervertebral disc. If the disc herniation is located posterior to the posterior longitudinal ligament, then it is grasped with a spoon and removed. Otherwise, the posterior longitudinal ligament or the posteriorly protruding portion of the posterior portion of the annulus fibrosus is dissected. After that, part of the dropped disc is removed. Produce hemostasis. Layer-by-layer sutures are applied to the wounds.

Some surgeons cut the dura mater and use a transdural approach. The disadvantage of the transdural approach is the need for wider removal of the posterior parts of the vertebrae, opening of the posterior and anterior dura mater, the possibility of subsequent intradural cicatricial processes.

If necessary, one or two articular processes can be eaten, which makes the operative access wider. However, this compromises the reliability of the stability of the spine at this level.

During the day, the patient is in the prone position. Symptomatic drug treatment is performed. From 2 days, the patient is allowed to change position. On the 8-10th day, he is discharged for outpatient treatment.

The described surgical intervention is purely palliative and eliminates only the compression of the spinal root by the prolapsed disc. This intervention is not aimed at curing the underlying disease, but only at eliminating the complication it generates. Removal of only part of the affected disc that has fallen out does not exclude the possibility of a relapse of the disease.

Conditionally radical surgery for injured lumbar discs

These operations are based on the proposal of Dandy (1942) not to be limited to removing only the fallen out part of the disc, but to remove the entire affected disc using a sharp bone spoon. By this, the author tried to solve the problem of preventing relapses and create conditions for the occurrence of fibrous ankylosis between adjacent bodies. However, this technique did not lead to the desired results. The number of relapses and poor outcomes remained high. This depended on the failure of the proposed surgical intervention. Too difficult and problematic is the possibility of complete removal of the disc through a small hole in its fibrous ring, the consistency of fibrous ankylosis in this extremely mobile spine is too unlikely. The main disadvantage of this intervention, in our opinion, is the impossibility of restoring the lost height of the intervertebral disc and the normalization of anatomical relationships in the posterior elements of the vertebrae, the impossibility of achieving bone fusion between the vertebral bodies.

Attempts by individual authors to “improve” this operation by introducing separate bone grafts into the defect between the vertebral bodies also did not lead to the desired result. Our experience in the surgical treatment of lumbar intervertebral osteochondrosis allows us to assert with some certainty that it is impossible to remove the endplates of the adjacent vertebral bodies with a bone spoon or curette enough to expose the spongy bone, without which it is impossible to count on the onset of bone fusion between the vertebral bodies. Naturally, placing individual bone grafts in an unprepared bed cannot lead to bone ankylosis. The introduction of these grafts through a small opening is difficult and unsafe. This method does not solve the problems of restoring the height of the intervertebral space and restoring normal relationships in the posterior elements of the vertebrae.

Attempts to combine removal of the disc with posterior spinal fusion (Ghormley, Love, Joung, Sicard, etc.) should also be classified as conditionally radical operations. As conceived by these authors, the number of unsatisfactory results in the surgical treatment of intervertebral osteochondrosis can be reduced by supplementing the surgical intervention with posterior fusion. In addition to the fact that in conditions of violation of the integrity of the posterior spine, it is extremely difficult to obtain arthrodesis of the posterior spine, this combined operational method treatment is unable to resolve the issue of restoring the normal height of the intervertebral space and normalizing the anatomical relationships in the posterior parts of the vertebrae. However, this method was a significant step forward in the surgical treatment of lumbar intervertebral osteochondrosis. Despite the fact that it did not lead to a significant improvement in the results of surgical treatment of intervertebral osteochondrosis, it nevertheless made it possible to clearly imagine that it is impossible to solve the issue of treating degenerative lesions of intervertebral discs with one "neurosurgical" approach.

Radical surgery for injured lumbar discs

A radical intervention should be understood as a surgical aid, which resolves all the main points of pathology caused by damage to the intervertebral disc. These main points are the removal of the entire affected disc, the creation of conditions for the onset of bone adhesion of the adjacent vertebral bodies, the restoration of the normal height of the intervertebral space, and the normalization of the anatomical relationships in the posterior parts of the vertebrae.

VD Chaklin's operation, proposed by him in 1931 for the treatment of spondylolisthesis, is the basis of radical surgical interventions used in the treatment of injuries of the lumbar intervertebral discs. The main points of this operation are the exposure of the anterior spine from the antero-external extraperitoneal approach, resection of 2/3 of the intervertebral joint and placement in the resulting bone graft defect. Subsequent flexion of the spine helps to reduce lumbar lordosis and the onset of bone adhesion between the bodies of adjacent vertebrae.

With regard to the treatment of intervertebral osteochondrosis, this intervention did not resolve the issue of removing the entire affected disc and normalizing the anatomical relationships of the posterior elements of the vertebrae. Wedge-shaped excision of the anterior parts of the intervertebral articulation and placement in the resulting wedge-shaped defect of a bone graft corresponding in size and shape did not create conditions for restoring the normal height of the intervertebral space and divergence along the length of the articular processes.

In 1958, Hensell reported 23 patients with intervertebral lumbar osteochondrosis, who were subjected to surgical treatment according to the following method. The position of the patient on the back. The skin, subcutaneous tissue, superficial fascia are dissected layer by layer with a paramedial incision. The sheath of the rectus abdominis muscle is opened. The rectus abdominis muscle is pulled outward. The peritoneum is peeled off until the lower lumbar vertebrae and the intervertebral discs between them become accessible. Removal of the affected disc is performed through the area of ​​the aortic bifurcation. A bone wedge about 3 cm in size is taken from the iliac crest and inserted into the defect between the vertebral bodies. Care must be taken to ensure that the bone graft does not induce root and dural sac pressure. The author warns about the need to protect the vessels well at the time of insertion of the wedge. After the operation, a plaster corset is applied for 4 weeks.

The disadvantages of this method include the possibility of intervention only on the two lower lumbar vertebrae, the presence of large blood vessels limiting the operating field from all sides, the use of a wedge-shaped bone graft to fill the defect between the bodies of adjacent vertebrae.

Total discectomy and wedging corporodesis

This name is understood as a surgical intervention undertaken in case of damage to the lumbar intervertebral discs, during which the entire damaged intervertebral disc is removed, with the exception of the posterior-outer parts of the annulus fibrosus, conditions are created for the onset of bone fusion between the bodies of adjacent vertebrae, the normal height of the intervertebral space is restored, and wedging occurs - reclpnation - of the inclinated articular processes.

It is known that with a loss of height by the intervertebral disc, the vertical diameter of the intervertebral foramen decreases due to the inevitably following inclination of the articular processes. delimiting the intervertebral foramen for a considerable extent, in which the spinal roots and radicular vessels pass, as well as the spinal ganglia lie. Therefore, in the process of the surgical intervention being undertaken, it is extremely important to restore the normal vertical diameter of the intervertebral spaces. Normalization of the anatomical relationships in the posterior parts of the two vertebrae l is achieved by wedging.

Studies have shown that in the process of wedging corporodesis, the vertical diameter of the intervertebral foramen increases to 1 mm.

Preoperative preparation consists in the usual manipulations performed before the intervention in the retroperitoneal space. In addition to general hygiene procedures, they thoroughly cleanse the intestines, empty the bladder. In the morning on the eve of the operation, the pubis and the anterior abdominal wall are shaved. On the eve of the operation at night, the patient receives sleeping pills and sedatives. Patients with an unstable nervous system are given drug preparation for several days before the operation.

Anesthesia - endotracheal anesthesia with controlled breathing. Relaxation of the muscles greatly facilitates the technical performance of the operation.

The victim is laid on his back. Lumbar lordosis is intensified with the help of a roller placed under the lower back. This should only be done when the victim is under anesthesia. With an enlarged lumbar lordosis, the spine, as it were, approaches the surface of the wound - its depth becomes smaller.

Technique of total discectomy and wedging corporodesis

The lumbar spine is exposed with the previously described anterior left-sided paramedial extraperitoneal approach. Depending on the level of the affected disc, access is used without resection or with resection of one of the lower ribs. The approach to the intervertebral discs is carried out after mobilization of the vessels, dissection of the prevertebral fascia and displacement of the vessels to the right. Penetration to the lower lumbar discs through the division of the abdominal aorta seems to us more difficult, and most importantly more dangerous. When using access through the aortic bifurcation, the surgical field is limited from all sides by large arterial and venous trunks. Only the lower valve of the limited space remains free from the vessels, in which the surgeon has to manipulate. When manipulating the discs, the surgeon must always ensure that the nearby vessels are not accidentally damaged by the surgical instrument. When the vessels are displaced to the right, the entire anterior and left lateral part of the discs and vertebral bodies is free from them. Only the lumbosacral muscle remains adjacent to the spine on the left. The surgeon can safely manipulate the instruments from right to left without any risk of damaging the blood vessels. Before proceeding with the manipulations on the discs, it is advisable to select and shift to the left the left borderline sympathetic trunk. This greatly increases the amount of space for disk manipulation. After dissection of the prevertebral fascia and displacement of the vessels to the right, the anterior-lateral surface of the bodies of the lumbar vertebrae and discs, covered by the anterior longitudinal ligament, opens wide. Before starting to manipulate the discs, you should expose the required disc wide enough. To perform a total discectomy, you should open the required disc and the adjacent sections of the adjacent vertebral bodies along the entire length. So, for example, to remove the V lumbar disc should be exposed upper part body of the I sacral vertebra V lumbar disc and the lower body of the V lumbar vertebra. Displaced vessels must be reliably protected by elevators, protecting them from accidental injury.

