Disc protrusion

What is the protrusion of the disc? It is such a violation of the spinal column, in which the spinal disc appears to protrude into the canal of the spine without tearing the fibrous ring. Many specialists characterize this condition as pregraining.

Protrusion is not an independent pathology. This is the result of some other pathological process in the spine, mainly in the lumbar or cervical region.

[1], [2], [3], [4], [5],

Reasons for protrusion of discs

What can serve as a factor in the development of protrusions? There are several options:

• age development of osteochondrosis is the main reason;
• traumatic lesions of the spinal column;
• various forms of curvature of the spinal column;
• hereditary factor;
• the presence of excess weight;
• mechanical and physical overload of the spine.

Protrusion occurs due to a change in the structure of the fibrous ring of a particular disc, a violation of the structure of fibrous tissue. The integrity of the outer shell of the ring is not disturbed (if the outer shell of the ring is damaged, in this case it is already possible to talk about the intervertebral hernia ). Apparent protrusion can reach 1-5 mm, and even more, and the protrusion dimensions up to 3 mm are considered to be harmless and may not exhibit any symptomatology.

Why do we feel pain with protrusions? The resulting protrusion of the disc protrudes into the canal of the spinal cord, squeezing, irritating and infringing the nerve fibers and vessels passing there. In addition, the function of the vertebra itself may be impaired.

Symptoms of protrusion of discs

Often protrusion proceeds without obvious signs and symptoms: protrusion of the ring up to 3 mm may not cause sufficient irritation of the nerve endings. Also, the presence of signs of pathology depends on the localization of the disorder and the extent of the disc protrusion into the vertebral canal.

The localization of the protrusion in the cervical vertebrae is considered the most dangerous for the patient's health.

Soreness can manifest itself in the neck, occiput, intercostal area, and with irradiation in the upper and lower limbs (depends on which nerve is squeezed). There may be loss of sensitivity of certain parts of the limbs (numbness), weakness in the muscles, pulling the pain along the muscles, disturbing the sciatic nerve. Often there is also a stiffness of the motor amplitude of the extremities and neck, burning pains in the affected area.

How much these or other symptoms will be expressed may depend on the primary disease that caused the protrusion to develop. The degree of compression of nerve endings also matters.

Manifestations of the disease often have an individual character, sometimes pain can occur only with sudden movements, inclinations, prolonged standing or sitting.

Types of protrusion discs

Consider some of the existing types of protrusions, which differ depending on the location and nature of protrusions.

Dorsal protrusion of discs

The most dangerous variant of pathology. More common in the lumbar spine. The difference of this protrusion from its other varieties is that with such a violation the bulge is directed towards the canal of the spinal cord. This means that, under certain conditions, the compression of the spinal cord is possible even with small bulges. This is fraught with the development of a significant pain syndrome, especially after excessive motor activity or uncomfortable and incorrect position of the back. During the recurrence of the pathology, pain can cause even a deep breath or a cough. Symptoms of dorsal protrusion are still not global: pathology can be treated if it is done in a timely manner.

[6],

Circular disc protrusion

This variant is the most common and represents a uniform circular protuberance of the disc with concomitant degenerative and dystrophic processes in the vertebral column. The protrusion may be in the limit of 3-12 mm, and the difference in the projection of the disc may not be more than 1 mm. Such a pathology is characterized by a chronic course and, in the absence of appropriate therapy, usually leads to an increase in neurological symptoms and to the onset of disability.

[7], [8], [9]

Median disc protrusion

Synonyms - median, medial, central, dorsomedian, posteromedian). It is a protuberance of the fibrous ring, directed into the central part of the canal of the spinal cord. Medial protrusions of the discs are infrequent, their prevalence is not more than 6% of the total number of protrusions. Median disk protrusion is rarely diagnosed in the early stages, the disease can occur without any obvious signs and symptoms that would cause the patient to see a doctor. Dangerous such pathologies are relatively hidden symptoms, and in the absence of proper treatment can increase, provoking more serious complications, sequestration. Median protrusions put pressure on the spinal cord, which in the future can cause the formation of paresis, abnormal functioning of the abdominal cavity.

Paramedian disc protrusion

This variant of protrusion is observed when the protrusion is located, both in the center of the midline and in its lateral part. The protrusion can be directed to the spinal anus, the canal of the spinal column. The paramedian protrusion may be right- or left-sided. This differentiation depends on which side of the spine the nerve fibers are squeezed. This is determined by the symptoms of the disease: the patient notes soreness, paresthesia, muscle weakness, deterioration of visual and auditory functions to a greater extent from the right or left side.

