The past tendency to refer patients with herniated intervertebral discs for surgery has long been outdated. For a long time, it was caused by a feeling of helplessness that occurs both in patients and (often) in the neurologists supervising them, due to the lack of knowledge about modern “restorative” treatment methods.
Damage to the spinal nerve during extrusion of the disc and the resulting swelling and inflammation can lead to very serious consequences for human health.
Removal of hernia through surgery - pros and cons
Since the cause of disc herniation is a long-lasting process of its destruction, the operation to remove the intervertebral disc or its fragment (in absolutely any modification of it!) Will never make the disc healthier and is not, and never was, a TREATMENT method. We can only call the treatment the process by which the function and structure of the damaged tissue is restored. Surgery for herniated intervertebral discs is not a treatment, but only an emergency method of “ambulance”, which is used only if when other methods of conservative treatment were ineffective.
In this case, the methods of conservative (ie non-surgical) treatment should be correct, complex and consistent, and it is necessary to include methods that restore the tissue of the intervertebral disc.
Unfortunately, even the most advanced modern treatment methods cannot provide a 100% guarantee of cure for a herniated disc, since a very large number of factors or (most often) their combination can lead to the development of the disease. There are clinical situations where even the most experienced specialist may be powerless to help the patient, and the use of the most correct treatment methods may be ineffective. But such situations in practical work with the use of modern methods of treatment are becoming less common.
There are always a number of cases where the current situation requires a doctor to assign a patient an operation. But the question of the appointment of an operation for herniated intervertebral disc is not decided on the basis of the personal opinion of the doctor or the size of the hernial protrusion, as determined by MRI, but on the basis of clear indications.
Causes of surgery
Indications for the appointment of surgery for herniated disc are as follows:
- Indication number 1. Pain that does not subside for more than 6 months with an adequate, properly conducted course of treatment,
- Indication number 2. Dysfunction of the pelvic organs with hernia in the lumbar spine,
- Indication number 3. Paralysis of the limb (arm or leg) or progressive muscle atrophy of the limb,
- Indication number 4. Progressive spondylolisthesis, i.e. "Slipping", "slipping" of one vertebra relative to others with a progressive decrease in the height of the damaged disc.
These clinical manifestations are grounds for seeking help from a specialist - a neurosurgeon.
MRI data that determine the size of a herniated disc and its localization should never be the basis for the appointment of surgical treatment.
Removal of herniated intervertebral department without surgery
It should be noted that even these indications for surgical treatment are not absolute. In our clinic, we have repeatedly achieved success in treatment, even in cases where there were paralysis, dysfunction of the pelvic organs in the form of urinary incontinence and various violations of potency. Such cases simply require more complex, complex and long-term treatment.
In the rest, in the overwhelming majority of cases, neither the stage of the disease, nor the severity of the pain syndrome and inflammation, nor even the sequestration of the hernia are indications for the purpose of surgery. Modern “revitalizing” treatment methods allow one to cope without surgery even in cases of sequestered disc herniation, i.e. in a state that until recently was considered an absolute indication for surgical treatment.
However, when a sequester occurs, there is a possibility that surgical treatment will be required, because when sequestered, the inner contents of the disk (fragments of the pulpal nucleus) through the ruptures of the fibrous ring are in the spinal space and, in addition to compression of the spinal nerves, vessels, the dura mater often cause a massive autoimmune response in response the appearance in the space of the spinal canal of protein fragments of the nucleus. Therefore, when conservative treatment is prescribed, this must necessarily be taken into account, since the use of “ordinary” tactics with the use of nonsteroidal anti-inflammatory drugs is absolutely insufficient.
The appointment of the correct treatment tactics in the overwhelming majority of cases makes it possible to cure the patient, return him to a normal, fulfilling life and eliminate the likelihood of surgery.
Methods of conservative treatment of hernia
Surgeries involving the removal of intervertebral hernia, bring quick relief from pain and other neurological disorders. But trauma to the tissues in the spine subsequently leads to the formation of adhesions and scarring, limitations in mobility and sensitivity. In addition, there are frequent cases of disc herniation in the same place or the formation of new ones in other intervertebral spaces.
Conservative treatment of hernia is a much longer method, sometimes painful, requiring patience, courage, perseverance and confidence in achieving the goal from the patient and the doctor.
Properly constructed tactics of conservative treatment not only relieves pain, but also contributes to the development of a new lifestyle. As a result, a person learns the rules of "safety" when dealing with his own spine: learns how to walk, run, sit and stand up correctly, lift weights, and the percentage of disease relapses decreases.