The anterior longitudinal ligament is dissected either U-shaped or in the form of the letter H in a horizontal position. This is not of fundamental importance and does not affect the subsequent stability of this part of the spine, firstly, because in the area of ​​the removed disc, bony fusion between the bodies of adjacent vertebrae subsequently occurs, and secondly, because in both in the subsequent case, the anterior longitudinal ligament at the site of the section is fused with a scar.

The dissected anterior longitudinal ligament is separated in the form of two lateral or one apron-shaped flap on the right base and retracted to the sides. The anterior longitudinal ligament is separated so that the marginal limbus and the adjacent part of the vertebral body are exposed. The fibrous ring of the intervertebral disc is exposed. Affected discs have a peculiar appearance and differ from a healthy disc. They do not have their characteristic turgor and will not stand in the form of a characteristic ridge over the vertebral bodies. Instead of the silvery-white color characteristic of a normal disc, they acquire yellowish color or ivory. To the inexperienced eye, it may seem that the height of the disc is lowered. This false impression is created because the lumbar spine is over-extended on the roller, which artificially enhances the lumbar lordosis. The stretched anterior sections of the annulus fibrosus give the false impression of a wide disc. The annulus fibrosus is separated from the anterior longitudinal ligament along the entire anterolateral surface. With a wide chisel and a hammer, the first section is made parallel to the endplate of the vertebral body adjacent to the disc. The width of the bit should be such that the section passes through the entire width of the body, with the exception of the lateral compact plates. The chisel should penetrate to a depth of 2/3 of the anteroposterior diameter of the vertebral body, which on average corresponds to 2.5 cm. The second section is performed in the same way in the region of the second vertebral body adjacent to the disc. These parallel sections are made in such a way that together with the disc to be removed, the endplates are detached and the cancellous bone of the adjacent vertebral bodies is exposed. If the chisel is incorrectly positioned and the sectional plane in the vertebral body does not pass near the endplate, venous bleeding from the venous sinuses of the vertebral bodies may occur.

With a narrower chisel, two parallel sections are made along the edges of the first in a plane perpendicular to the first two sections. With the help of an osteotome inserted into one of the sections, the isolated disc is easily dislocated from its bed and removed. Usually, minor venous bleeding from its bed is stopped by tamponade with a gauze cloth moistened with warm saline table salt. With the help of bone trays, the posterior portions of the disc are removed. After removal of the disc, the posterior part of the annulus fibrosus becomes clearly visible. The "hernial gates" are clearly visible, through which it is possible to extract the fallen out part of the nucleus pulposus. The remnants of the disc in the area of ​​the intervertebral foramen should be especially carefully removed using a curved small bone spoon. In this case, manipulations should be careful and gentle so as not to damage the roots passing here.

This concludes the first stage of the operation - total discectomy. When comparing the disc masses removed using the anterior approach, with the number of them removed from the posterior-external approach, it becomes quite obvious how palliative the operation performed through the posterior approach is.

The second, no less important and crucial moment of the operation is the "wedging" corporodez. The transplant introduced into the formed defect should facilitate the onset of bone fusion between the bodies of adjacent vertebrae, restore the normal height of the intervertebral space and wedge the posterior parts of the vertebrae so that the anatomical relationships in them are normalized. The anterior sections of the vertebral bodies should bend over the anterior edge of the graft placed between them. Then the posterior parts of the vertebrae - the arches and articular processes - fan-apart. The disturbed normal anatomical relationships in the posterior-external intervertebral joints will be restored, and due to this, the intervertebral foramen will slightly expand, narrowed due to a decrease in the height of the affected disc.

Consequently, a graft placed between the bodies of adjacent vertebrae must meet two main requirements: it must facilitate the fastest onset of the bone block between the bodies of adjacent vertebrae and its anterior section must be so strong. to withstand the great pressure exerted on it by the bodies of the adjacent vertebrae when wedging.

Where does this transplant come from? With a well-defined, rather massive ridge of the iliac wing, the graft should be taken from the ridge. You can take it from the superior metaphysis of the tibia. In this latter case, the anterior section of the graft will consist of strong cortical bone, the tibial crest, and the cancellous bone of the metaphysis, which has good osteogenic properties. This is of no fundamental importance. It is important that the graft is taken correctly and in the correct size and shape. True, the structure of the iliac crest graft is closer to the structure of the vertebral bodies. The graft should have the following dimensions: its height anterior section should be 3-4 mm more than the height of the intervertebral defect, in width its anterior section should correspond to the width of the defect in the frontal plane, the length of the graft should be equal to 2/3 anteroposterior size defect. Its anterior section should be somewhat wider than the posterior one - it narrows posteriorly. In the intervertebral defect, the graft should be positioned so that its anterior margin does not stand outside the anterior surface of the vertebral bodies. Its posterior edge should not contact the posterior part of the annulus fibrosus of the disc. There should be some space between the posterior edge of the graft and the annulus of the disc. This is to prevent accidental compression of the anterior dural sac or spinal roots by the posterior edge of the graft.

Before placing the graft in the intervertebral defect, the height of the roller under the lumbar spine is slightly increased. Thus, lordosis and the height of the intervertebral defect increase even more. It is necessary to increase the height of the roller carefully, dosed. The graft is placed in the intervertebral defect so that its anterior edge is 2-3 mm into the defect and a corresponding gap is formed between the anterior edge of the vertebral bodies and the anterior edge of the graft. The roller of the operating table is lowered to the level of the table plane. Eliminate lordosis. In the wound, you can clearly see how the vertebral bodies come together and the graft, placed between them, is well wedged. It is firmly and reliably held by the bodies of the closed vertebrae. Already at this moment, partial wedging of the posterior parts of the vertebrae begins. Subsequently, when the patient in the postoperative period is given the position of flexion of the spine, this wedging will increase even more. No additional grafts in the form of bone gravel should be introduced into the defect, because they can be displaced posteriorly and subsequently, during bone formation, cause compression of the anterior part of the dural sac or roots. The graft should be shaped like this. so that he performs the intervertebral defect within the specified boundaries.

Flaps of the separated anterior longitudinal ligament are placed over the graft. The edges of these flaps are sutured. It should be borne in mind that more often these flaps fail to completely close the area of ​​the anterior part of the graft, since due to the restoration of the height of the intervertebral space, the size of these flaps is insufficient.

Thorough hemostasis during the operation is absolutely essential. Layer-by-layer sutured the wound of the anterior abdominal wall... Antibiotics are administered. Apply an aseptic bandage. During the operation, blood loss is replenished, it is usually insignificant.

With the correct management of anesthesia, spontaneous breathing is restored by the end of the operation. Extubation is performed. With stable performance blood pressure and replenishment of blood loss, blood transfusion is stopped. Usually, no significant fluctuations in blood pressure are observed either during surgery or in the postoperative period.

The patient is put to bed on a hard shield in a supine position. The hips and legs are bent at the hip and knee joints at an angle of 30 ° and 45 °. For this, under the area knee joints put a high roller. This achieves some flexion of the lumbar spine and relaxation of the lumbar-iliac and limb muscles. The patient remains in this position for the first 6-8 days.

Symptomatic drug treatment is performed. There may be a short-term urinary retention. To prevent intestinal paresis, 10% sodium chloride solution is injected intravenously in an amount of 100 ml, subcutaneously - a solution of proserin. They are treated with antibiotics. In the early days, an easily digestible diet is prescribed.

On the 7-8th day, the patient is placed in bed equipped with special devices. The hammock in which the patient is sitting is made of dense material. The footrest and backrest are made of plastic. These devices are very patient-friendly and hygienic. The flexion position of the lumbar spine further wedges the posterior vertebrae. The patient is in this position for 4 months. After this period, a plaster corset is applied and the patient is discharged. After 4 months, the corset is removed. By this time, the presence of a bone block between the vertebral bodies is usually radiographically noted, and the treatment is considered complete.