Foraminal disc protrusion

A rare form of protrusions, which is characterized by protrusion towards the outer or inner edge of the spinal canal. By this principle, the foramen protrusions are divided into extraphoraminal and intraphoraminal. There is also a defeat throughout the canal, as a complicated course of these forms of protrusions. This option is called the actual foraminal protrusion. This form of the disease is most susceptible to the lumbosacral spine.

[10], [11], [12], [13], [14]

Rear disc protrusion

This name is usually applied to the signs of a topical protrusion posteriorly in the direction from the abdomen to the back. Especially often, this localization leads to a close contact of the fibrous ring with the spinal cord, which is fraught with pain, loss of sensitivity of some areas, a violation of motility, the functionality of the abdominal cavity organs.

Zadnobokovaya (posterolateral) protrusion of the disk

Very common type of protrusion. The name suggests that the formation of the protrusion passes posteriorly and sideways relative to the axis of the spine. This location of the pathology increases the possibility of influencing the nerve endings from both sides, as well as the remaining structural segments of the spinal cord. Like the lateral type, the posterolateral protrusion is prone to asymptomatic flow until a mechanical effect on the nerve fibers is detected.

Degenerative disc protrusion

This name is applicable to all types of protrusions, since the very appearance of the pathology is directly related to the development of the degenerative process in the structure of the fibrous ring surrounding the disc. As a result of this process, the ring becomes thinner, becomes inelastic, microcracks are formed in it, to which a pulpous gelatinous nucleus is displaced. A convex element is formed, which we call protrusion. The degenerative process can take place in several stages:

• damage (swelling of the pulpous core);
• protrusion (protrusion of the nucleus into the canal of the spine without rupturing the fibrous ring);
• hernia (violation of the integrity of the fibrous disk disc).

Degeneration of tissues can be a consequence of osteochondrosis, dysplasia, posture disorders, traumatic spine lesions.

[15], [16]

Polysegmentary protrusion of discs

Pathology, in which degeneration and dystrophic changes are observed simultaneously in several segments of the spinal column. As a rule, it is a consequence of polysegmental osteochondrosis, it can be accompanied by signs of vertebrobasilar insufficiency (headache, dizziness). It is often determined in the cervical spine, less often in the cervicothoracic and median thoracic zone.

Diffusive protrusion of intervertebral discs

For this type of pathology is characterized by uneven and repeated prominence of the disc of any of the spine. Diffuse protrusion indicates that the disk is damaged by 25-50% - this is quite a strong protrusion. The forecast for such damage depends on its size and direction of formation.

[17], [18], [19]

Protrusion of cervical discs

When there is a pathology in the cervical discs there is a reaction of squeezing the spinal structures. This provokes the appearance of cervical pain, weakness of the muscles of the shoulder girdle, upper limbs, numbness and tenderness along the arm.

The neck department has seven vertebrae: discs are located between them. Wear of these discs contributes to the appearance of protrusions.

The protrusion of the C3-C4 disk

Such a term indicates that the damage occurred in the cervical region of the spine, in the central part of the neck part between the third and fourth cervical vertebra. Pathology can be confirmed only with magnetic resonance examination of the cervical region of the spine. Most often, this pathology occurs due to traumatic effects on this area.

The protrusion of the C5-C6 disk

One of the most common protrusions in the cervical region, localized between the fifth and sixth cervical vertebra. It can occur against a background of a hernia, cervical kyphosis, lesions of other intervertebral discs. Symptomatology of this pathology - headaches, numbness in the fingers, pain along the upper limb, muscle weakness of the wrist and biceps, soreness in the neck. Infringement of the nerve end c6 may manifest as a violation of the sensitivity of the thumb and index finger of the hand. The causes may be trauma, or osteochondrosis of the cervical region.

The protrusion of the disk C7-C6

The disc protrusion is in the region between the seventh and sixth vertebrae. Is manifested cervical and headaches, stiffness of the head movements, a violation of the sensitivity of the fingers of the hand. Pathology is susceptible to conservative treatment. In the absence of necessary therapeutic measures can lead to the development of a hernia, vertebrogenic radiculopathy.