The main principle on which non-operation treatment of intervertebral hernia is based is that it should be comprehensive. And in this complex there are three main areas that use certain methods and techniques of therapy.
The first direction - the elimination of pain, inflammation, stimulation of blood and lymph circulation
- Anesthesia and removal of inflammation is carried out with the help of tablets, blockades, pharmacopuncture, using drugs of the NSAID group - ketorolac, diclofenac, meloxicam, and others. Local injections of anesthetics (blockade) and glucocorticoids are also used.
- Pentoxifylline and xanthinol nicotinate drugs can improve the microcirculation of drugs.
- Physical therapy in the form of ultrasound with hydrocortisone, the use of diadynamic currents, electrophoresis with drugs in the area of the affected intervertebral disk. Thermal physiotherapy, underwater massage, acupuncture are carried out.
Laser treatment, laser phoresis with the use of medications, which have recently been successfully applied also act as physiotherapy.
- To relieve the tension of the vertebral muscles in pain syndrome allows the appointment of drugs that relax the muscles - sirdalud, mydocalm, baclofen.
- For disc herniation in the cervical spine, the vertebral artery supplying the brain often suffers. In this case, Actovegin is prescribed to improve microcirculation and better glucose uptake.
- Antioxidant therapy also helps to improve the condition of the nerve structures in the intervertebral region of compression.
The second direction - reducing the trauma of nerve structures
- Bed rest in the acute period, the use of positional position treatment, the use of orthopedic mattresses.
- Wearing semi-rigid corsets, bandages, to reduce the amount of movement in the spine at the level of the lesion.
- Methods of traction (traction) of the spine, including with the help of special mattresses that provide prophylactic traction.
- Massage and manual therapy are very effective methods, but their use must strictly take into account the stages of the disease, for example, in the acute period, massage in the area of the hernia is prohibited, but numb and painful hands or feet can be massaged, but also useful.
In case of chronic pain, massage is indicated, but the patient needs to be trained in the correct behavior after the session - how to stand up correctly, use a corset so that the protective muscular tension does not work again.
Defanotherapy - a type of manual exposure allows you to relax strained muscles in the affected area with the help of massage, reflexology, and in addition, instills the patient the skills of correct movements in terms of spinal health.
- Movement treatment - from exercise therapy under the guidance of an instructor in the clinic to kinesitherapy in the medical center on special simulators.
There are many sets of exercises developed by specialists involved in diseases of the spine - S. Bubnovsky, V. Pilyuyko, V. Dikul, Yu. Popov and others. However, in order for conservative treatment of intervertebral hernia to bring relief, an experienced doctor should choose the exercises individually for each patient, taking into account the manifestations of his disease, the nature and nature of the environment.
- Teaching patients the right movements that do not harm the spine. This is no less important than the use of medications, since, even having achieved a positive effect from massage, manual and drug therapy, a person can again cater to the hospital bed, simply getting it wrong from the chair.
- Psychological correction. A patient undergoing treatment for herniation of the intervertebral hernia has to largely change his life and habits, learn not only to endure, but also to overcome pain, not to be lazy to regularly follow the doctor's recommendations. All this is the key to the success of therapy, and psychological assistance to such patients is necessary.
The third direction - reducing the size of intervertebral protrusion
In addition to the operation in which complete removal of intervertebral hernia is performed, conservative treatment can be carried out by the local injection of homeopathic remedies. Special physiotherapy is also used - electrophoresis of medicines that soften and reduce hernia of the intervertebral disk.
Therapeutic effects should include at least two directions, and preferably all three. As a result of this approach, not only relief of pain, reduction of inflammation processes is provided, but also microcirculation is enhanced, stimulating the removal of decay products and the improvement of tissues in the affected area of nerve structures in the intervertebral region.
Thus, having heard the formidable diagnosis, do not panic and look for a surgical clinic. To treat a herniated disc without an operation is not only possible, but preferable for everyone who does not have a critical condition. It is only necessary to be patient and unswervingly strive towards the goal.
Patient's problems with intervertebral hernia
Injury of the nerve processes of a certain spinal segment leads to unbearable pain and regular systemic and organ disorders:
- Intervertebral hernia of the lumbar spine is manifested by pain, non-rheological symptoms in the legs and dysfunction of the pelvic organs,
- Hernial formation, formed in the thoracic spine, disrupts cardiac and respiratory activity,
- Hernia, affecting the cervical vertebrae, makes itself known to know headaches and pain in the upper extremities.
