What is a sequestered herniation of the spine? The symptoms and treatment

Sequestered herniation of the spine develops as a result of violation of the integrity of the shell of the intervertebral disc (fibrous ring). As a result of its content falls into the spinal canal, where it creates a compression on the nerves and spinal cord. When sequestration is the separation of the fragment of the nucleus pulposus. This can lead to the violation of the integrity of the Dura of the spinal cord. The result aktiviziruyutsya irreversible processes.

Секвестрированная грыжа позвоночника развивается вследствие нарушения целостности оболочки межпозвонкового диска (фиброзного кольца)

Reasons

The factors contributing to the development of hernial protrusion, are divided into two groups: main and indirect. The first group includes:

  • degenerative and destructive processes, they can have natural causes, for example, the gradual destruction of the tissue structure during aging, isolated and pathological reasons — they are the result of diseases (osteochondrosis, osteoarthritis, etc.), posture (lordosis, kyphosis, scoliosis, etc.);
  • cracked vertebrae, discs, and such deformations often occur in trauma.

Among the indirect signs say:

  • the weakening of the muscles of the back, abdomen, neck, leading to increased pressure on the spine;
  • excessive stress on the vertebrae — employment, professional sport;
  • deficiency of nutrients;
  • the decrease in the daily volume of fluid;
  • pregnancy;
  • overweight;
  • long stay in one position;
  • awkward body position;
  • sharp movement.

Symptoms

The clinical picture varies depending on the location of the hernial diverticulum. Common symptoms:

  • back pain, which may be the cause of the infringement of the nerve endings, spinal cord, muscle tension, spasm;
  • numbness;
  • tingling in the extremities;
  • the weakening of muscle tissue;
  • backache when there is a sudden change of position;
  • violation of urination, defecation;
  • the limitation of mobility.

If sequestration hernia occurred in the cervical or thoracic spine, pain is felt in the shoulder girdle, neck, headache. Often the protrusion is between the vertebrae C6-C7. With the defeat of intervertebral disk in the lumbar region, lumbosacral syndrome cauda equina. It is a complex of symptoms, including reduced motor activity, loss of sensitivity. There is a strong pain in the lower back (dorsalgia). Most often a hernia develops in the region of the vertebrae L5 S1.

Diagnosis

Patients with a tendency to sequestration are directed to complete the survey. The main diagnostic measure — an MRI or CT scan. The neurologist may recommend x-rays. This method is less informative, but allows you to rule out other diseases that have similar symptoms.

how is MRI

how is CT

Classification

In the direction of protrusion of the hernia is divided into types:

  • dorsal — sequestration occurs in the posterior part of the disc;
  • medial Parmigiana (paramedicine) — in this case, the formation is formed in the midline of the intervertebral disc sequestration occurs in the spinal canal;
  • lateral — a pathological process develops from the left or right side of the disk;
  • ventral — sequestration happens in front of the pulpous ring.

Медиально-парамедианная (парамедиальная). В данном случае образование формируется по срединной линии межпозвонкового диска, секвестрация происходит в области спинномозгового канала

Localization

Depending on where the hernia is located, there are several types:

  • herniation of the cervical;
  • pathology of the thoracic;
  • hernial protrusion of the lumbar.

Treatment

When sequestration effective drug, conservative therapy. This diagnosis is an indication for surgery. Radical treatment of hernia is carried out because of the separation of the fragment. For comparison, other varieties of the bulging operation is assigned rarely. This is due to the high probability of repeated development of pathological education.

When sequestered, lost fragments are not absorbed. This means that the hernia continues to exert pressure on the surrounding tissue, vital organs (spinal cord). In this case, to eliminate the strong pain can only surgery. Additionally, it is recommended conservative treatment, it can reduce the intensity of pain, helps to restore the damaged disk. The separated fragments will not be able to return to the place, however, through comprehensive treatment to eliminate the effects of sequestration hernia.

Drug

Can be assigned the following drugs:

  1. 1Nonsteroidal anti-inflammatory drugs. They help to stop the signs of inflammation (fever, pain, swelling). When sequestered hernia anti-inflammatory drugs contribute to the temporary elimination of symptoms. If not removed, the separated phase, soon the signs will reappear.
  2. 2Steroid drugs are more aggressive. They provoke the emergence of a large number of side effects, have many limitations. Steroid remedies recommended with increasing pain when the drugs of the NSAIDs group did not help to alleviate the condition of the patient.
  3. 3Blockade. Can be assigned to injection of potent tools. If sequestered hernia area was in the spinal canal and creates compression on the Dura of the spinal cord, nerve endings, no drugs of this group can not do.
  4. 4Narcotic analgesics have the same readings as the blockade. Their prescribed for unbearable pain.
  5. 5muscle Relaxants. These tools can be used to reduce muscular tension, eliminate diseases. In result, pain is reduced.

With the help of medication greatly facilitated the patient’s life. The drug is taken in the preoperative period. This is due to the need to address acute symptoms.

