Herniated Schmorl of the lumbar, thoracic spine: what is this, how to treat

Hernia Schmorl's spinal cord or Schmorl's cartilaginous nodule is an x-ray concept, it was first described by a German scientist, physician Christian Schmorl.

Hernia Schmorl - spilling or punching cartilage tissues of the end plates into the spongy bone, inside the body of the lower or upper vertebra. It often has a genetic nature or is formed in the early childhood period as a result of the rapid growth of the human body.

As this child grows, soft tissues can quickly stretch, and bone tissues can not react so quickly to rapid growth and begin to lag behind in development. The result of this process is the formation of voids inside the vertebrae (in their spongy body). After the passage of time, the end plates of the vertebrae fall into these voids.

The Schmorl's hernia differs from the usual intervertebral hernia in the following way:

• Localization (location). 
• Vascular-neural bundles are not involved in the pathological reaction. 
• Hernia does not squeeze the spinal cord and spinal cord. 
• Clinical manifestations may be absent or very scarce, because In the formation of the Schmorl hernia, only the body of the vertebrae and the intervertebral discs take part. 
• Almost always occurs in childhood and adolescence.

[1]

Why is Schmorl's hernia dangerous?

1. Hernia Schmorl over time contributes to the thinning of the vertebrae, makes them vulnerable to physical stress and shock, and as a result, a compression fracture (very severe pathology) may occur. 
2. Involvement of the intervertebral disc in the pathological process, its punching or falling into the hernia, significantly impairs the function of the spine, which can cause disability. 
3. Also, Schmorl's hernia helps increase the load on the intervertebral joints, which is one of the reasons for the early arthrosis of these joints. 
4. The Schmorl's hernia found on the x-ray can be a harbinger of the formation of an intervertebral hernia.

That's why Shmorl's hernia is dangerous, i.e. Their complications. Therefore, even in the absence of clinical manifestations of this hernia, but there are randomly revealed radiologic signs of it, you need to start therapy immediately to prevent the occurrence of complications.

Causes of Schmorl's hernia

There are the following causes of Schmorl's hernia:

1. Hereditary predisposition (individual features of the structure of the end plates of the vertebrae). 
2. Rapid growth of the child in the early or adolescent period, accompanied by a lag in the growth of bone tissue with normal growth of the cartilaginous. And as a consequence - voids are formed in the vertebrae and are filled with a cartilaginous tissue. 
3. Microtrauma of the spinal column or excessive physical exertion on it (for example, in sports: jumping, dancing - shaping, aerobics or during pregnancy). 
4. Injury resulting from sudden lifting of gravity or from falling from top to bottom. 
5. Deformation of bone and cartilage tissue due to osteoporosis, especially in old age. 
6. Deterioration of blood supply to the vertebrae, as a result of which they become less strong and are simply punctured by intervertebral discs (causes of impaired blood supply to the spine - stoop, kyphosis, Sheyerman-Mau disease, sedentary life, often in astronauts). 
7. Lack of calcium in bone tissue. 
8. Violation of metabolic processes in the intervertebral disk.

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

Symptoms of Schmorl's hernia

Clinical symptoms of hernia Schmorl usually absent or very scarce. Since the hernia of Schmorl: 

• does not compress the nerve roots and vessels, 
• does not cause aseptic inflammation, 
• does not cause muscle spasms.

Hernia Schmorl, as indicated earlier, is an X-ray and is very often detected accidentally, during diagnostic examinations related to other problems of the spine. Sometimes pain may appear, local (local) nature. Such pain often appears during exercise and decreases or disappears during the rest period. In this regard, the main complaints are the inability to perform exercises in full during sports.

Palpatory (with palpation) in the area of the affected vertebra may appear minor soreness and determine the muscle spasm. Neurological and vascular changes are not observed.

Herniated Schmorl of the lumbar spine

The hernia of the lumbar spine is usually not manifested. But it can be accompanied by increased fatigue in the lumbar region, a sense of discomfort and reduced flexibility of the back. It is detected accidentally during a diagnostic X-ray examination of the spine for other diseases. Very rarely, a Schmorl's hernia can cause pain in the lumbar and lower extremities, which occurs under the influence of physical exertion or is the initial sign of a complication of the hernia. With the progression of the pathological process, the intervertebral disc may collapse into the hernia completely, which will disrupt the function of the lumbar vertebrae. In addition, the hernia of the lumbar spine is a weak point where a compression fracture of the vertebra can occur. It happens: 

• with a significant lateral load on the vertebral column, 
• during a strong blow, 
• In the case of compression of the spinal column along the axis.