Thus, methods of troubleshooting directly depend on the location and size of the hernial protrusion, as well as on the stage of development of the pathological process and the presence of complications.
Modern medicine offers a conservative (in some cases - an alternative) and surgical treatment. There is no definite preference, because it is impossible to argue that some methods are effective, while others are useless.
Pain and inflammation removal
As painkillers can be used as weak (aspirin, paracetamol), and potent analgesics (nurofen, indomethacin).
In addition, nonsteroidal anti-inflammatory drugs (movalis, diclofenac, ibuprofen) have been shown to combat inflammation. NSAIDs relieve pain well, lower body temperature to normal numbers and eliminate signs of general malaise.
It is important to note that modern pharmacology offers drugs and prolonged action with similar therapeutic effects, such as ketoprofen, ceberex and piroxicam. But, removing muscle spasm (mydocalm, tolperil), work at the level of the central nervous system. Under the influence of muscle relaxants, the central nervous system sends signals to the muscles for relaxation.
Medicines for external use (voltaren gel, fastum gel, nimesulide) well complement the whole range of therapeutic measures to combat inflammation and pain.
Physiotherapy for the lumbar
How to treat intervertebral lumbar hernia with various physical factors? When the acute phase of the process subsides, the question of returning to normal life arises.
Lifestyle will have to be radically revised, since physical activity must be abandoned. The load on the spine should be minimized.
The medical process will take a long time, because the patient will need patience. It is important to carry out all medical recommendations to perform in full, without neglecting the individual procedures. Only in the aggregate, medical procedures give the desired effect and guarantee a favorable outcome of the pathological process.
Physiotherapy care involves the appointment of electrophoresis, phonophoresis and mud therapy. Magnetotherapy and laser therapy also occupy not the last place in the medical process of intervertebral hernia of the lumbar spine.
A beneficial effect on the course of the disease has a course massage. As well as an individual program of therapeutic gymnastics, focused on strengthening the muscular back frame.
Video on the treatment of intervertebral hernia:
We treat intervertebral neck hernia
How to treat intervertebral hernia of the cervical spine? Conservative methods are primarily aimed at improving the nutrition of the fibrous ring of the injured disc, relaxing the triggers (strained muscles) and strengthening the muscles in the area of hernia formation. But how to treat intervertebral hernia at home?
As a rule, all therapeutic measures are focused on balancing the spine. Therefore, with a hernia in the cervical region, bed rest and absolute rest are not shown. The patient must understand that the quickest restoration of the functions of the neck completely depends on his efforts.
It is important to stop the pain and relax the muscles in the place of their maximum tension. For uniform distribution of the load, use a time-tested Shantz collar.
The intervertebral disc needs to create optimal conditions for recovery, and the pulpous nucleus should be given the opportunity to take its anatomically correct position.
It is worth noting that the fixing orthosis needs to be removed periodically. Muscles should not only relax, but also work, while keeping your neck in balance.
At the forefront of the treatment process is pain syndrome, which complements neurological symptoms. Elimination of pain is carried out in several directions at once:
- Pain killers are used to temporarily relieve pain. In this case, medicines are used (indomethacin, baralgin), which effectively eliminate the painful focus. In the first 2-3 days, it is advisable to carry out therapy by injecting drugs, and then take the tablet form of drugs.
- If the pain is badly relieved or does not leave the patient at all, then a Novocainic blockade with hormones is shown. This kind of help helps to relieve the patient from suffering quickly and efficiently.
Physiotherapy in the treatment of the cervical spine
How to treat hernia of the intervertebral disc of the neck with the help of physiotherapy?
The cervical spine, having a hernial protrusion, responds well to physiotherapeutic methods. Therefore, the use of magnetic therapy, electrophoresis, paraffin and ozokerite applications is shown.
With regard to massage for intervertebral hernia of the cervical spine, then there must be an extremely cautious approach. Excessive zeal for neck muscles is unacceptable.
A therapeutic gymnastics is selected exclusively on an individual basis.
Thus, intervertebral hernia can be treated without surgery, like many diseases of the musculoskeletal system. Only unsuccessful conservative treatment can be an indication for surgery.
The best prevention of intervertebral hernia is a targeted build-up of the back muscles that hold the spine together, like a mast of a sailing vessel. In the process of treatment after an acute period, the appointment of physiotherapy exercises is mandatory for the patient.