Subsidence of intervertebral discs, osteochondrosis and spondylosis are conditions that, if they arise, are already difficult to treat or recover. A decrease in the height of the disc and the growth of osteophytes can only be suspended or slowed down, but it is quite possible to improve the condition of the cartilaginous tissues of the joints.

Conservative treatment methods include A complex approach which consists of:

• relieving pain medication, physiotherapy and manual procedures;
• active and passive development of the joint, improving blood circulation and lymph flow in it;
• working out the soft tissues of the whole organism and the pathological area to restore trophism and metabolic processes;
• improving the condition of the cartilage of the spinal column and the whole body with drugs, physiotherapy, exercise therapy;
• strengthening of bone, muscle and ligamentous structures of the body;
• if necessary, reducing the pressure on each other and the soft tissues of bone growths by the method surgical intervention.

Drug therapy is represented by means:

• local and general pain relievers to relieve pain;
• muscle relaxants to eliminate muscle spasms;
• if necessary, NSAIDs to relieve inflammation;
• chondroprotectors to improve the condition and nutrition of cartilage tissues;
• vasodilating and activating intercellular metabolism drugs to improve blood circulation and metabolic processes.

Physiotherapy procedures should be combined with therapeutic exercises, various types of massages, swimming, yoga and other physical activities. Recently, cryotherapy and spinal traction (apparatus, natural, water, kinesiological, etc.) have gained wide popularity in the treatment of diseases of the spine.

If necessary, complete rest and / or wearing a corset may be recommended to the patient for a certain period. The psychological attitude of the patient himself, the rejection of bad habits, the rethinking of the entire lifestyle and the appropriate diet play an important role in the treatment.

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Initially, the term osteochondrosis denoted a group of diseases of a predominantly inflammatory nature of the subchondral space of the long bones of the skeleton and the apophyses of the short bones.

Intervertebral osteochondrosis means only a degenerative-dystrophic process in the discs of one or more parts of the spinal column. Primary inflammatory process in this case, in the absence of timely treatment and with the continuing influence of the provoking factor, it also extends to the bone-ligamentous apparatus adjacent to the disc

Each person's spinal column is made up of vertebrae. Disks are located between these vertebrae, which mainly perform the function of a shock absorber. That is, the intervertebral discs do not allow adjacent vertebrae to come into contact with each other, soften the movement, and reduce the load.

The anatomy of the disc is represented by the central nucleus and the annulus fibrosus - thick cloth, which surrounds the entire core in a circle. Under the influence of certain reasons, the structure of the nucleus and connective tissue discs are steadily violated, this leads to dysfunction of shock absorption, to a decrease in mobility and to a deterioration in elasticity. A similar condition manifests itself in different symptoms.

Causes of occurrence

As the body ages, intervertebral osteochondrosis is observed to varying degrees in every person. But if the body is constantly influenced by factors negatively affecting the spinal column, then the bone-cartilaginous structures are destroyed quickly and all the unpleasant symptoms of the disease appear at a fairly young age.

Intervertebral osteochondrosis develops due to the negative influence of the following factors:

• With constant hypodynamia. That is, degenerative changes occur most often with a sedentary lifestyle.
• Impaired metabolism.
• Infectious diseases.
• Overweight.
• Improper nutrition - the use of fatty, low fortified foods, various food additives.
• Injuries and injuries of the vertebral bodies.
• Diseases of the musculoskeletal system, this group includes curvature of the spine, flat feet.
• In women, the load on the spinal column increases significantly during pregnancy and with the constant wearing of high heels.
• Emotional stress.
• Bad habits - smoking, alcohol abuse.

A hereditary factor has a certain influence on the development of intervertebral osteochondrosis. Under the influence of all these provoking reasons, blood circulation in the intervertebral structures is significantly impaired, metabolic processes slow down, an insufficient amount of trace elements and vitamins enter the tissues and cells. That is, all conditions are created for the occurrence of inflammatory and dystrophic changes in the discs.

Degrees

• Intervertebral osteochondrosis of the first degree is characterized by a decrease in the height of the disc, it seems to flatten, which leads to the appearance of microcracks in the annulus fibrosus. At this stage of the development of the disease, the patient may complain of periodic sharp pains with a certain localization, resembling an electric discharge.
• With the second degree of osteochondrosis, the height of the disc steadily decreases, the jelly-like part of the nucleus dries out, and cracks form in the annulus fibrosus. The pathological process is accompanied by inflammation and irritation of the nerve endings.
• The third stage is characterized by complete rupture of the annulus fibrosus and protrusion of the central part of the disc. Thus, we are talking about the resulting intervertebral hernia. At this stage of the disease, the vessels and nerves passing next to the altered vertebrae are infringed, which affects the appearance of certain symptoms of the disease.

Localization types

Intervertebral osteochondrosis can affect any part of the spinal column. Common osteochondrosis covers more than one anatomical region of the spine. By localization, the local pathological process is subdivided into:

• Cervical osteochondrosis. This type of disease is detected most often and can be in fairly young people.
• Thoracic osteochondrosis is the most rare view localization of the disease. This is due to the fact that this department is less mobile.
• Lumbar osteochondrosis.
• Sacrococcygeal intervertebral osteochondrosis.

Diagnostics

The diagnosis of intervertebral osteochondrosis is established by a neurologist. First, the patient is examined, anamnesis is taken, and complaints are clarified. To confirm the diagnosis from instrumental examination methods are prescribed:

• X-ray of the spine.
• MRI is used to detect an intervertebral hernia, assess pathological changes in the spinal cord.
• Discography is prescribed for a complete examination of all damaged disc structures.
• Electromyography or electroneurography is done to detect damage in the nerve pathways.

Symptoms

The clinical picture of intervertebral osteochondrosis depends on the degree of inflammatory and degenerative changes... The first sign is pain, as a rule, it is combined with some movement disorder in the affected segment of the spine.

The pain can be so pronounced that it sharply reduces a person's working capacity, disrupts his psychoemotional state and is removed only after the use of drug blockades. The signs of the disease also depend on the type of localization of osteochondrosis.

Symptoms of the disease in the cervical spine

The diagnosis of intervertebral osteochondrosis of the cervical spine is exposed most often. The main symptoms are:

• Frequent headaches and dizziness.
• Pain in the upper limbs and chest.
• Numbness of the cervical spine and limitation of its mobility.
• Weakness and tenderness in the hands.

Cervical intervertebral osteochondrosis is also often manifested by pressure surges, darkening in the eyes, severe weakness. This is explained by the fact that the supply passes through the vertebrae of this section. different departments cerebral vertebral artery. Its compression as a result of changes in the anatomical position of the discs and leads to the occurrence of various pathological changes in health.

Manifestations of the disease in the thoracic region

The thoracic spine is affected by pathological changes less often than others. The main reason for this type of localization of osteochondrosis is the curvature of the spinal column or its injury.

The symptomatology of the changes occurring is somewhat different from the symptoms of the disease in other departments. The pain is not so pronounced, it is usually aching, intermittent and dull. Sometimes there are pains and numbness in the limbs, goose bumps are recorded in the chest area.

Compression of the nerve endings involved in the innervation of internal organs leads to the development of discomfort in the region of the liver, stomach and heart.

Due to the fact that the symptoms of thoracic osteochondrosis are identical and other diseases are often diagnosed incorrectly. It is necessary to distinguish from osteochondrosis of the thoracic region of gastritis, angina pectoris, intercostal neuralgia.

Symptoms of lumbar intervertebral osteochondrosis

Intervertebral osteochondrosis, affecting the lumbar spine, occurs most often. And most of all it comes to light with this type of localization of middle-aged male patients. The main symptoms include:

• Severe pain in the lumbar region and marked limitation of mobility.
• Painful sensations are recorded in the buttocks, thighs, legs.
• Patients complain of unexpected lumbago.

This type of intervertebral osteochondrosis is often manifested by impaired sensitivity skin on the legs, which is explained by pinched nerve endings. Paresthesias and weakness in the lower extremities occur periodically.

Treatment

Treatment of the identified osteochondrosis of the spine is aimed at relieving pain, reducing inflammation, restoring mobility of the vertebrae, improving blood circulation and metabolic reactions.

It is necessary to use not only medicines, but also physiotherapy, courses of specially selected massage, physiotherapy exercises. Drug treatment is selected based on the manifestations of the disease and mainly consists of:

• Non-steroidal anti-inflammatory drugs. This group of drugs reduces swelling and inflammation, which affects the relief of pain. Use Nise, Ketanov, Movalis, Diclofenac. This group of drugs is selected by a doctor and appointed for a strictly defined time, as it can cause a number of adverse reactions.
• Painkillers are used for severe pain syndrome. Sometimes it is possible to stop an attack of pain only with a drug blockade.
• Complexes of vitamins are necessary to enhance metabolic reactions in nerve tissues. Assign Milgamma, Unigamma.
• They use drugs that improve blood flow - Trental, Euphyllin.
• Muscle relaxants are medicines that relieve muscle spasms. Most often, for osteochondrosis, Tizanidine, Midocalm are prescribed.
• After the main treatment, chondroprotectors are selected - drugs that restore altered cartilage tissue. This group of drugs is used for a long time, and in old age courses.

