The fibrous ring is located in the human body in 3 places: intervertebral discs, aortic and pulmonary valves. It is the basis of these valves. Anuli (annuli) fibrosi (cordis), BNA - ring-shaped formations of dense elastic connective tissue surrounding the aortic aperture and pulmonary trunk. This ring divides the left ventricle and the aorta, 3 pockets of lunate cusps adjoin it. They are tightly closed with diastole and do not provide the opportunity for regurgitation of blood from the aorta. In the area of the fibrous ring, there is a certain extension of the aorta into 2 valves, behind each of which are the Valsalva sinuses (small sinus). They give rise to the coronary arteries - right and left.
Valve mechanism
During systole, the valve cusps from the ventricle are pressed against the walls of the aorta, and the passage for blood into the aorta opens. After the passage of blood, its movement slows down in the sinuses. Near the walls of the aorta, small whirlpool vortices appear, which move the valves from the walls to the middle of the aorta. The speed of this process is high; when the lumen in the ventricle is tightly closed, it is accompanied by a characteristic sound. It is heard on auscultation as a heart tone.
The aortic valve has a number of ailments of various etiologies, in which various diseases play a significant role - valve insufficiency is associated with them. The opposite condition, when valve stenosis occurs, is due to the compaction of the fibrous ring.
With age (after 50 years), calcium deposits (calcification of the aortic valve) or fatty atherosclerotic plaques appear on the edges of the valve flaps. In this case, it is noted that the fibrous ring is sealed. These are growths, they not only do not completely close the valves, but also partially overlap the lumen itself. All this disrupts blood flow and leads to the development of heart failure. There is aortic stenosis.
A pulmonary valve (PC), or pulmonary valve (CL), is located between the right ventricle and the pulmonary artery. Its main task is to prevent the reverse flow of blood from the pulmonary trunk to the right ventricle to the diastole and to provide a one-way blood flow in the pulmonary circulation. This valve also has 3 flaps that open only in one direction - into the lumen of the pulmonary trunk. The principle of operation of this valve is identical to the aortic. The fibrous ring here serves as a supporting frame for the valves. It has a triangular cross-sectional view. In its composition, collagen, as well as elastin and a little cartilage tissue, are the main component. PC disease also manifests itself in the form of its insufficiency or narrowing due to the compaction of the fibrous ring.
But most often, this term means precisely the ring of the intervertebral disc, since in it violations are found more often than others.
Disc ring
The fibrous ring of the spine is not one, it is located between all vertebrae - anulus (annulus) fibrosus, PNA, BNA, JNA. This is an annular outer hard layer of collagen fibers surrounding the pulp of the disk. Where it is located? The vertebrae are divided by disks - these are elastic cartilage tissues that play the role of shock absorbers when vertical loads are applied to the spine. Such a disk is a fibrous ring and pulp. Pulp is a semi-liquid core located in the center of the disk, and the ring is its retainer.
There are many layers, they are very durable, powerful and densely interwoven in a spiral. The disc itself is attached to the vertebra by hyaline cartilage and provides flexibility of the spine. When a person lifts a load from an inclined position, the disk is compressed and its core is flattened due to the increase in pressure.
The fibrous ring also makes this pressure uniform. With age and for a number of pathological reasons, changes occur not only throughout the body, but also in this ring.
Due to malnutrition, elastic elastic fibers begin to be replaced very gradually by scar tissue, the strength of joint cells (chondrocytes and chondroblasts) decreases, and the elasticity of the connective tissue on the surface of the disc also. The level of protein glycans, which retained water in the disk and ensured its elasticity, decreases. The hydrophilicity of the disk is noticeably lower. The fibrous ring becomes thinner, and cracks appear on it due to malnutrition, where the core pulp begins to partially shift. The structure of the inner fibers of the ring is broken, but the outer is still preserved. This condition is called disc protrusion, in other words, it precedes hernia.
The pressure inside the disk without treatment increases, and as a result, the fibrous ring ruptures. This is a hernia.
True intervertebral hernia is spoken when, when a fibrous ring of the intervertebral disc ruptures, prolapse occurs - prolapse of the pulp into the spinal canal. In this case, nerve endings are almost always infringed to varying degrees with severe pain, inflammation and swelling of the tissues and a decrease in immunity.
Further rupture of the fibrous ring and pathological changes in the cells of the damaged disc can lead to the development of autoimmune processes in the body. This has irreversible consequences for all vital systems. Intervertebral hernia is a rupture of the fibrous ring, which needs to be eliminated as soon as possible in order to avoid muscle atrophy, reduce spinal mobility and subsequent disability.
Disk hernia is also dangerous because a disk that is not in its place leads to a narrowing of the spinal cord channel and impaired blood circulation in it. If a rupture of the fibrous ring of the intervertebral disc compresses the nerve roots of the lumbosacral, then this is horse tail syndrome.
