The most dangerous variation of the intervertebral hernia is sequestered hernia of the spine (sequestration). This pathology is characterized by a displacement of the disk into the canal of the spine, in particular to that part of it, where the dura mater and nerves are located. All this contributes to the development of severe pain, paralysis of the lower extremities.
In 81% of cases, the disease leads to disability, so doctors are prone to surgical treatment of the disease. Pathology serves as the trigger mechanism of the autoimmune process, when the cells of the disk, when they enter the spinal canal, are perceived by the body as foreign, therefore the process of self-destruction begins.
Characteristics of the problem
The spine consists of vertebrae, which are fastened together by disks, which ensure its mobility and amortization. The disk consists of a cartilaginous membrane, inside of which there is a pulpous nucleus. With the displacement or rupture of this shell, as well as the prolapse of the nucleus, they speak of the development of a hernia.
With the advanced form of the disease, the risk of developing the so-called horse tail syndrome – damage to the bundle of spinal nerves – increases. All this leads to disruption of the intestines, bladder, and susceptibility of the skin of the legs.
The presence of this syndrome in a person requires immediate surgery to prevent irreversible consequences in the functioning of the nervous system. [/ Color-box]
Physical activity, injuries, infectious diseases can cause necrotic changes in the intervertebral disc, its affected area enters the spinal canal and provokes the development of the inflammatory process, accumulation of fluid and pus.
In medicine, it is customary to distinguish the following varieties of hernias depending on the location of the pulpous nucleus:
- Cervical spine: sequestered hernia of the L6-L7 disc or L3-L4 disc is characterized by pinching of the nerves, release of the contents of the vertebrae, and impaired blood flow.
- Lumbar: sequestered disc herniation L4-L5 is the most common in medical practice, it is characterized by kyphosis, which makes it difficult to keep the back straight, impaired motor and sensory sensitivity.
- Lumbosacral: sequestered hernia L5-S1 causes the development of dangerous complications, including a violation of the genitourinary system, which manifests itself in spontaneous uncontrolled urination.
In most cases, a hernia develops in those vertebrae that are most susceptible to power loads. Most often, in medicine, a pathology of the lumbar region is diagnosed.
Hernia sequestration has four degrees of difficulty:
- The first degree is characterized by disc degeneration as a result of age-related changes or exposure to negative factors.
- The second degree is caused by the development of prolapse, in which the disc protrudes into the canal of the spine.
- The third degree in which extrusion occurs when the core extends beyond the cartilage, but is still associated with it.
- The fourth stage is characterized by the appearance of sequestration, in which the nucleus enters the canal of the spine.
Causes of hernia formation in the spine
Sequestration of a hernia of the intervertebral disc occurs most often due to osteochondrosis, congenital abnormalities, obesity, strong power loads, improper nutrition of disk cells.
Malnutrition of the cells leads to the appearance of a hernia. In the cartilage, which is located in the disk, there are no capillaries, so it feeds on other vessels that surround it. This process starts when a person makes movements. In the absence of motor activity, oxygen does not enter the disk, as a result of which its strength decreases, and cartilage tissue ruptures. Also, this pathology is provoked by addictions, metabolic disorders, lack of calcium and phosphorus in the body.
Spinal injury can provoke the appearance of a hernia, strong power loads, being in the same position for a long time, hypothermia, stress, congenital or acquired pathology of the spine.
During the diagnosis, it is important to find out the cause of the disease to prevent relapse after treatment.
Deterioration of a person’s condition with subsequent development of a hernia of the cervical and thoracic vertebrae can cause heavy lifting, improper posture, stress and hypothermia.
Symptoms and signs of a hernia of the spine
The development of sequestering hernia is more complicated than with a conventional intervertebral hernia. It begins acutely and proceeds with constant pain. Very rarely, signs of the disease appear slightly, without causing inconvenience to the person.
Pain syndrome appears on the pathological site, gradually it spreads lower, reaches the thigh surface, provoking limitation of limb mobility. The limb eventually becomes weak, numb, loses reflexes. Over time, paralysis may develop.