Protrusion of thorax discs

The protrusions of the discs of the thoracic region of the spine are rare. This is explained by the fact that the motor activity of the thoracic vertebrae is an order of magnitude lower than the lumbar or cervical localization, so the development of discs is less frequent. However, despite this, a certain mobility is still present, and in the dystrophic process protrusions can form in the discs.

The clinical picture of the disease is directly dependent on the dislocation of the pathology and the degree of compression of the nearest nerve endings. Usually, the following symptoms are present:

• soreness of the middle part of the spine;
• intercostal neuralgia;
• limitation of back mobility;
• weakening of the muscles of the abdominal wall;
• feeling of pressure in the epigastric zone;
• cardialgia;
• disturbances of respiratory functions;
• feeling of numbness in the front part of the trunk.

Manifestations of pathology are individual, therefore for a precise diagnosis it is necessary to undergo a number of additional examinations.

Lumbar disc protrusions

Perhaps the most vulnerable area of the spine is the lumbar region. Here the center of gravity of the body is located, therefore, this part accounts for the greater part of the total physical load. As a symptom of the disease can be identified the appearance of radiculitis, lumbar pain, weakness and numbness in the lower extremities. In severe cases, a disruption of the functionality of the urinary system is possible.

• L2-L3 disc protrusion is a rare type of protrusion, occurring in 1% of cases. It is accompanied by shooting pains in the lower back, loss of sensitivity of the feet or toes. Significant protrusions in size, which provoke disorders of urination, are subject to surgical therapy.
• Disc protrusion L5. There may be damage to the disc of the fifth lumbar vertebra in such combinations:
• L5-S1 disc protrusion is a defect of the fibrous ring between the first sacral and fifth lumbar vertebrae. A very common area of the lesion, it can be observed in half the cases of protrusions of the lumbar region. Often combined with antesponilolistezom, retrospondilolistezom, spondyloarthrosis, uncoarthrosis, intervertebral hernia. It can be caused mainly by osteochondrosis changes. As a consequence of this defeat, it is possible to develop infringement of lumbar and sacral nerve endings, or a neural bundle in the vertebral canal.
• L4-L5 disc protrusion is a defect between the 4th and 5th vertebrae of the waist. Can occur in 40% of lesions of the waist. In most cases, it is accompanied by a hernia or protrusion of L5-S1. It is provoked by traumatic injuries, or by constant significant physical exertion. Usually soreness comes abruptly, against the backdrop of a "piercing" - a kind of crunchy sound that followed the lifting of gravity or tilt.
• L3-L4 disc protrusion is a defect between the 3rd and 4th vertebra of the waist. It is observed not so often, only in 5% of situations. Rarely manifested separately, more often in conjunction with the lesion of neighboring lumbar and sacral discs or vertebrae.

Effects of protrusion of discs

To explain what the consequences may be with protrusion of discs, it is necessary to trace their appearance in stages:

• the emergence of protrusion begins with a change in the structure of the disc. Its fibers are weakened, degenerative destruction of tissue occurs, the ring around the disc is covered with microcracks. During this period, the patient may feel some soreness and muscle discomfort;
• at the subsequent stage, the protuberance of the ring protrusion occurs. Soreness becomes more intense, paresthesia can be observed;
• the final stage is a consequence. In the absence of proper treatment of microcracks, the rings form into a rupture - in fact, this is already the stage of the intervertebral hernia. Soreness becomes acute, movements in the spine are disturbed, loss of sensitivity of limb sites arises.

In addition to a hernia, the risk in the disease may be concealed in the possible squeezing of nerve fibers. This leads to a violation of the innervation of the tissues and, as a consequence, to partial or complete paralysis.

Agree, the consequences of this disease are such that you should make every effort to treat protrusions. Address in time to the doctor, without waiting for the appearance of dangerous symptoms.

[20], [21]

Diagnosis of protrusion of discs

The qualified diagnosis of this pathology is based, first of all, on the presence of a characteristic clinical symptomatology of protrusion. Probably, consultation of the neuropathologist and vertebrologist is required.

Among the instrumental methods of investigation, it is necessary to identify the main diagnostic technique - magnetic resonance imaging (MRI) of the damaged vertebral column. This method provides almost exhaustive information about the presence, size, degree of development of protrusion and hernias, the state of the spine as a whole, the formation of inflammatory foci.

Research using a computer tomograph is sometimes used, however, this is not a very informative method, having a large error in diagnosis.

Also, possible, but not very informative methods include x-ray examination.

