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Herniated pulposus: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Herniated pulposus (protrusion, rupture or prolapse of the intervertebral disc) is the prolapse of the central part of the intervertebral disc through the fibrous ring.
Symptoms of the herniated pulp nucleus occur when the disc presses on the nearest nerve root, causing segmental radiculopathy with paresthesias and weakness in the innervation zone of the affected nerve. Diagnosis of the hernia of the pulpous nucleus is performed with CT, MRI and CT-myelography. In mild disease, the treatment of a herniated pulpal core involves the use of NSAIDs and, if necessary, other analgesics. In rare cases, bed rest is indicated. With an increasing neurologic deficit, non-curative pain or sphincter dysfunction, an urgent surgical operation is indicated (for example, disk or laminectomy).
[Causes of a herniated pulpous nucleus
Between the vertebrae are the cartilaginous discs, consisting of an external fibrous ring and an inner pulpous core. When degenerative changes (with or without trauma) lead to protrusion or rupture of the fibrous ring in the lumbosacral and cervical region, the nucleus shifts posteriorly and / or laterally into the epidural space. When a disc hernia presses on the nerve root, there is radiculopathy. Protrusion posteriorly can squeeze the spinal cord or ponytail, especially with congenital stenosis of the spinal canal. In the lumbar region, when the disc is protruding more than 80%, the nerve roots L5 or S1 are affected, and in the cervical spine - usually C5 and C7. Herniated disc is common and often asymptomatic.
Symptoms of a herniated pulpous nucleus
Symptoms of a herniated pulpous nucleus, as with other lesions of the nerve roots, with herniated disc pain usually occurs suddenly, and the compression of the spinal cord can also develop. With a hernia in the lumbosacral division, lifting the straight leg (roots tightened) causes pain in the back or leg (if the disc's hernia is in the center, then the pain is bilateral). With a hernia in the cervical region, pain occurs when the neck is bent or tilted. Compression of the cervical spinal cord can cause a spastic paresis of the lower extremities. Compression of the horse's tail often leads to a delay or incontinence of urine due to a disorder in the function of sphincters.
Diagnosis of a herniated pulpous nucleus
Perform CT, MRI or CT-myelography of the affected area. EMG can detect the affected root. Often there are asymptomatic hernias of the intervertebral disc, therefore, before assigning invasive procedures, the doctor should carefully compare the symptoms with the MRI data.
Treatment of a herniated pulpous nucleus
If the neurologic deficit is not severe and does not progress, conservative treatment of a herniated pulpous nucleus is indicated, since in 95% of cases of herniated discs patients recover without surgical operation in about 3 months. It is necessary to limit heavy physical work, but walking and light workload (for example, lifting less than 2-5 kg) should be allowed with portability. Prolonged bed rest (including traction) is contraindicated. If necessary, NSAIDs and other analgesics are used to relieve pain.
If lumbar radiculopathy leads to persistent or progressive neurologic deficit (weakness, decreased sensitivity) or to severe non-curative pain in the innervation zone of the affected root, consideration should be given to the possibility of invasive procedures. Usually it is a microscopic disco and a laminectomy with the removal of a hernia. Percutaneous access to remove a herniated disc still undergoes the evaluation stage. Injections of chymopapain for the purpose of lysis of the hernia are not recommended. With a sharp compression of the spinal cord or the horse's tail (for example, causing a delay or urinary incontinence), immediate surgical intervention is shown.
Immediate surgical decompression is indicated with radiculopathy of the cervical region complicated by symptoms of spinal cord injury. In other cases, the question of it is posed only if the non-surgical treatment is ineffective.