2 comments

I have cervical osteochondrosis of traumatic origin. And always the exacerbation of osteochondrosis is accompanied by acute myositis - inflammation of the neck muscles. It is necessary to treat with pain relievers and anti-inflammatory drugs. I don’t know if this is a common combination of diseases, or I’m unique ... With an exacerbation, the neck does not turn at all and muscle pain... Very unpleasant sensation. After acute phase massage helps well. As I understand it, osteochondrosis is for life….

The diagnosis was traumatic lower back osteochondrosis, I was diagnosed more than 20 years ago. After courses of blockades and non-steroidal anti-inflammatory drugs, remission occurred for a while, and then again an exacerbation. I decided to fight with the help of physical education. He raised the literature on this topic, the book by V. Dikul "We treat the back from hernias and protrusions" was especially useful. I have selected suitable exercises to strengthen the muscle corset, I perform them, and for many years I have been leading a full-fledged lifestyle. Sometimes there are exacerbations, but in a mild form.

Decrease in the height of the intervertebral discs: development process, consequences, treatment

Intervertebral discs are cartilaginous formations that connect the bony elements of the spine. They provide flexibility and mobility of the spinal column, body turns, absorb loads and shocks during running, jumping and other movements. Constant mechanical stress, aging of the body, the harmful influence of external factors and diseases gradually lead to the fact that the cartilage loses its natural qualities, wears out and sags.

Etiology of the development of the disease

Anatomically, the intervertebral discs consist of a dense membrane (annulus fibrosus) and a softer gelatinous middle (nucleus pulposus), enclosed between hyaline plates that adjoin the vertebral bodies.

The discs do not contain blood vessels, so the cartilage fibers are nourished and supplied with water in a diffuse manner from the surrounding soft tissues. Thus, the normal functioning of the intervertebral discs is possible only with the normal condition of muscle tissue (correct adequate physical activity and active blood circulation).

The development of degenerative-dystrophic changes in the body (osteochondrosis) and a sedentary lifestyle causes a deterioration in the nutrition of the back muscles and intervertebral discs. As a result, there is stiffness in some segments, soreness during movement, edema, spasms, which further complicates blood circulation in the pathological area.

Gradually, the cartilaginous tissues lose water, their elasticity decreases, the fibrous membrane begins to crack, and the disc itself flattens, becomes lower and sometimes goes beyond the anatomically acceptable limits.

The next stage of the disease or the stage of osteochondrosis is the development of deforming spondylosis. Subsidence and extrusion of the fibrous fibers of the cartilage under the weight of the body and during physical exertion leads to the fact that the intervertebral discs pull down the hyaline plates and the surface of the bone tissue connected to them. Thus, there are bone growths on the vertebral bodies - osteophytes.

To some extent, the formation of osteophytes is a protective reaction of the body to the destruction of cartilage and its going beyond its natural limits. As a result, the discs are limited in the lateral planes and can no longer go beyond the edges of the bone growths (crawl even further). Although this condition significantly impairs the mobility of the affected segment, it does not cause any special pain.

The further development of the disease is characterized by the degeneration of cartilaginous tissues into denser ones, similar in quality to bone, which makes the discs suffer even more.

Stages of pathology and their symptoms

The development of the disease is conventionally divided into several stages:

• The initial stage or the stage of implicit changes, in which there is a slight damage to the membranes of the annulus fibrosus, but the height of the intervertebral disc itself remains unchanged. The only disturbing symptom is some stiffness of movements in the morning hours and discomfort after unusual and excessive physical exertion.
• The stage of progression of degenerative disorders, pronounced disc sagging and damage to the fibrous membrane. At this stage, there is a stiffness in the muscles of the back and ligaments, which are no longer able to support the spine. Curvature of posture (scoliosis, kyphosis, lordosis), instability of the vertebrae and other pathologies can be observed. The patient feels pain after physical exertion and / or prolonged exposure to static and uncomfortable positions.
• The stage of active deformation of the disc ring, its cracking, going beyond the permissible limits. Possible formation of intervertebral protrusions or hernias, which are characterized by local edema, inflammation, muscle tissue spasm. Violation of microcirculation of blood and lymph causes severe pain syndrome, as well as pinching of blood vessels and nerve roots. May be accompanied by loss of sensitivity, paresis or paralysis of the extremities, dysfunctions of internal organs.
• The stage of progression of spondylosis, in which the intervertebral discs significantly lose their height, go beyond the vertebral bodies, and osteophytes are formed. At this stage of the development of the disease, ankylosing joints can occur, which is fraught with a complete loss of mobility of the segment, and, consequently, the patient's disability.

Treatment of the disease

Subsidence of intervertebral discs, osteochondrosis and spondylosis are conditions that, if they arise, are already difficult to treat or recover. A decrease in the height of the disc and the growth of osteophytes can only be suspended or slowed down, but it is quite possible to improve the condition of the cartilaginous tissues of the joints.

Conservative treatment methods involve an integrated approach, which consists of:

• relieving pain with medication, physiotherapy and manual procedures;
• active and passive development of the joint, improving blood circulation and lymph flow in it;
• working out the soft tissues of the whole organism and the pathological area to restore trophism and metabolic processes;
• improving the condition of the cartilage of the spinal column and the whole body with drugs, physiotherapy, exercise therapy;
• strengthening of bone, muscle and ligamentous structures of the body;
• if necessary, reducing the pressure on each other and the soft tissues of bone growths by the method of surgical intervention.

Drug therapy is represented by means:

• local and general pain relievers to relieve pain;
• muscle relaxants to eliminate muscle spasms;
• if necessary, NSAIDs to relieve inflammation;
• chondroprotectors to improve the condition and nutrition of cartilage tissues;
• vasodilating and activating intercellular metabolism drugs to improve blood circulation and metabolic processes.

Physiotherapy procedures should be combined with therapeutic exercises, various types of massages, swimming, yoga and other physical activities. Recently, cryotherapy and spinal traction (apparatus, natural, water, kinesiological, etc.) have gained wide popularity in the treatment of diseases of the spine.

If necessary, complete rest and / or wearing a corset may be recommended to the patient for a certain period. The psychological attitude of the patient himself, the rejection of bad habits, the rethinking of the entire lifestyle and the appropriate diet play an important role in the treatment.

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I would like to express my gratitude to the massage master Ruslan Anatolyevich! The headaches subsided after 4 treatments! This is despite the fact that the general course is to consolidate the effect of 7-10 procedures, so I was told. I will definitely go through the whole course, as this is.

After a difficult childbirth of his wife (hypoxia in the baby), the neurologist advised to contact Dr. Zhanna Nikolaevna Balabanova (clinic in Mitino). After the first 2 sessions, the baby showed noticeable improvements, and in a year the neurologist noted that the child did not have a single one.

Sorokin Sergei Dmitrievich with his golden hands saved me from terrible pain in the lower back! They tormented for a whole year in pain. Wherever and what procedures he did not take, nothing helped! Fortunately, I got to this wonderful person. Low bow to such.

I hobbled to the clinic gritting my teeth in pain. Already after the first massage sessions with Ruslan Anatolyevich Iksanov and defanotherapy with Dmitry Anatolyevich Toroptsev, I felt significant relief. Five sessions have passed and I am already free.

I chose a clinic for a very long time, for the treatment of an intervertebral hernia, according to reviews I stopped at the Bobyr clinic, now I understand that I did it not in vain, although the treatment was not easy, nevertheless the result is very good, for this I thank Mikhail Bobyr.

I would like to express my deep gratitude to the doctor of the clinic in Mitino, Nikolai Alexandrovich Nikolsky. After five sessions of manual therapy, he literally put me on my feet. very attentive, sensitive and professional doctor. Thanks.

Osteochondrosis of the lumbar intervertebral discs

Osteochondrosis of intervertebral discs # 8212; symptoms of various parts of the spine

Intervertebral osteochondrosis is characterized by damage to the discs located between the vertebrae, as well as damage to their bodies and joint surfaces. This disease is quite common and is accompanied by characteristic back pain and other unpleasant symptoms. The disease can be localized in any vertebral region, but the most common area affected by this ailment is the sacral and lumbar, less often the thoracic and cervical.