A number of additional studies can be assigned to clarify the presence of an inflammatory process in the tissues: this is the application of positive myelography, pneumomyelography, veno-vertebralgia, vertebral arteriography, discography, epidurography, pneumoepidurography. The doctor makes a decision about such researches individually.

[22], [23], [24]

Treatment of disc protrusion

Treatment of pathology is complex, conservative, with the use of traction in stationary and outpatient settings.

Treatment of protrusion of the discs of the lumbar region and other parts of the spine should be aimed at preventing the growth of osteochondrosis manifestations of the spinal column: the correct mode of the working day, the exclusion of a significant and long-term load, and heavy physical labor.

At the heart of therapeutic measures aimed at treating protrusion of the L5-S1 disc, and other types of lesions of the lumbosacral section, is the elimination of pain and nerve fiber compression syndrome, restoration of trophism and muscle innervation.

Medication for the protrusion of intervertebral discs may include: - symptomatic therapy aimed at removing edema of the near-vertebral zone and arresting painful sensations. This can be the use of non-steroidal anti-inflammatory drugs (diclofenac, nimesil, ibuprofen, orthophene, movalis, etc.), spasmolytic agents and agents that relax muscular muscles (midocalsm, sirdalud), analgesics (analgin, butadione). Medications should influence the development of dystrophic processes in the tissues and remove the inflammatory reaction. The injections with protrusion of the discs are prescribed during the first few days of treatment: the most common solution of diclofenac sodium is 2.5% for intramuscular injections. Subsequently, they switch to the use of oral means. If the pain does not pass within three days of treatment, the doctor should be consulted immediately.

It is also important to use external preparations in the form of ointments and creams (viprosal, diclofenac-gel, diclac gel, fastum gel, espol). Such funds begin to be used on 3-4 days of treatment on the background of general drug therapy.

• rehabilitation methods, accelerating the process of regeneration and strengthening the muscular corset. This can be the use of exercise therapy for protrusion of discs (including underwater in the pool), swimming procedures, the method of traction in a therapeutic traction chair or surface, the method of stretching with immersion in warm water in an inclined or horizontal position, as well as vertical extraction afloat in special equipment in the pool. Massage with protrusion of discs can be combined with other physiotherapeutic procedures (electrophoresis, light therapy, acupuncture, acupressure). The combination of various procedures to help relax the spasms of muscle, stop soreness, strengthen the muscles of the back.

Sometimes manual correction of "protrusion" is practiced. However, such manipulations should be handled only by a qualified specialist who possesses certain skills and techniques.

There are situations when the conservative method of treatment does not bring the expected result. In such cases, the use of minimally invasive surgical interventions by puncture is possible. Among such procedures are the following:

• method of bone blockade. Assumes the introduction of the drug directly into the spine at the site of the pathology. The patient feels the effect of the method almost instantly: pain ceases, puffiness disappears, muscle spasm weakens;
• method of laser vaporization of a disk. A fairly effective procedure, however, applied only in the early stages of pathology, when the nucleus still has a glandular consistency. The procedure provides for the effect of the laser on the protruding pulpous nucleus (the so-called "cauterization").
• method of hydroplastic. The most gentle procedure. Under pressure, a special fluid enters the center of the damaged disc. The liquid flushes the destroyed parts of the disk, hydrotesting the undamaged zones. The procedure for the whole of it (about 20 minutes) is controlled by X-ray. The method is recognized as one of the most effective.
• method of cold plasma nucleoplasty. It determines the introduction of a cold plasma into the damaged disc, which evaporates the parts of the nucleus, reducing the disc pressure. Thanks to this, the effect on the nerve endings is minimized and the pain recedes.

Gymnastics with protrusion of the disc

It is worth noting that exercises with protrusions of the discs are assigned and controlled by the doctor, since incorrectly performed movements can not only not cure, but also exacerbate the problem. The training should be approved and checked by a doctor.

• The first exercise. We lie on our backs, our arms are free, our legs are bent at the knees. We raise the pelvis, leaning on the feet and the shoulder girdle. We carry out with repetitions up to 10 times.
• The second exercise. We kneel, resting our knees and palms on the floor. We raise simultaneously the right arm and the left leg, and vice versa. Repeat several times.
• The third exercise. We lay on the back, legs straight. We make the movement of the trunk upward (as if we are shaking the press), lingering in the upper position for a few seconds. Repeat as far as possible.
• The fourth exercise. We lay on the back, hands and feet straight. We lift straight legs at an angle of 30-45 degrees and make cross-flies ("scissors"). Repeats up to 10 times.
• Fifth exercise. We sit on the floor, legs straight. We try to reach the toes with our hands.
• The sixth exercise. We lay on the stomach, legs and arms straight. We lift the upper part of the trunk, without tearing off the legs and stomach from the floor. We stay in the upper position for a few seconds, go down. Number of repetitions up to 10.