Therefore, the revealed hernia Schmorl requires timely therapy. Hernia Schmorl can form at any level of the lumbar spine. In this department there are five vertebrae, and they are the largest, because the lumbar region has a heavy load. Depending on the place of origin of the hernia, an X-ray "diagnosis" of Schmorl's hernia L1, L2, L3, L4 or L5 will be exhibited.

Herniated Schmorl of the thoracic spine

Hernia schmorl of the thoracic spine can form at any level of the thoracic spine and is less common in relation to other types of hernias. Most often it occurs at the level of th8 - th12. Often the Schmorl's hernia is asymptomatic. Because Only bone tissue is affected, and there are no nerve endings. A lack of pain syndrome, accompanied by untimely diagnosis of a hernia. As the Schmorl hernia grows in the thoracic spine, there may be an increased overall fatigue and a local fatigue in the thoracic region of the back. Increased overall fatigue occurs due to disruption of the internal organs - the heart and lungs (dyspnea, rapid heart rate may occur). Over time, there is pain in the back, especially during physical exertion, which decreases at rest and can give in hands.

Cervical hernia

The hernia of the neck is most often due to the softness of the cervical vertebrae. At the initial stage and with a small magnitude, the herniation of Schmorl's hernia in the cervical region is asymptomatic. With the progression of the process, there is weakness, fatigue and soreness in the neck, especially during exercise. Progression of the hernia of the cervical region (its increase or complication) may be accompanied by a violation of cerebral circulation, which is clinically manifested by headache, drowsiness, general weakness, increased fatigue.

[6], [7], [8], [9],

Multiple Schmorl's hernias

Multiple hernias of Schmorl affect a significant segment of the spinal column, as a result of which their main manifestations are: 

• chronic pain that increases in an upright position (when a person stands or sits) and decreases in a prone position. 
• Visually, such people noticeably increased the inclination of the spinal column forward, as well as the natural curvatures of the spine, thoracic and lumbar, are smoothed, so that it forms a strongly straight form. 
• There is a stoop and a broken posture. 
• Also, there is an increased fatigue of the back and as a result, working capacity decreases.

Multiple hernias of Schmorl may have an asymptomatic course, especially in those cases when the central part of the vertebrae is affected. Typically, these hernias are identified accidentally in early childhood and adolescence, and often can disappear on their own. The cause of these hernias is a genetic predisposition (most often) and possibly a lack of calcium.

If multiple Schmorl hernias are located on the front of the vertebrae, then a high risk of intervertebral hernia and compression fracture. Often such deformations on the anterior part of the vertebrae occur in the lumbar region and can be accompanied by central hernias in a number of located parts of the spinal column. Such a pathology requires obligatory observation of a specialist and timely therapy.

The intervertebral hernia of Schmorl

The intervertebral hernia of Schmorl can be single and multiple. A single intervertebral hernia Schmorl, usually, does not show clinical symptoms. But if several such hernias are present at once in the spine (especially in one of its parts), this leads to a disruption of its mobility and curvature. Single intervertebral hernias of Schmorl are formed usually in adulthood and elderly and are localized mainly in the lumbosacral department. Multiple hernias of Schmorl meet in young and more often in the thoracic spine. The intervertebral hernia of Shmorl is revealed accidentally during radiography about another disease.

Central hernia of Schmorl

• The central hernia of Shmorl is more favorable and usually occurs. Usually, the course of this hernia is asymptomatic and it is determined with the help of an x-ray or tomographic survey method. In cases when the central hernia of Schmorl is large, then the clinical symptoms characteristic of osteochondrosis appear: 
• pain arising during walking, prolonged standing or when tilted; 
• a feeling of fatigue in the back; 
• possible pain in the lower back, irradiating to the lower limbs; 
• change (restriction) mobility of the spinal column in the affected department.

In case of accidental detection of central Schmorl's hernia it is better to appear to a specialist in order to start prevention of possible complications in a timely manner.

[10], [11]

Hernia hernia and pregnancy

Hernia and pregnancy are compatible. Especially if before the pregnancy the hernia itself did not manifest itself in any way. But in any case, if a Schmorl hernia is found during pregnancy, it is necessary to be under special control of a doctor (orthopedist, neurologist, obstetrician-gynecologist) and take care of yourself. Because during pregnancy, the load on the spine increases significantly. Perhaps during pregnancy, you will need to wear a supporting belt, corset or bandage, and also go to the pool. All these activities will be very useful for both the pregnant woman and the future child. If the Schmorl's hernia is detected before pregnancy, it is recommended to first fix the back before planning it.