Osteochondrosis of the intervertebral discs is accompanied, primarily by degeneration of bone tissue and cartilage in the spinal column. Most often, this pathology occurs in people who are overweight or in people who are subject to strong physical exertion. Also, osteochondrosis does not bypass people who lead an inactive lifestyle or abuse smoking and drinking alcohol.

Osteochondrosis of intervertebral discs affects people aged 30 to 40 years, but there are cases of the appearance of the disease in adolescents. Pathology manifests itself in various symptoms, the nature of which depends on the area of ​​the location of the focus of its development. The main symptom of this disease is pain of a permanent nature, the appearance of which is caused by irritation of the nerve roots, which is accompanied by the following manifestations:

• Increased sensitivity of nerve endings;
• The onset of puffiness and fibrosis;
• Circulatory disorders.

Pain can radiate to different parts of the body, including the back of the head, neck, legs, shoulder blades, or shoulders. As the disease progresses, there is a decreased or hypersensitivity in the region of the limbs, which is accompanied by constant chilliness of the arms or legs. Symptoms of osteochondrosis of intervertebral discs depend on the stage of the pathology and the place of its localization.

Symptoms of cervical osteochondrosis

Intervertebral osteochondrosis of the cervical spine is relatively common. At risk are people engaged in monotonous work: programmers, designers, watchmakers, dentists, etc. Driving is also a predisposing factor for the appearance of degenerative-dystrophic changes in the spinal column. This ailment manifests itself with the following symptoms:

• Mild headaches;
• Dizziness;
• Pain in the area upper limbs and chest;
• Lumbago;
• Numbness of the tongue.

Cervical osteochondrosis is also characterized by a sharp rise in pressure and darkening in the eyes. This is due to the structural features of the cervical region of the spinal column. Through the region of the transverse processes of the vertebrae of the cervical region, not only the canal for the spinal cord passes, but also the so-called vertebral artery. It is directed into the cranial cavity and is necessary to provide nutrition to the cerebellum, vestibular apparatus and centers lying in the region of the base of the brain and the occiput.

Due to the displacement of the vertebrae, a reflex spasm occurs vertebral artery, which in severe cases is accompanied by squeezing. Thus, there is a violation of the blood supply to the vegetative centers and centers of balance, which are responsible for the vital processes of the body.

This process becomes the reason for the emergence of a common diagnosis of vegetative-vascular dystonia.

Cervical osteochondrosis can manifest with radicular symptoms (cervical radiculitis), which consist in the fact that the pain is given to the hands or fingers, which is accompanied by their characteristic numbness and constant chills. The reason for this is the violation of impulses passing through the nerve fibers.

Symptoms of breast osteochondrosis

The defeat of the thoracic spine is a very rare occurrence. The main reason degenerative-dystrophic changes in this area is a curvature of the spine or scoliosis. The symptomatology of this pathology is very different from osteochondrosis of the lumbar and cervical type, and consists in the following manifestations:

• No acute pain;
• Dull or aching pain manifestations;
• Pain and numbness in the chest;
• Feeling of goose bumps in the chest area;
• Pain in the heart, stomach and liver.

Due to the confusion of symptoms, this type of osteochondrosis is often mistaken for other diseases, for example, angina pectoris or gastritis. Also, by the nature of the manifestations, a similar pathology can be mistaken for intercostal neuralgia or a heart attack, when pain radiates to the subscapularis.

Symptoms of lumbar osteochondrosis

There is intervertebral osteochondrosis of the lumbar spine most often, which is explained by the presence of this part of the spinal column in constant tension. The most common complication of this kind of pathology is the development of an intervertebral hernia of the lumbar spine.

Among the symptoms of lumbosacral osteochondrosis are:

• Pain in the lumbar region;
• Restriction of mobility;
• Pain radiating to the legs;
• Unexpected lumbago.

Frequent manifestations of this type of osteochondrosis is a violation of the sensitivity of the skin on the legs, which is caused by pinching of the roots of the spinal cord. The cause of the development of this ailment is a chronic injury or compression fracture.

Osteochondrosis of the intervertebral discs of the lumbar spine can be complicated by the instability of the vertebrae, in which the discs cease to fix parts of the spinal column, which, under the influence of gravity, is accompanied by the development pathological processes in the nearby internal organs, as well as its departure from the sacrum.

Any person can develop osteochondrosis of the cervical, thoracic or lumbar spine, so one should not neglect measures to prevent this disease. To do this, you should engage in regular gymnastic exercises, give up bad habits and try to constantly maintain correct posture.

The intervertebral disc is a formation consisting of fibrous and cartilaginous tissue, which contains a nucleus in the center and is located between two adjacent vertebrae. Moreover, it is important to understand that the intervertebral discs do not contain blood vessels, which means that food comes to them from the tissues that surround them. For this reason, when the nutrition of the back muscles is disturbed, namely due to the vessels that pass here and the discs of the spine are fed, the blood supply to these important structures is disrupted.

The disc itself is quite elastic, but in the absence of a sufficient amount of nutrients, it begins to lose water, which greatly affects its height and elasticity, and the fibrous ring itself becomes more fragile. All this negatively affects the general condition of the spine, its instability increases, and one of the most frequent manifestations of this pathology can be considered a decrease in the height of the intervertebral discs.

With the further course of the pathology, the cartilage tissue of the spine becomes more like bone, which is called degeneration or degeneration. At the same time, the disc suffers even more, it decreases, loses its height, ceases to perform one of the most important functions - depreciation. In addition, he begins to put pressure on the nerve endings located nearby. All this causes severe pain. This condition is called osteochondrosis or spondylosis, and is very common among both the female and male population.

A decrease in the height of the intervertebral disc L5-S1 can also be observed with traumatic injury back. If the injury occurs without compromising the integrity of the annulus fibrosus, it is called protrusion. But if there is a tear of the ring, the nucleus goes beyond it, then this is called a herniated disc.

What does it threaten

In total, four stages of pathology are distinguished. And each of them has its own special characteristics. On initial stage the course of the disease is hidden. The only symptom is back discomfort in the morning, which disappears after a few hours. The height of the discs remains unchanged.

In the second stage, the pain sensations become stronger, the deformation of the fibrous ring begins, the stability of the affected area of ​​the spine is severely disturbed. Pinching of the nerve roots can be observed, blood and lymph flow is disturbed, and a moderate decrease in the height of the intervertebral discs is detected.

At the third stage, further deformation of the disk ring occurs and its rupture occurs. Pathologies such as scoliosis are well pronounced. kyphosis or lordosis. And, finally, the final stage is the shift and hardening of the vertebrae, which is accompanied by severe pain. A person has severely limited opportunities for movement. The disc height is reduced to its minimum.

As a result, disruptions in the work of the pelvic organs, complete loss of sensitivity, even paralysis of the muscles of the lower extremities can occur. As a result, a person gets a disability and can only move in a wheelchair.

Conservative therapy

In the early stages of development, a moderate decrease in the height of the intervertebral discs, which can be seen on the images, is treated conservative method... However, it is important to understand that treatment should be comprehensive and medications alone cannot be dispensed with.

When making this diagnosis, it is imperative to create a sparing regimen for the back for a while, engage in physiotherapy exercises, swimming, get a referral from a doctor for physiotherapy and massage.

As for the spine stretching procedure, it can be carried out only after a complete examination and a doctor's appointment. Otherwise, such treatment can lead to serious consequences. If spinal traction is still prescribed, then it is better to choose its underwater option, that is, using the pool. Medication should be used only as directed by a doctor and in individually selected dosages.

If conservative treatment for several months does not bring visible relief, then surgery may be prescribed. There are certain indications here, for example, persistent lumbago, functional incompetence of the vertebrae, chronic compression of the roots. The doctor decides which operation will be the most effective, and here everything depends not only on the degree of development of the pathology, but also on the patient's age, his general health and his weight.

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The main Diseases What is fraught with and why the height of the intervertebral discs can be reduced

What is the risk and why the height of the intervertebral discs can be reduced

During the examination of the spine, the diagnosis was made: the height of the intervertebral discs is reduced, what does this mean and how dangerous is it? What to do next, continue to live a normal life, or is it better to do something? It is better to know the answers to these questions from childhood, since more than 80% of people in the world, albeit in varying degrees but are related to back problems.

In order to understand how and why there is a decrease in the height of the intervertebral discs, you need to delve a little into the anatomy.

The structure of the spine and the function of the intervertebral discs

The spine is the main support of the human body, consisting of segments (parts), namely the vertebrae. Performs a supportive, shock-absorbing (thanks to intervertebral discs) and protective functions (protects the spinal cord from damage).

The spinal cord, located respectively in the spinal canal of the spine, is a rather elastic structure that can adapt to changes in body position. Depending on the section of the spine, the spinal nerves branch off from it, innervating certain parts of the body.