Conservative therapy

Recommended methods of physiotherapy:

  • electrophoresis;
  • UHF;
  • pulsed current;
  • massage.

Electrophoresis

UHF

Additionally, use of means of alternative medicine — acupuncture. The goal of conservative treatment and relief of the patient’s condition, strengthening muscles of abdomen and back, which will reduce the load on the spine. In addition, with physiotherapy, acupuncture is the impact on biologically active points. The result is the restoration of blood microcirculation in the affected area, normalizes metabolism, allowing you to stop the disc degeneration.

massage

acupuncture

Folk remedies

When sequestered hernia this method is the least efficient, so it can not be used as a standalone tool. However, it is acceptable to use to alleviate the condition along with medications and physical therapy. Recipes that are used for this pathology:

  1. 1aloe Juice, honey, alcohol. Components take in the ratio 1:2:3. They must mix, then leave for 1 day in a warm room. Then medication can be placed in the refrigerator. Means to impregnate the gauze, then do a compress, cover it with plastic wrap, a woolen scarf. The duration is 1 hour.
  2. 2Bran. Prepare a broth. Will need 1 tbsp. l. raw, 2 Cup of hot water. Capacity with the mixture to boil for 30 minutes. The cure then cool, strain and drink three times a day. A decoction of the bran helps to reduce the intensity of inflammation of the nerve endings and normalizes metabolism. It contains vitamin b, which is important for restoration of bone and cartilage. Immediately after taking the medicine there is a growing pain. Unpleasant symptoms are a result of the beginning of the recovery process of the nerve endings. Soon the pain goes away.

Отвар отрубей помогает уменьшить интенсивность воспаления нервных окончаний, нормализует обмен веществ. Он содержит витамин В, который важен для восстановления костных и хрящевых тканей

Physiotherapy

The development of sequestration of the disc is often the result of the weakening of the muscles. To strengthen them, it is recommended to perform gymnastics. In the set of exercises included only those movements that are performed gently, slowly. Sharp turns, slopes should be deleted, because this is one of the reasons for the development of the process of sequestration. Gymnastics should definitely wearing a corset. This will avoid additional strain muscles and to prevent further degradation of the nucleus pulposus.

Operation

Sequestered herniated disc is removed using minimally invasive procedures, invasive surgeries. In the first case, to access the deformed disk on the skin small incision is made, use a retractor. Tissue while damaged is minimal and recovery takes less time. The likelihood of bleeding low. For rehabilitation pain level mild, discomfort are faster than with invasive surgery. Common techniques: endoscopy, microdiscectomy, plastic intervertebral disc.

minimally invasive removal

microdiscectomy

Testimony

Surgery may be recommended in some cases:

  • the size of the hernia protrusion, significant (more than 9 mm);
  • when sequestration part of the disc was in the spinal canal and provoke unbearable pain, and numerous complications, including paralysis;
  • the limitation, the patient cannot stand on his feet;
  • medicines do not help alleviate the condition, conservative therapy does not work for more than 6 months;
  • multiple improvement with subsequent deterioration.

Rehabilitation

Unlike other varieties of protrusions gruzevich sequestered education is the most serious complication with lesions of the spine. For this reason, the recovery period will take longer. After the operation it is necessary to exclude physical activity into 1-2 months, depending on the size of the separated fragment, and the condition of the tissues of the disc. You can sit down not earlier than 4 weeks after excision of a hernia.

При выполнении физических упражнений рекомендуется носить корсет. Однако нельзя надевать его на весь день. Рекомендуемая длительность: от 3 до 6 часов, что зависит от вида корсета и состояния позвоночника

For the first month to lift weights more than 1.5 kg is prohibited. After the second month you can gradually increase the load. In subsequent months, add 0.5 kg to each hand. When you exercise, it is recommended to wear a corset. However, you cannot wear it all day. Recommended duration: 3 to 6 hours, depending on the shape of a corset and the condition of the spine.

Complications

When sequestration hernial diverticulum is a risk of paralysis of the lower limbs, which might be the case when the deformed disc in the lumbosacral region. If the degradation of the nucleus pulposus in the neck, numbness in the hands. It significantly limits mobility. May develop autoimmune inflammatory process. Sekvestirovanii fraught with caudal migration. The most severe complications: spinal shock, respiratory arrest, paralysis of the organs of the pelvis.

При секвестрации грыжевого выпячивания есть опасность развития паралича нижних конечностей

Prevention

To avoid the sequestered hernial diverticulum is possible, eliminating the source of pressure. With this purpose, limit physical activity, at home and during exercises it is impossible to do sharp movements. If the patient leads a sedentary life, it is necessary to frequently change the body position. To prevent hernia the doctor may prescribe chondro — drugs that protect the cartilage layer of the disk. Thanks to them stops the process of degradation of tissue. Additionally normalize the diet, since it is necessary to fill the shortage of nutrients.