Consequences of Schmorl's hernia

The consequences of Schmorl's hernia can be varied. It can exist for a long time and does not manifest itself in any way, does not progress and is not complicated. But if it increases, the process progresses, the following consequences occur: 

• the formation of an intervertebral hernia, a more serious disease requiring prolonged therapy with possible surgical intervention. Since the pathological process is already involved in the vascular-neural bundles and even the spinal cord. 
• There is a tendency to compression fractures of the spine, which can occur during physical exertion (especially in people involved in sports). 
• The increasing strain on the intervertebral joints provokes the development of early arthrosis of these joints. 
• Violated posture, flexibility and mobility of the spinal column. 
• A pronounced curvature of the spine develops - kyphosis occurs if the thoracic and lordosis are affected, if the lumbar spine is affected.

Such consequences not only disrupt the movement when walking, bring soreness and discomfort, but also make it impossible to engage in sports, and even, can lead to disability. Taking into account the possible consequences of Schmorl's hernia it is necessary to take the necessary measures in time to prevent its progression.

[12], [13]

Diagnosis of Schmorl's hernia

Diagnosis of Schmorl's hernia is based on: 

• complaints - the presence or absence of pain, its localization, the dependence of pain on the action of physical exertion, whether the pain is in a prone position. 
• Stories of the disease - whether there are relatives of hernia Shmorlja in the family, whether spinal injuries, etc. Have been noted before. 
• Visual examination and palpation along the spinal column - whether there are curvatures or swelling of soft tissues. 
• Additional methods of examination - radiography (the main method in diagnosis), computed tomography or magnetic resonance imaging.

If necessary, the consultation of doctors of the following specialties is conducted: orthopedist, neuropathologist, vertebrologist.

[14], [15], [16]

Treatment of Schmorl's hernia

The identification of usuric defects in the spinal column is the reason to start the treatment of Schmorl's hernia. In the absence of clinical symptoms, therapy will be aimed at preventing the progression of the pathological process.

The hernia of Schmorl's hernia (usurpative defects) is carried out taking into account a number of factors: gender, age, the peculiarities of labor activity, the degree of severity of the process, concomitant diseases. In addition, with hernia therapy, it is necessary to take into account its cause.

The goals of the treatment of Schmorl's hernia:

1. In the presence of pain syndrome - its elimination. 
2. It is necessary to improve metabolic processes in bone tissue. 
3. Improve circulation of the back muscles. 
4. Normalize and restore the flexibility of the spine. 
5. Reduce or eliminate muscle spasm (muscle relaxation). 
6. Warn the occurrence of complications.

The herniation of Schmorl's hernia is basically conservative, aimed at strengthening the musculoskeletal skeleton and is as follows.

• Balanced and rational nutrition - fermented milk products (cottage cheese, cheese, kefir, milk), fish, caviar, soy products (milk, tofu), protein products - "favorite food" of the spine. It is necessary to reduce the use of salt, tk. It is deposited on bones and joints. 
• Control your weight, because this is an additional burden on the spine. 
• In the presence of pain, analgesic and anti-inflammatory drugs (dicloberl, nimesil, movalis) are prescribed. 
• Sometimes medicines are used to strengthen the skeleton - calcium preparations - calcitonin (alostin, myocalcic), vitamin D can be taken, fish oil (in capsules). It should not be forgotten that the use of funds that strengthen the skeleton can have an adverse effect on the excretory system (kidneys) and the ligamentous apparatus, so before using them, consult a doctor. 
• Exclude riding a motorcycle, jumping into the water, carrying heavy loads. 
• Therapeutic gymnastics is a fairly effective method by which the muscles of the back are strengthened, and the flexibility of the spinal column improves. 
• Swimming is also an excellent method of strengthening the muscles of the back and spine. 
• Therapeutic massage - relieves fatigue and pain in the back, reduces muscle spasm, normalizes blood circulation and strengthens the muscles of the back. 
• Manual therapy - improves blood circulation in the affected area of the spinal column and expands the intervertebral space. 
• Acupuncture. 
• Extension of the spine (traction) - improves the circulation of tissues and increases the intervertebral lumen. 
• Hirudotherapy - the imposition of medical leeches on the affected department, which secrete active substances that improve local blood circulation and metabolic processes. 
• Apitherapy - treatment with the help of bee products (the effect of bee stings).

Treatment of Schmorl's hernia with alternative methods is not much different from official medicine, where gymnastics and massage are also used. Apply alcohol tinctures from medicinal plants - dandelion, chestnut flowers or a mixture of horse radish and raw potatoes.

Operative treatment

Operation with hernia Schmorlja is not shown. When it is detected, conservative therapy is performed with a set of physiotherapeutic measures. The operation can be indicated in case of complication of a hernia, when an intervertebral hernia has formed or a fracture, resulting in a significant deterioration of the human condition and conservative therapy does not produce results (muscle weakness, back pain, internal disorders, etc.).

