With a partial uniform outflow of tissues of the intervertebral disc beyond the space surrounding the vertebrae, the patient is diagnosed with circular protrusion. Pathology is characterized by a latent (latent) course, so it is often detected by chance at the next medical examination or the detection of another disease. But over time, the first clinical manifestations of circular protrusion of the intervertebral disc arise – a disorder of sensitivity and pain in the affected segment.
Description of pathology
Circular protrusion of the disk occurs without violating the integrity of the outer part of the fibrous ring. There is also no displacement of the pulpous nucleus. This protrusion differs from the intervertebral hernia, but, nevertheless, is considered the initial stage of its formation. Most often, discs of the lumbosacral spine are involved in the pathology process, less often cervical and thoracic.
The risk group includes women and men from 30 to 50 years old. Circular and uniform protrusion of the disc occurs as a result of loss of elasticity by cartilaginous tissues. Low motor activity, excessive physical activity, congenital or acquired abnormalities of the spinal column predispose to this. Very often, circular protrusion of the disc is observed in patients with osteochondrosis.
Overweight, bad habits, endocrine and metabolic disorders – diabetes mellitus, adrenal gland pathologies, hypothyroidism become factors that provoke changes in the structure of cartilaginous tissues.
The main stages of the development of the disease
Circular protrusion of the intervertebral discs are classified depending on the stage of the course of pathological processes. This allows you to immediately determine the tactics of therapy and begin treatment immediately after the diagnostic measures.
The first stage
The cartilaginous tissues of the intervertebral discs receive nutrients diffusely, as the vascular bed in them decreases over time. Under the influence of external or internal negative factors, the trophy is upset. There is a lack of nutrients and loss of ability of the discs to retain the moisture necessary for regeneration. Their surface “dries”, is covered with the smallest radial cracks. At this stage of circular protrusion, any symptoms are absent or mild.
The second stage
The intervertebral discs become thinner, denser, and cease to perform depreciation functions. Loss of stability leads to their slight protrusion (up to 3 mm) beyond the borders of the vertebrae. At this stage, the first clinical manifestations of circular protrusion occur – pain in the area of the deformed discs and limitation of mobility. When squeezing the sensitive nerve endings located between the vertebrae, pain is felt in organs that have innervation common with the vertebral structures.
The third stage
The vertebral segment is increasingly losing stability, so the size of the circular protrusion increases (from 4 to 6-7 mm). The pulpous nucleus is displaced to the outer edges of the disk, the probability of rupture of the fibrous ring is significantly increased. The severity of pain increases due to compression of the spinal roots, soft tissues, small blood vessels.
Types of disease
The direction of prolapse of the intervertebral disc has an effect on the course of the pathology and the clinical picture. Protrusions are divided into several types depending on the direction of the circular protrusion of the cartilaginous structures.
In more than 50% of patients with protrusions, a uniform, annular protrusion of the intervertebral disc is diagnosed. Most often, the pathology is localized in the lumbosacral spine. It is characterized by uniform bulging of the disc in all areas of the fibrous ring. This becomes the reason for the infringement of the spinal roots, narrowing of the intervertebral canal, the appearance of symptoms of neurogenic origin.
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The protrusion is located on the side of the spinal column and almost always presses on one of the nearby spinal roots. Circular-foraminal protrusion is left-sided, anteroposterior and anterolateral. Foraminal bulging in the direction of the intervertebral foramen is also distinguished. The pathological condition provokes episodic or constant pain localized in the area of damaged intervertebral discs.
With circular dorsal protrusion, the protrusion of the disc occurs to the center of the spinal canal. When bulging a large disk, spinal tissue is involved in the pathological process. Protrusion in the lumbar spine is localized, clinically manifested by severe pain, aggravated by movement. They irradiate not only in the hips, legs, groin and buttocks. Reflected pains spread to internal organs, often reducing their functional activity.
Signs and symptoms
The nature and severity of the clinical picture is influenced by the shape, appearance, location and size of the protrusion. For uniformly circular protrusion, an asymptomatic course is characteristic. The first painful sensations arise only at the stage of compression of the sensitive nerve endings. The remaining protrusion forms manifest much earlier, since the displaced disc immediately irritates the spinal roots. The pain is first localized in a certain area of the spine, and then radiates to the periphery. Sensitivity decreases in areas of the body that share a common innervation with the affected root.
In the lumbar spine
The lumbosacral spine is most often exposed to protrusion of the disc due to increased loads, a wide range of movements. Painful sensations occur in the lower back, spreading to the buttocks, ankles, and then the feet. In addition to pain, in the clinical picture there are tingling, burning, a feeling of “creeping goosebumps.” Mobility in the lumbar is limited by muscle spasm that appears to reduce the intensity of pain.
In the thoracic region
Circular protrusion of the thoracic vertebrae is rarely diagnosed, since they do not experience serious stress and are reliably linked to the ribs. But the protrusion of this localization becomes the cause of clinical manifestations unlike the symptoms of pathologies of the musculoskeletal system. These include pain in the heart, kidneys, gastrointestinal tract. For protrusion in the thoracic region, unpleasant sensations along the intercostal space are characteristic.
In the cervical region
Circular protrusion, localized in the neck, is accompanied by acute pain. They are burning, piercing, resembling a backache. The severity of pain increases when you try to turn your head to the side or tilt. First, they appear on the site of protrusion of the intervertebral disc, and then radiate to the shoulders, forearms, hands. In the hands and fingers “creeping goose bumps”, slight burning, numbness are felt. The reason for neck stiffness is not only an increased tone of skeletal muscles. A person intentionally restricts movement so as not to experience severe pain.
The diagnosis is made on the basis of patient complaints, the presence of a history of degenerative-dystrophic pathologies. On palpation, pain is felt, excessive tension located near the vertebrae of the muscles. To confirm the diagnosis, a number of instrumental studies are performed:
- radiography to assess the distance between the vertebrae, detect signs of osteochondrosis, congenital or acquired abnormalities;
- MRI to determine the localization of the protrusion, its size, degree of infringement of connective tissue structures.
One of the most informative methods for diagnosing circular protrusion is electroneuromyography. Using this study, functional changes and innervation disorders are detected.
To eliminate the pain, non-steroidal anti-inflammatory drugs are used, medical blockades are carried out. Patients are prescribed a long course of chondroprotectors, partially restoring the affected discs. Ointments help to get rid of weak discomfort, and acute pain can be stopped by parenteral administration of painkiller solutions.
The therapeutic schemes include 5-10 sessions of physiotherapy (magnetotherapy, laser therapy, UHF therapy), massage, balneotherapy, exercise therapy.
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