• The head, shoulders and arms are innervated by nerves that branch from the cervical spine.
• The middle part of the body is accordingly innervated by nerves branching from the thoracic spine.
• Lower body and legs - innervated by nerves that branch from the lumbosacral segment of the spine.

Consequently, if problems arise with innervation (impaired sensitivity, severe pain reaction, etc.) of any parts of the body, one can suspect the development of pathology in the corresponding part of the spine.

From the moment a person began to walk upright, the load on the spinal column increased significantly. Accordingly, the role of the intervertebral discs has grown.

Intervertebral discs

Fibrous, cartilage-like structures consisting of a nucleus surrounded by a fibrous (tendon-like) ring and a circular plate-like structure between the vertebrae are called intervertebral discs. Their main purpose is depreciation (load mitigation).

How does the decrease in the height of the intervertebral discs develop?

There is one important point in the structure of the intervertebral discs related to the development of pathology - they do not contain blood vessels, therefore nutrients enter them from the tissues located in the neighborhood. In particular, the latter include the spinal muscles. Therefore, when dystrophy (malnutrition) of the spinal muscles occurs, malnutrition and intervertebral discs occur.

The jelly-like, but at the same time rather elastic (thanks to the fibrous ring limiting it) the core of the disc provides a reliable and at the same time elastic connection of the vertebrae to each other. As a result of a violation of the supply of nutrients, the disc begins to dehydrate, lose its height and elasticity, the fibrous ring also loses its flexibility, becomes more fragile. There is a deterioration in the connection of the vertebrae, instability increases in the affected motor spine.

With the further development of the process, degeneration (degeneration) and hardening of the cartilaginous tissue of the disc occurs, it becomes similar to bone. The disc decreases even more in size, loses height, ceases to perform a shock-absorbing function and begins to press on the nerve endings, causing pain.

Degenerative-dystrophic (degeneration and malnutrition) processes in which there is a decrease in the height of the intervertebral discs and the rapid growth of osteophytes (bone formations) are called osteochondrosis (spondylosis). The terms have Greek roots, meaning respectively - the joint (spine), the ending -oz characterizes dystrophic (malnutrition) changes.

Complicated course of osteochondrosis

According to a similar scenario, pathology occurs not only with diseases that cause disruption of trophic discs. Most often, with injuries of the spine or with traumatic stress, the disc is squeezed, followed by protrusion of the nucleus, if this occurs without violating the integrity of the fibrous ring, then it is called protrusion, if the prolapse (protrusion) is accompanied by a rupture of the ring and the exit of the nucleus beyond its limits, this is herniated disc.

At the same time, as a result of squeezing, the height of the discs also decreases, and with a further increase in pressure, the size of the hernia will increase.

What threatens a decrease in the height of the intervertebral discs

I. The initial, still hidden form of the flow. Minor discomfort, usually in the morning and disappears during the day. Most people do not seek help, although they feel limited mobility. The affected disc has the same height as the healthy (adjacent) one.

II. Pain appears, the annulus fibrosus deforms, the stability of the affected spine is disturbed, pathological mobility develops, nerve endings are pinched (causing pain). Blood and lymph flows are impaired. The height of the intervertebral disc is reduced, a quarter less than the neighboring one.

III. Further deformation and rupture of the disc ring, the formation of a hernia. Deforming pathology of the affected vertebral sections (scoliosis - deflection of the spine to the side, kyphosis - hump or lordosis - deflection back). Affected disc, half the size of a healthy disc.

IV. Final. Displacement and compaction of the affected vertebrae, accompanied by painful sensations and bone growths. Sharp pain on movement, minimal mobility. Disability is possible. An even more significant reduction in the height of the disc.

The result of a complication of a herniated disc can be: dysfunction of the pelvic organs and loss of sensitivity, paralysis of the leg muscles, movement in a wheelchair.

What to do, how to prevent

Eat right, engage in recreational physical exercises, drink enough fluid (at least 2 liters per day, maintains normal metabolism), do not overload the spine (lifting heavy weights), avoid injuries, stress and hypothermia, with sedentary work - do gymnastic pauses, periodically undergo a preventive examination of the spine, and if problems are found, immediately seek help.

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The spine is made up of thirty-three bones known as the vertebrae. Each vertebra is separated from adjacent ones, directly by means of intervertebral discs, by spongy, but powerful enough connective tissues. The intervertebral discs, along with the ligaments and bony processes, connect individual vertebrae to help keep the vertebrae aligned and curved throughout the column, while still allowing them to move.

The spine has such a channel, in which there are very important vital elements associated with cerebrospinal fluid... In such a channel there is the brain itself and it is surrounded by it. On both sides of the spine there are small holes that allow the root to exit the canal.

• Spine sections
• Types and classification
• Stages
• Diagnostics of the herniated disc
• Symptoms
• Causes of pathology
• Why does a hernia appear?
• Operation
• Nucleoplasty

Spine

The spine has three sections:

• Cervical - has seven vertebrae in the neck. These vertebrae are small and allow neck mobility.
• Thoracic - consists of 12 back vertebrae. They are larger and stronger than the cervical vertebrae. Each thoracic vertebra is attached to a rib on both sides. This provides significant rigidity and strength in the thoracic spine.
• Lumbar - usually consists of five vertebrae. They are located below the thoracic vertebrae and are labeled (L1, L2, L3, L4, L5) in descending order from the very top. The intervertebral discs are numbered. The first lumbar disc is labeled L1-2, and they are labeled sequentially downward L5 S1. s1 - represents the sacrum that connects the spine to the pelvis.

These vertebrae are the largest because they can handle the most stress. Herniated disc l4 s1 is rare. The vertebrae in the lumbar spine are more mobile than those in the thoracic spine. Due to these factors, the lumbar spine suffers more from degenerative diseases and disc herniation.

The sacrococcygeal is the lowest part of the spine. It attaches to both sides of the pelvis. The fifth vertebra in the lumbar lower spine can sometimes be fused with the sacrum.

A herniated disc occurs when the fibrous outer portion of the disc ruptures and the pulpous (jelly-like) nucleus breaks through the fibrous ring of the intervertebral disc. When a herniated disc compresses a nearby nerve, the nerve is pinched, causing pain, numbness, tingling, or weakness in the arms or legs. The substance that makes up the jelly-like nucleus of the disc can also inflame and irritate the nerve, causing additional pain.

Types and classification

Intervertebral hernias are divided into three types:

1. By size:

• Protrusion - protrusion of the disc by 1-3 mm.
• Prolapse - prolapse of the disc by 3-6 mm.
• Hernia development - protrusion of the disc by 6 to 15.

2. By the type of tissue, intervertebral hernia:

• Bone (spondylosis osteophyte) - is diagnosed very rarely (in 1% of cases) in the elderly.
• Cartilaginous (osteophytes) - develop in 15% of patients.
• Pulpous (Schmorl's hernia) - formed in 84% of cases.

3. In the direction of exit in accordance with the center of gravity of the vertebral segment:

• Foraminal - hernial protrusion is carried out through the hole from which the nerve endings exit
• Median disc herniation - characterized by radial fracture of the circular disc cartilage. The exit gate in this case is directed to the periphery from the circular platform of the vertebral body
• Left-sided
• Right-sided
• Front
• Back

Stages

The progression of pathology ranges from sudden to slow onset of symptoms. There are four stages:

1. Disc protrusion
2. Dropped disc
3. Extrusion disc
4. Absorbed disc

Stages 1 and 2 are called incomplete intervertebral hernias, and stages 3 and 4 are called complete hernias. Neurological deficits can include sensory changes (i.e. tingling, numbness) and changes in movement (weakness, impaired reflex functions). These changes are caused by compression of the nerve created by pressure from the inner disc.

Hernia progression

• Cervical - pain spreads to the neck, shoulders, and arms.
• Chest - pain spreads to the chest.
• Lumbar - pain spreads to the buttocks, thighs, legs.

Cauda equina syndrome occurs from a central disc herniation and is a serious condition requiring immediate surgery. Symptoms include bilateral leg pain, loss of perianal sensation (anus), bladder paralysis, and anal sphincter weakness.

Diagnostics of the herniated disc

The spine is examined in a standing patient. Because of muscle spasm, you can see the loss of the normal curvature of the spine. Radicular pain (inflammation of the spinal nerve) may increase with pressure on the affected area.

Test (straight leg).

The patient lies down, the knee is pulled apart, and the hip is flexed. If the pain intensifies, this indicates inflammation of the lower lumbosacral nerve roots. Other neurological tests are done to check for loss of sensation and motor function. Changes in pathological reflexes may indicate the location of the hernia.