Physiotherapy

LFK with hernia Shmorlja or therapeutic exercise - the concept of using various methods of exercise - running, walking, swimming, gymnastics, etc. The method of curative physical education is used for the prevention, treatment of Schmorl's hernia, in the rehabilitation period and as a supporting therapy. Physiotherapy is shown at any age. Physical training: 

• improve metabolic processes throughout the body, 
• increase immunity and resistance of the body to various infections, 
• improve blood circulation and trophism of body tissues, 
• strengthen the musculoskeletal system,
• positively affect the psychoemotional state.

The load during exercise therapy should match the capabilities of the body and is selected individually for each.

Exercises

Exercises with hernia Schmorl made in conjunction with stretching and massage. 

1. Pull-up - strengthens the muscles of the hands, back and chest. 
2. Rod presses from the prone position, without back bending. 
3. Makhi hands with dumbbells in the sides. The starting position - it is necessary to sit down and lower your hands down. Then hands with dumbbells should be smoothly raised above the shoulders, hold for a couple of seconds and lower. 
4. Training of the press, the muscles of the back and glutes. 
5. Shragi - exercises to strengthen the trapezius muscle (posterior region of the neck and upper back) - lifting and lowering the shoulders with the load. You can perform lying, standing or sitting. 
6. Hyperextension - overextension, hyperextension. Strengthens the rectus muscles of the back, gluteus muscles and hip flexors. Especially this exercise is recommended for those who have a weak back. To perform it, you need to lie on your stomach in the simulator, the heels should be under a special roller. Then the torso is lifted up and back - ten times, two or three approaches.

[17], [18], [19], [20],

Gymnastics

Medical gymnastics with hernia Shmorlja - one of the main methods of therapeutic physical training. Therapeutic exercises are prescribed and conducted under the strict supervision of a physician. A type of curative gymnastics is corrective. With its help, the muscular system (especially the back) is strengthened, the ligamentous apparatus, joints (including the intervertebral), the flexibility of the spine increases, as a result of which the defects of the musculoskeletal system are eliminated (such as impaired posture, curved spine, etc.). Therapeutic gymnastics with Schmorl's hernia is usually prescribed in combination with breathing exercises.

Massage

Massage with hernia Schmorl - a very effective and effective method of its therapy. It is important that the therapeutic massage is carried out by a competent specialist, since The manipulation should be gentle, soft and, most importantly, did not worsen the pathology. Very well proven acupressure. Thanks to the massage: 

• improves blood circulation, 
• strengthened muscles of the back, 
• relieves fatigue and tension of the muscles of the back, 
• decreases and eliminates pain in the back, 
• the trophism of musculoskeletal tissues improves.

Massage with hernia Shmorlja is carried out in conjunction with other methods of its treatment.

Prevention of Schmorl's hernia

Prophylaxis of Schmorl's hernia is non-specific and consists of the following measures. 

1. To lead an active way of life in all periods of life - to do gymnastics, swimming, running, walking. 
2. Carry out physiotherapy - various types of relaxing massage. 
3. People with special working conditions - long work in the vertical position, professional sports (jumping, skaters, etc.) should carefully monitor the health of the back, and with the slightest pain and discomfort in the spine, seek help from a specialist. 
4. Watch your weight, because Excess weight is an additional burden on the spine. 
5. To lead a healthy lifestyle - to exclude smoking and the use of alcoholic beverages, which worsen the blood circulation and as a consequence - the trophism (feeding) of tissues.

Prognosis of Schmorl's hernia

The prognosis of Schmorl's hernia for health is favorable with its timely detection, and for professional activity is relatively favorable, especially for athletes. The danger of such a hernia is its asymptomatic, tk. The absence of clinical manifestations contributes to the progression of the disease and the occurrence of its complications (compression fractures, arthrosis, intervertebral hernias, etc.). But carrying out all the necessary preventive measures, active way of life, attentive attitude to one's health will ensure the general health and health of the spine.

Schmorl's hernia and army

The hernia of Shmorl and the army is a twofold question. On the one hand, Schmorl's hernia, which has an asymptomatic course, is not a contraindication for a conscript, it is even possible to enter and study in military educational institutions. On the other hand, when the Schmorl hernia became complicated (which is especially characteristic of multiple Schmorl hernias) and manifests itself as a violation of sensory and motor functions, then of course such a draftee is not fit for military service. But the question of the suitability of a draftee with a found hernia Schmorl will be decided by a doctor's consultation after his additional examination.