All these changes require an immediate visit to the doctor and treatment. Therapy can be conservative - in 90% it gives good results, but only if you see a doctor in a timely manner. Surgery is indicated when there is a pronounced neurological symptomatology.
Violation mechanism
From the point of view of biophysics, an adult middle-aged man in an upright position puts a load on his spine of 30 kg. Even with a slight forward tilt, this load will double, and when tilted to a right angle, the pressure will already be 210 kg. If at the same time a person still lifts the load, what will happen to the spine? The core of the disk will look for a way out due to strong compression and will begin to be pushed back - to the weakest point of the vertebra. That's why it is not recommended to lift weights, leaning forward, but you need to sit down and stand with a straight back.
With a single injury, such a squeezed flattened pulp fragment will grow with fibers, and the hole in the fibrous ring will close. If the loads are constant, then the protrusion of the disk occurs - the first stage of change. The height of the intervertebral disc decreases, and the vertebral joints begin to experience constant tension.
With damage to the thoracic spine, the changes are not so catastrophic and noticeable, there is no big load. The biggest damage is lumbar and cervical. Here the joints wear off the fastest.
As a compensation, the body begins to give osteophytes (bone growths), mobility is limited even more, etc. A vicious circle arises. As a rule, the pathology in the form of a rupture of the fibrous ring of the disk appears after the age of 40 years (more often in men).
Causes of hernia
Damage to the fibrous ring occurs for many reasons.
- Weight lifting and increased physical activity.
- Hip dislocation of a congenital nature.
- Impaired metabolism.
- Kyphoses and scoliosis.
- Regular mechanical injuries of the spine due to sports or professional activities.
- Osteochondrosis (discs are compressed by osteophytes).
Predisposing factors for hernia
The following factors can be attributed to provoking factors:
- Sedentary lifestyle.
- Sedentary work with poor posture.
- Hereditary predisposition.
- Age-related changes in the body.
- Infectious diseases.
- Hypothermia.
- Bad habits.
- Continuous sitting at a computer, desk or driving.
Forms and stages of hernia
By the type of localization of the disk displacement, there are:
- Edge protrusion of the disk, while damage to the fibrous ring will be in the form of a crack.
- Another option - the disk may swell up, but it does not go beyond the ring.
- When the ring ruptures, the disk is displaced and the pulp simultaneously exits into the spinal canal.
- And another option is to split the disk into several fragments.
Stages of intervertebral hernia
The following stages are classified:
- The first stage lasts about 3-4 months and is called protrusion of the fibrous rings. Its dimensions can reach no more than 3 mm. The ring had just cracked, and only part of the pulp came out. But in the future, the pulp continues to leak and causes inflammation and compression of the nerve endings. The hernia in this period is soft and watery, moderately mobile, and the pain syndrome has a different degree of severity. In acute pain, movements are limited, bed rest is observed. If the pain is moderate, you need to move more, this will allow the hernia to sit more comfortably so as not to cause pain. This stage allows the restoration of the fibrous ring by tightening the crack. It is forbidden only to lean forward, as this helps to squeeze out the pulp.
- The second stage (prolapse) - 3-6 months. Without treatment, the core sticks out further and further (extrusion), the disk loses power due to vascular disturbance. The result is a rupture of the fibrous ring of the spine, and the pulpous nucleus extends beyond the disc, maintaining its integrity. Such a hernia has a size of up to 1.5 cm. This stage of development of the hernia is completed. But if treatment occurs, by the end of 3 months the disc herniation will gradually become dehydrated and decrease in size - resorption. Often even up to half their size.
- The third stage (sequestration) - 6-12 months. Without treatment, fragments of the nucleus and rings go beyond the disk space. Pinched nerves become stronger, and pain often becomes continuous. With proper treatment, the hernia is compacted and the rupture of the ring can scar by 60%.
- 4th stage - 12-24 months: the hernia became tightly motionless. There are no changes, disability returns, but the functional activity of the disk is already lost. Vertebrae continue their degenerative process - they converge and can grow together. The development of complications is only a matter of time.
And if you remember that the spine after 45 is not at all the same as it was at 20, you will not torture it with incorrect behavior, the more positive will be the effect on the disk, and the risk of transition to extrusion will decrease.
Symptoms and signs
The main symptom of the disease is a slowly growing pain syndrome. The pain when lifting the leg, which disappears when bent, is very characteristic.
With a small hernia, back pain is intermittent, dull or aching (lumbago). With a sharp movement, an uncomfortable position, sneezing, it can intensify.
Cervical lesion
Dizziness, cephalalgia, nausea, tinnitus, weakness and irritability, fatigue and increased pressure can occur - these are manifestations of brain hypoxia. Tingling in the shoulders, poor sleep are also symptoms of this problem.
Thoracic department
The defeat of this department is rare. First, pain occurs in the area of the shoulder blades with a return to the chest, the sensitivity of the hands may decrease, numbness and paresthesia appear.