An x-ray and an MRI (magnetic resonance imaging) scan containing more detailed information... MRI is the best technique that allows the doctor to see the soft tissues of the spine that are invisible on conventional x-rays.

The examination and test results are compared to make a correct diagnosis. This includes locating the hernia and determining options for subsequent treatment.

Symptoms

Dorsal herniated disc is usually asymptomatic, but sometimes the appearance of such symptoms is observed: discomfort, pain in the lower back that lasts for a long time. The pain gets worse over time. She starts to be convulsive. Discomfort is especially felt after physical exertion in one position. The patient may hear clicks or crunching sounds in the back.

During pain, the pain is intense, even during breathing and coughing. Over time, the pain begins to radiate to the leg. As a result of worsening discomfort in the back, it is difficult to straighten the leg, the knee reflex worsens, and other symptoms are observed.

If left untreated, the condition will gradually worsen, leading to rupture of the annulus fibrosus, which can lead to permanent paralysis. To choose a treatment, it is necessary to find out the cause of the hernia.

Median disc herniation is one of the variants of posterior disc herniation L5 S1, L4 L5 is formed in the place where nerve trunks leave the spinal cord canal. Leads to serious pathology.

Circular hernia of the intervertebral disc manifests itself in a peculiar way: movement becomes difficult, general mobility deteriorates. At the site of the lesion, edema, which can squeeze not only the roots, but also the spinal cord.

A sequestered herniated disc is an extremely difficult option. There is a prolapse of the nucleus pulposus of the disc into the area of ​​the spinal canal, where the spinal nerves pass. The disease occurs in people suffering from a herniated disc with protrusion or protrusion of the disc. Refers to the third degree of complexity.

Causes of pathology

Age-related changes in the fibrous and cartilaginous tissues of the spine contribute to disc protrusion and rupture of the annulus fibrosus, causing the formation of hernias. Jumping, injuries and weight strongly affect the intervertebral spaces.

Main reasons:

• Spine or neck injuries.
• Deformation with age.
• Improper lifting.
• Disease of ODA (musculoskeletal system).
• Joint disease (arthrosis, arthritis).
• Syphilis.
• Obesity.
• Long-term osteochondrosis.

Herniated disc occurs most often in the lumbar spine, especially in L4 L5 and L5 S1 levels (L - lumbar, S - sacral). This is because the lumbar spine carries most of the body's weight. Especially important in cases of large hernias.

The most vulnerable people are between the ages of 30 and 50, because the spine loses its elasticity with age. Circular disc herniation most often affects the L5 S1 segment.

C5 C6 (C6 nerve roots) - Herniated C5 C6 intervertebral discs can cause weakness in the biceps (in the front of the upper arms) and wrist extensors. Numbness and tingling along with pain may radiate to the side thumb hands. This is one of the most common cases of cervical disc herniation.

In cervical hernia, the vertebrae of the C6 C7 segments are most often affected. C6 C7 (C7 nerve root) - A herniated disc in this area can cause weakness in the triceps (muscles in the back of the shoulder and extending to the forearm) and extensor muscles of the fingers. Numbness and tingling along with pain can spread down the triceps and into the middle finger.

Spine segment pathology table

Why does a hernia appear?

The intervertebral discs are flexible bushings between the vertebrae. Their main workplace is the space for the spinal nerves, which exit the spinal cord through the bony windows (called the intervertebral foramen) and act as shock absorbers. The discs are made of two separate parts.

Fibrous ring. The annular space is the outside of the disc. It consists of connective rings (can be compared to rings on a tree). Part of the pulp center contains a jelly core. The liquid cannot be compressed, so these jelly centers act as shock absorbers.

As you carry the weight, the pressure pushes the core towards the outside of the disc 360 degrees. As you lean forward, the nucleus is pushed more towards the back of the disc. Ring fibers are generally stiff enough to contain the disc during ordinary activities including work.

But when there is too much discal pressure, these layers can become ligaments and begin to break down from the inside. As the innermost layers begin to tear, the core jelly begins to be forced out by the outer (right or left or both) posterior portions of the disc. The larger the gap, the larger the bulge.

Injuries that cause the intervertebral discs bulge the hernia. It can be caused by either acute trauma or repetitive physical exertion. Mechanical stress acts on injured or weakened annular ligaments and allows the jelly to bulge outward.

If a bulge (often referred to as a herniated disc) protrudes over a small area (less than 25% of the circumference of the disc), then we call it as the focal point of the disc. However, all too often, the vertebral disc can bulge over large areas (up to 50% of the circumference of the disc). This pathology is called diffuse herniated disc.

The differences in the two cases are insignificant. Focal disc swellings are more localized, causing pain that is usually focused in one area. This is because there are fewer nerves involved. It should be borne in mind that a herniated disc can often cause sciatica.

Because diffuse disc bulges take up more space, they tend to cause a wider range of symptoms. Pain is often on both sides. But due to the pressure on the cord, it can give other symptoms due to several spinal nerves.

The pain helps you know what kind of disc herniation you are dealing with. Recovery time may be longer for a diffuse hernia.

Paramedian disc herniation is also known by several other names, including posterolateral disc herniation, paramedial disc bulge, paramedian disc bulge, and paramedial disc bulge. This phenomenon, regardless of the exact diagnostic terminology, is the most common type of disc herniation among the existing ones. It is most common in the lumbar spine.

While it is not critical to fully understand the nature of posterolateral herniation, compared to lateral or central disc herniation, it is always good idea to learn the basics about disc bulges in order to improve your chances of successful treatment and pain relief. After all, each type of hernia can produce different effects on different types nervous tissue.

These hernias have an asymmetrical bulge of the pattern. They can affect the right side or left side disc, and usually enter the lateral notch on the lateral side of the spinal cord.

In some cases, the paramedial hernia usually falls on the frontal or lateral dural sac. In more rare cases, these hernias may actually involve the spinal cord.

Remember that a hernia that completely or partially blocks the foraminal space is called a foraminal disc herniation.

The paramedial disc may bulge out broadly or be focal. In most cases, it does not cause problems, the symptomatic pain caused does not require any special care, and will most likely go away on its own.

Some hernias may require professional medical treatment and even surgery. This is especially true for severe and proven cases of pinched nerves or spinal stenosis where the bulge actually compresses the spinal cord.

Be sure to compare any actual symptoms with clinical symptoms after diagnosis to improve the chances of successful treatment, no matter which therapy you choose. If the symptoms do not match the diagnosis, then any treatment is unlikely to be successful.

Median disc herniation is a type of back injury that can cause severe pain that usually lasts for a period of time. A pinched nerve can cause a herniated disc. At this point, the victim may feel a variety of sensations, from numbness and tingling weakness in the muscles to a feeling of electric shock to the spine.

In some cases, the patient may actually lose control of the functionality of the bladder. People with herniated discs can develop chronic problems and often spend years recovering from the injury. The older the age, the higher the likelihood of developing a herniated disc.

Most people find it difficult to name the exact cause of hernia formation. The severity is necessary

raise with knees bent at the legs, as if grouping. Rarely, a traumatic event like a fall or a blow to the back can cause a herniated disc.

Operation

If a course of non-surgical treatment (usually four to six weeks) is not effective in relieving the pain of the hernia. Often microdiscectomy (a type of lumbar decompression surgery) is used to treat compression of a nerve with a herniated disc.

During a minimally invasive microdiscectomy procedure, the herniated disc under the nerve root is removed. By giving the nerve root more space, the pressure is relieved and the nerve root can begin to release.

The microdiscectomy procedure is usually successful in relieving leg pain (sciatica) caused by a herniated disc. Although it will take several weeks or months for the nerve to recover. Patients often feel relief in their legs and generally have minimal discomfort after surgery.

Conservative methods

The first step of treatment is usually rest and the use of NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen, naproxen, or COX-2 inhibitors. cervical hernia the intervertebral disc is severe and lasts more than two weeks, doctors may prescribe additional medications, including:

1. steroids to reduce inflammation and relieve pain
2. strong pain reliever if pain is severe.

If the pain lasts more than two to four weeks, the following are often recommended:

• Physical therapy and exercise to help relieve pressure on the nerve root Chiropractic manipulation at low speed may be beneficial.
• However, caution should be used with manipulation if the patient is experiencing any neurological disorder.
• Guide traction to release the nerve leaving the spinal canal.
• Epidural injection to relieve pain and inflammation.

Percutaneous treatment of intervertebral disc herniation

In the absence of significant pain relief with conservative treatment, including oral pain relievers and anti-inflammatory drugs, surgery is recommended. Precise control of needle positioning ensures optimal distribution of steroids along the painful nerve root. Conventional surgery offers suboptimal results that often result in disability.