Depending on the location of the hernia, the following symptoms may occur:
- Cervical region: VVD, changes in blood pressure, pain in the head, extending to the arm, shoulder and shoulder blade, numbness of the extremities, impaired vision and hearing, emotional sphere. In a severe case, pathology can lead to complete paralysis and respiratory arrest.
- Thoracic: chest pain, intercostal neuralgia, inability to breathe air to the full breast. This pathology is very rare.
- Lumbosacral: pain in the lower back, extending to the leg, thigh, sacrum, foot, perineum, as well as decreased muscle tone, impaired activity of the peritoneum and pelvis.
With a long course of the disease, the intervertebral disc becomes thinner, it dries up, and the hernia is necrotic and falls off under the influence of any load. When the sequestration settles in the spinal canal, when it does not affect the nerves and brain, moderate pains occur that do not cause much discomfort to a person.
In case of trauma, complete destruction of the disc occurs, which can lead to pain shock, paralysis, and respiratory arrest.
Sequestered intervertebral hernia is diagnosed using standard diagnostic techniques. First, the doctor conducts a conversation and an initial examination, finds out the possible cause of the development of pathology, as well as the neurological status of the patient. Then he gives direction to the following examinations:
- Laboratory tests of blood and urine;
- Radiography allows you to see changes in the bones and tissues of the spine;
- MRI or PET of the spine makes it possible to see the location of the hernia, to />
As additional research methods, ultrasound, CT, scintigraphy and others are used.
Treatment of pathology
Sequestered spinal hernia treatment is difficult, because the hernia is located in the spinal canal, surrounded by bone walls, so it’s hard to get to it. Also in the pathological area there is inflammation and degeneration of bones, cartilage and muscles. It is conservative treatment that most often does not produce results. But doctors always consider surgical intervention in extreme cases, using first the classical methods of therapy.
First, the patient is prescribed painkillers and anti-inflammatory drugs, as well as local blockades. These medications make it possible to eliminate pain, muscle spasm, swelling, thereby reducing the pressure of the hernia on the nerves and spinal cord. Also, the patient is prescribed relaxants, vitamins, antidepressants, drugs that improve blood flow. Doctors recommend sleeping on an orthopedic mattress during treatment.
During treatment, the doctor may prescribe diuretics to relieve tissue swelling, nootropic and vascular agents to normalize blood circulation, chondoprotectors, as well as anticonvulsants for the relief of neuropathic pain
Conservative treatment is carried out for a long period of time. This can sometimes take more than two years.
Most often, the treatment of sequestered hernia of the spine does not do without surgery. It is prescribed in the case when the patient is in critical condition due to the development of paralysis and disruption of the internal organs, a pain syndrome that cannot be eliminated in the usual way.
Surgery is also performed in case of sharp muscle atrophy, inflammation of the spinal cord and nerves. If conservative treatment has not yielded any results within six months, and the patient’s condition has worsened, the doctor also prescribes surgery.
In medicine, there have been cases when a sequester hernia of the spine itself resolved after separation from the intervertebral disc.
In frequent cases, endoscopy is used as a surgical method, which makes it possible to avoid complications and relapse, as well as accelerate the patient’s rehabilitation process.
Also in surgical medicine to remove a hernia is used:
- Diskectomy is an operation in which a partial or complete removal of a disk occurs. Most often, the intervertebral disc is removed completely to prevent the development of a relapse of the pathology.
- Percutaneous nucleoplasty is an operation in which a puncture needle is inserted into the disc cavity, cold plasma is delivered through it, destroying the hernia.
- Minimally invasive surgery involves making an incision on the back and removing a hernia through it.
After surgery, the patient undergoes a rehabilitation course. Over time, the doctor prescribes therapeutic exercises and physiotherapy.
Prognosis and prevention
The prognosis of the disease is mixed. At the initial stages of the development of pathology, doctors prescribe conservative treatment, which can be quite long, but does not always give positive results. Surgery can provoke the development of severe complications.
Prevention of the disease should be aimed at maintaining a healthy lifestyle. It is recommended to periodically undergo a medical examination to prevent the development of pathology.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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