Herniated disc (spinal disc herniation) is a medical condition that is most common in middle-aged people. The disease manifests itself as pain or movement syndromes. This is one of the most common causes of back pain.
The spine is made of small fragments (vertebrae) with intervertebral discs between them. They provide spine mobility. Nucleus pulposus is one of the disc structures. It is surrounded by a fibrous ring. If this ring ruptures, the nucleus pulposus protrudes to the spinal canal. That is exactly how herniated disc develops.
According to etiology, there are traumatic and non-traumatic hernias. Spinal injuries cause protrusions in approximately 10% of cases. The fractures of the cervical spine end up with hernias in 50% of cases.
Non-traumatic herniated disc can develop due to various diseases, including:
Risk factors for spinal disc herniation are:
The clinical manifestations depend on the herniated disc localization. Most often it is the lumbar spine (over 80% of cases). Thoracic disc herniation is very rare and account for only 1% of clinical cases.
Possible localization of lumbar herniated disc:
The main symptom of the herniated disc is pain, which is characterized in the following way:
Located in the lumbosacral spine, the pathological process has the following symptoms:
The vast majority of patients suffer from the muscle spasm in the area of intervertebral hernia formation. Numbness of the skin in the area of innervation of the pinched nerve, paresis, paralysis of the muscles, and pelvic organ disorders can develop. Over time, these disorders worsen due to nerve atrophy.
Symptoms of the cervical herniated disc:
A thoracic herniated disc can be very similar to heart diseases or diseases of other organs of the thoracic cavity.
MRI (Magnetic Resonance Imaging) is the best diagnostic method for herniated disc. CT (Computed Tomography) and myelography can be used for diagnosis
With the exception of surgical methods, all treatments are aimed to eliminate symptoms of the disease. These include:
Most patients reach compensation of the disease by conservative treatments. Other patients need surgery, which is performed in case of:
Following types of surgeries can be done:
Microdiscectomy. A fragment of the intervertebral disc is removed together with the herniation. Currentl,y microdiscectomy is considered as a “gold standard” in the field of surgical treatment of the herniated disc.
Endoscopic nucleotomy. If hernia is not big, it is an alternative of microdiscectomy. This is a high-tech endoscopic procedure, which does not even require hospitalization. Its efficiency is almost the same as that of microdiscectomy, but this technique causes more relapses. The advantage is a low risk of complications compared with open surgery.
Discectomy with intervertebral disc prosthesis. The intervertebral disc is removed and replaced with an artificial one. This surgery excludes any risk of recurrence. The hernia can develop only in other area of the spine in the future. After the prosthesis placement the patient’s mobility is preserved.
The conservative treatments help to eliminate or significantly relieve symptoms of the herniated disc in 80-85%.
According to various studies, 80-95% of patients have a considerable and steady clinical improvement after microdiscectomy. The risk of relapse is from 2 to 18%. It depends on the size of the fibrous ring defect.
Endoscopic nucleotomy leads to the considerable improvement in 75-85% of cases. The necessity for the repeated surgery is nearly 2 times higher than after microdiscectomy.
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