To achieve minimally invasive discal decompression, various percutaneous techniques have been developed. Their principle is to remove a small volume of the nucleus, which leads to an important decrease in intradiscal pressure, and then a decrease in pressure inside the herniated disc.

These operations are shown, only for hernias detected by computed tomography or magnetic resonance imaging. Techniques such as radio frequency or laser nucleotomy seem to be more effective than purely mechanical nucleotomy. But, in fact, there are few positive reviews.

Treatment of pain in symptomatic disc herniation depends mainly on conservative care, combining rest, physical therapy, analgesics, and anti-inflammatory drugs. The suboptimal results of traditional open surgery have led to the development of minimally invasive techniques.

The minimally invasive percutaneous techniques used today are designed to remove a small amount of the central nucleus in order to reduce intradiscal pressure and thus avoid compression.

Radicular pain due to herniated disc cannot be explained using a purely mechanical approach. Steroid injections are contraindicated in patients with diabetes mellitus, peptic ulcer stomach and pregnant women. In patients with coagulation disorders, epidural puncture is contraindicated.

Nucleoplasty

This is a surgery to remove a herniated disc. Performed under local anesthesia through a puncture needle. The needle is inserted into the cavity of the intervertebral disc. During the operation, constant X-ray control is carried out. The procedure is performed on an outpatient basis.

Image guidance is provided by CT, MRI, or fluoroscopy. CT guidance is often preferred as it allows precise planning and positioning of the needle. Connective tissue injection requires strict asepsis. When removing herniated discs using such an operation, the effect on the disc tissue is performed with cold plasma.

Treatment of a herniated disc is difficult due to the individualized nature of the pain and symptoms of each patient. A treatment option that relieves pain and discomfort for one patient may not work for another. By consulting several specialists, the patient can find the most appropriate treatment option for their case, and can avoid surgery.

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Symptoms and treatment of lumbar chondrosis

Lumbar chondrosis is a degenerative disease that affects the lumbar spine.

This pathology is based on the destruction of the cartilaginous ring of the intervertebral disc with prolapse of the nucleus pulposus forward (towards the abdominal cavity) or posteriorly (towards the spinal canal) with the formation of Schmorl's hernias.

Causes of the disease:

• Metabolic disorders, in particular, excessive calcium deposition in cartilage tissue;
• Excessive stress on the spine: obesity, weight lifting, especially incorrect;
• Poor posture leading to incorrect load distribution;
• Spine injury;
• Hypodynamia;
• Heredity.

Clinical manifestations of the disease

The symptoms of lumbar chondrosis are associated with the processes that occur when the intervertebral disc is destroyed and the nucleus prolapse:

The destruction of the cartilaginous ring leads to a decrease in the height of the intervertebral disc, as a result of which there is an infringement of the nerve roots that emerge from the spinal canal in the affected area. As a result of the infringement, an inflammatory reaction occurs and local edema tissues not visible to the eye. At the level of the lumbar spine, there are nerve roots that innervate the pelvic organs and lower extremities.

Therefore, pain when they are infringed occurs in the lower back (sciatica) and spreads to the perineum and along the outer surface of the thigh to the toes (lumbodynia). The pain syndrome is of a different nature: the pain can be dull or burning, aching and shooting. The pain intensifies after physical exertion, with a change in body position, with a cough.

Also, in this area, a violation of sensitivity may occur, manifested by hypesthesia (decreased sensitivity) or paresthesia (creeping creeps, tingling).

Reflexively, muscle spasm occurs in the area of ​​pain, limiting motor activity at the site of the lesion.

In advanced cases, when the destroyed intervertebral joint calcifies, a limitation of the range of motion in this area develops. This is manifested by a decrease in the severity of lumbar lordosis and a compensatory increase in the thoracic kyphosis (hump).

The classic picture of lumbar chondrosis is represented by the following symptoms:

• Lumbodynia;
• Sciatica;
• Violation of the sensitivity of the skin of the lower extremities;
• Spasm of the muscles of the lumbar region.

Stages of osteochondrosis of the spine

1. Damage to the nucleus pulposus of the intervertebral disc. Due to metabolic disorders in the nucleus pulposus, water is lost, the nucleus decreases in size, loses its elasticity and cannot cope with the stress. All this happens unnoticed by the patient and he does not seek help, although this stage is reversible.
2. Damage to the fibrous ring of the intervertebral disc. Excessive stress on the spine causes the disc to crack. The nucleus is squeezed out through the tears of the disc. Back pain may appear at this stage.
3. Herniated disc. The prolapsed nucleus exerts pressure on the tears, increasing them in size. At this stage, the rate of loss is so great that it can lead to clinical manifestations infringement of nerve roots and muscle spasm.
4. Degenerative changes in the spine. To unload the destroyed disc, the adjacent vertebrae begin to expand in width, forming osteophytes. All this limits the mobility of the injured segment and prevents its further destruction.

Available diagnostic methods

Based on typical clinical picture, which is confirmed by instrumental research methods:

• X-ray is the most affordable diagnostic method. Allows you to clarify the localization of damage, to see a decrease in the height of both the vertebrae themselves and the intervertebral discs, as well as the presence of osteophytes. With this type of diagnosis, it is impossible to detect the presence of disc herniation.
• Computed tomography also refers to X-ray methods, but, thanks to layer-by-layer photographing of the image, followed by comparing the images into one picture using computer programs, it allows you to examine the smallest details of the structure of the spine. It is used when simple radiography is not informative.
• MRI is the gold standard for diagnosing not only chondrosis, but also its complications such as protrusion and disc herniation, which are clearly visible on MRI scans.

Treating the disease and relieving pain symptoms

The main objectives of the treatment of lumbar chondrosis include:

1. Elimination of the causes of compression of the nerve roots;
2. Elimination of muscle spasm and movement disorders in the damaged segment;
3. Creation of the correct stereotype of movements to prevent new injuries.

The most effective methods for the complete cure of lumbar chondrosis include:

Drug therapy

Pain relief plays a large role in reducing muscle spasm and restoring spinal mobility.

• Pain relievers for lumbar chondrosis are represented by an extensive group of non-steroidal anti-inflammatory drugs. You can take tablets in the form of creams, gels, ointments, patches with a medicinal substance externally. When administered orally, it must be remembered that the course of administration should not be more than 5 days due to their negative impact on the gastric mucosa;
• Muscle relaxants reduce pathological muscle spasm;
• Chondroprotectors with prolonged use can stop the destruction of the intervertebral disc.
• Medicines that improve the nutrition of damaged roots: B vitamins, vascular preparations.

Manual therapy

A set of manual techniques that are aimed at restoring the mobility of the damaged segment. The specialist, with the help of rhythmic movements and traction, achieves a reflex reduction in pain. To achieve a lasting effect, it is necessary to carry out 10-15 sessions. To consolidate the result, the doctor may advise you to continue stretching yourself at home, showing the basic techniques.

Reflexology

It is based on the principle of interaction of active points on the body with internal organs by means of impulses that activate the metabolism in the affected organ. Has established itself as an excellent analgesic method that allows you to do without drugs... Depending on the methods of influencing active points, reflexology is divided into acupuncture, manopressopuncture (acupressure), thermopuncture (warming up), cryopuncture (exposure to active points with cold), electroacupuncture and many other techniques. The specific method and area of ​​influence is selected by a specialist reflexologist.

Physiotherapy

Gymnastics is indicated for acute chondrosis of the lumbar spine, but it has limitations depending on the period of the disease:

1. In the acute period, all exercises should be performed only while lying down. The main goal is to gently stretch the damaged area;
2. In the subacute period, a more active stretching of the spine is performed, exercises aimed at forming a muscular corset around the spine are added;
3. During the period of remission, exercises are aimed at maintaining the tone of the muscles that form a protective corset.

Physiotherapy

An important method of additional treatment for chondrosis of the spine, which, in combination with other methods, allows you to achieve a faster and more lasting result. Regardless of the technique, physiotherapy is aimed at reducing inflammation and relieving muscle spasm.

Complications with which a neglected disease is fraught

• Protrusion (bulging) of the disc.
• Herniated disc.
• Violation of the architectonics of the spine: flattening of the lumbar lordosis leads to an increase in kyphosis in the thoracic region.
• Compression of the spinal cord by a hernial protrusion.

How to avoid spinal chondrosis

If you follow simple rules, you can not only avoid problems with the spine, but also stop the progression of existing ones:

Formation of correct stereotypes in life

• It is recommended to lift and lower weights only in a squatting position, without leaning forward, if possible, distribute the load on both hands;
• Avoid sudden movements;
• Clean with a mop, vacuum cleaner;
• In the garden, work not in a slope, but in a squatting position;
• Regular performance of physiotherapy exercises;
• Avoid hypothermia of the lumbar region;
• Do not stay in one position for a long time, especially with a bent spine.

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