Lumbar
The lesion most often, usually between the 4th and 5th vertebrae or the 5th lumbar and 1st sacral vertebra. The pain is pronounced and permanent. With an intense load, a backache of pain (lumbago) appears. All unpleasant sensations appear in the legs: irritation of the sciatic nerve, tingling, numbness of the toes, muscle weakness, difficulty walking.
Autonomic disorders: wet, swollen skin, redness or pallor of the skin, burning sensation and heat in the legs. From the nervous system, radicular symptoms - paresthesia after prolonged sitting, decreased muscle sensitivity.
With the progression of the process, the algia becomes pulsating, tugging, the hip and lower leg hurt. L5 S1 intervertebral disc herniation gives knee pain that runs along the inner thigh; with strong pressure on the spine - backache in the leg.
Additional signs:
- it is difficult to straighten the back, it becomes inactive;
- legs are also difficult to straighten;
- palpation pain.
To reduce pain, the patient often changes posture, as a result of which scoliosis gradually develops. In advanced cases, urine outflow is disturbed, stool instability appears, and impotence is often diagnosed in men.
Diagnosis of intervertebral hernia
You need to start with a consultation of a neurologist. There will be an appointment for MRI, this examination gives complete information about the size of protrusions, the degree of narrowing of the spinal canal, the severity of inflammation, the presence of concomitant pathology.
CT of the spine is not so informative: it often distorts the size of protrusions and the results are incorrect.
Also, the doctor can prescribe an x-ray of the spine - he will not give information about the hernia, but will help to rule out diseases similar in symptoms.
Consequences for the patient
A person loses the ability to move. With horse tail syndrome, the function of the pelvic organs is impaired - there is urinary and fecal incontinence, impotence in men.
Treatment
Treatment of any type of vertebral hernia has one scheme. It includes:
- Glucocorticosteroids are often administered epidurally (Kenalog, Diprospan, Methylprednisolone) - once every 3 months.
- NSAIDs (Indomethacin, Ketoprofen, Diclofenac, Arcoxia, Dexalgin, Meloxicam) - used for less severe inflammation to reduce and relieve pain. They are also used locally in the form of ointments.
- Novocainic and lidocaine blockades, anesthetics can also have the effect of electrophoresis.
- Preparations for improving microcirculation are angioprotectors (Pentoxifylline, Actovegin, Trental).
- B vitamins in injections to speed up the regeneration process.
- To accelerate the growth of elasticity and the rapid healing of disk cracks - “Karipazim”, compresses with “Dimexidum”, “Bischofite”.
If no improvement has occurred within 6 months of conservative treatment, surgery is recommended.
Operation
The main methods of surgical intervention:
- Discectomy - complete excision of the disc through an incision along the midline of the back. In recent years, such an operation is performed endoscopically.
- Laminectomy - excision of the arch of the vertebra.
- Ligamentectomy - excision of the ligament of the vertebra with preservation of its arch.
- Chemonucleolysis - drying of leaked pulp with papain preparations.
- When compressing the spinal roots, an operation is performed to release them. This is especially shown in horse tail syndrome.
- Fusion - the disc is replaced with a bone graft from the patient’s pelvic bone.
- Laser disk decompression - a laser beam heats the hernia to 70 degrees, and the protruding pulp evaporates without touching the cartilage ring. The laser is applicable if the protrusion appeared and lasts about six months, no more.
The success of the operation largely depends on the postoperative period of rehabilitation. First of all, it is wearing a bandage and a minimum of physical activity for 2 months.
Rehabilitation period
It is marked by the elimination of pain and inflammation. It includes:
- physiotherapy;
- ;
- massage;
- manual therapy;
- Exercise therapy;
- diet;
- UVT.
Physiotherapy is possible only in half the cases and should be prescribed by a doctor (UHF, magnetotherapy, phonophoresis, hydrotherapy, balneotherapy, thalassotherapy). The latter is treatment with seawater, algae and the coastal climate.
Additional conditions for successful rehabilitation include:
- minimal physical activity;
- refusal of physical activity;
- alternation of heat and cold to the affected area;
- after 3 weeks - traction (spinal traction).
Sanatorium treatment is very indicated after completion of all procedures. It is advisable to carry out balneotherapy (radon, sulfide, turpentine baths), mud therapy.
Lifestyle after an acute period
It is necessary to protect your spine: do not carry heavy loads, do not overheat and do not overcool. Adversely affects the spine for a long stay in one position. Movement cannot be stopped, but twisting of the spine, sudden movements should be excluded. We must not forget about the hardening of the body.
Hernia prophylaxis
Preventive measures include:
- Moderately active lifestyle with the exception of high loads on the spine.
- Control of correct posture.
- Weight lifting exception.
- Daily walks.
- Swimming lessons.
- Sleep on orthopedic mattresses.
- Normalization of weight.
- The treatment of all chronic diseases.
Pathologies of the fibrous ring are a very dangerous phenomenon that can lead to disability. At the first unpleasant symptoms, you should immediately consult a doctor.