Due to the regular, but metered, subjectively pleasant movement, the muscles return to normal tone between tension and relaxation. Strength training allows you to properly hold the spine and keep the discs flexible and elastic.
In addition to regular walks and movements in the water (for example, light water aerobics), daily target gymnastics are especially important. A physical therapist will help you with your individual choice of exercises. Anything that strengthens the back, abdominal and pelvic muscles will also help the discs stay healthy.
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Sequestered hernia is detected using magnetic resonance or computed tomography (the first is more informative). The disease is manifested by a sudden exacerbation, severe pain.
A fragment of the intervertebral disc that fell into the canal is small and is not capable of harming the vessels or nerves, but the autoimmune reaction is the most dangerous with the development of the disease.
This means that the body “regards” the fallen pulpous nucleus of the intervertebral disk as a foreign body. A foreign body must be destroyed. In fact, the immune system is “attacked” by the person’s own tissues.
If immune cells are not able to destroy a disk fragment completely, then at least they are able to begin the processes of rejection.
Immune complexes continue to circulate in human blood and are deposited on cartilage tissues. This is manifested by symptoms of rheumatism, which is impossible to ignore.
Possibilities of conservative treatment
Treatment without surgery is a real challenge. But in order to make such a decision, the doctor must take into account a number of factors:
- size and place of sequestration,
- direction of development of sequestered hernia,
- the ratio of the size of the hernia and the size of the spine (it should not be larger than the surface of the vertebrae, especially in the narrow canal of the cervical region),
- possible complications
- the degree of impairment of quality of life, disability in a patient.
Thus, in order to make the right decision, the doctor must conduct a full clinical and laboratory examination.
As a sequestration, his "behavior" can determine the direction of treatment and suggest its effectiveness.
In the acute period, the doctor relieves pain and inflammation, and during recovery, special exercises are prescribed (they strengthen the muscles around the spine and relieve their spasms). The effect of physical therapy exercises is noted by all who cured the pathology without surgery.
Ossification of the intervertebral fissure can be considered a success, which will prevent the recurrence of fragments of the pulpal nucleus - usually MRI scans of this gap are grown a year or two after the start of therapy.
The operation to remove a sequestered hernia can be scheduled if there are various indications:
- relative - ineffectiveness of conservative methods (drugs, physiotherapy, etc.),
- absolute - compression of the spinal cord, dysfunction of the internal organs.
How to operate a hernia? Surgery can be performed in various ways:
- Laminectomy. It implies the removal of the entire disk together with the dropped pulpous nucleus and the fibrous ring. Instead of a disk, an artificial implant is installed, which preserves the desired anatomical structure of this segment of the spinal column, while the adjacent vertebrae will be rigidly connected (fixed).
- Microdiscectomy. Apply microsurgical instruments, an operating microscope. All hernial protrusion or free part of the disk is removed.
- Endoscopic microdiscectomy. Minimally invasive surgery: the surgeon makes a small incision (approximately 2.5 cm). The thinnest tool removes the remnants of the pulpal nucleus.
- Laser vaporization (evaporation). The laser light guide heats up the core of the disk, it loses water and decreases in volume - the volume of the hernial protrusion is also reduced.
- Laser reconstruction. This is not the destruction of the disk, but, on the contrary, its restoration. When heated by a laser beam, cartilage cells begin to grow, then they fill cracks in the destroyed structure - the process takes 3-6 months.
The type of operation also determines how long it takes.
It is allowed to operate the patient only according to strict indications. Moreover, it is not a guarantee of recovery.
Rehabilitation is quite long - its timing depends on the characteristics of the sequester, its location. And in 20% of cases, the help of a surgeon does not give the proper result.
Most often, there is a choice to do the operation or not, since (with proper efforts on the part of the doctor and the patient) with the majority of spinal hernias, including those with sequestered, it is possible to cope with the methods of conservative therapy.
Surgical techniques always involve a certain amount of risk. But sometimes, if the pain syndrome and neurological symptoms increase, and other treatment options are ineffective, one cannot do without surgery.
A selection of my useful materials on the health of the spine and joints, which I recommend you to look at:
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Denial of responsibility
The information in the articles is intended solely for general information and should not be used for self-diagnosis of health problems or for medical purposes. This article is not a substitute for medical advice from a doctor (neurologist, therapist). Please consult your doctor first to know exactly the cause of your health problem.