Before training muscles should be warmed up with usual physical exercises or a light jog. Gymnastics classes will be more effective if combined with swimming.

Treatment of disc protrusion by alternative means

As an adjunct to drug therapy, painkiller, anti-inflammatory, restorative and bactericidal action of the following medicines is used:

• flowers of elderberry black, birch leaves, willow bark in the ratio 1: 4: 5. Infusion take ½ cup to 4 times a day before meals;
• blossoms of black elderberry, nettle nettle leaves, parsley root, willow bark in equal proportions. Infusion take ½ cup to 4 times a day before meals;
• leaves of birch, leaves of nettle dioecious, grass of violet tricolor in equal doses. Infusion is taken by ½ cup to 6 times a day before meals.

Enhances the anti-inflammatory effect of vitamin tea from the leaves of black currant, cowberry and hips, mixed in equal parts. Tea is drunk two cups a day before meals.

A good effect is provided by a bath with a decoction of chamomile: this procedure increases blood circulation in the restrained areas, removes signs of inflammation.

The means of alternative treatment, of course, are good. However, do not use them as an independent treatment method. Only in conjunction with traditional medicine can you achieve the desired result and cure spinal injury.

Diet with protrusion of the disc

Any pathology of the spine, associated with the development of degenerative processes, requires certain changes in nutrition. Food with protrusions should be rich in minerals, vitamins, and should not contain substances that destroy the bone system.

In the production of cartilaginous and connective tissues, a special role is played by the presence of chondroprotectors and collagen fibers. Such substances are contained in bone decoction and gelatin, so the use of jelly desserts, caviar, jellied meat and fish will be very useful.

You should drink enough fluids to maintain electrolyte balance and remove from the body toxic substances formed due to the inflammatory process.

It is very important not to overeat: with protrusion, there is absolutely no need for extra burden on the spine, which creates a full stomach and overweight.

It is necessary to limit the daily amount of salt. The so-called "deposition of salts" is an invariable companion of osteochondrosis, the root causes of protrusion. In order to reduce the burden on the bone system and reduce the amount of salts in the body, it is not enough just to drink water. It is also necessary to abandon the salted, smoked, spicy. It is also desirable to reduce the amount of sugar - about the excess weight we already said.

Among the compulsory products that must be on the patient's table with protrusion of the disc, you can select a sufficient amount of dairy products, legumes, vegetables, greens and nuts. These are products containing calcium, magnesium, manganese, vitamins necessary for the bone system.

Try to get rid of the habit of drinking coffee in the morning - coffee removes calcium from the body, and it can also interfere with its absorption. In an extreme case, if you really can not refuse, drink coffee with milk or cream: this will keep the balance of calcium. But no more than a cup a day!

[25], [26]

Prophylaxis of protrusion of intervertebral discs

What can prevent protrusion? First of all, you need to protect your back and spine: do not allow physical overloads, injuries, colds. It will not be superfluous to periodically visit a doctor - a chiropractor, a vertebrologist, an osteopath.

There are many types of massage effects - reflex massage, relaxing, therapeutic, shiatsu. All of them bring not only pleasure, but also activate metabolic processes in the skin and muscle tissue, improve regeneration processes.

A good preventive effect is exercised by yoga. Practice shows that yoga perfectly heals and strengthens the muscles of the back, and also improves the mobility of the spine.

It is important to monitor your posture: during standing, walking, and especially during a long sitting position. Do not slouch, do not bend your back. With a long, monotonous back position, try to take breaks, get up, walk, do some simple physical exercises.

In the morning, exercise, during the day - swim in the pool, do your favorite sports.

Watch your weight: obese people are more prone to diseases of the spine and bone system.

Probably, each of us at least once felt pain in the neck or lower back, often without giving it much importance. Pain is a signal. The signal to the fact that everything is not good in the body is a call to action.

Having felt pain, do not be lazy, address to the good expert if you do not wish sometime to appear on an operational table with the started stage of disease. The protrusion of the disc is susceptible to conservative treatment if it is started on time.