To understand what constitutes a Schmorl's hernia of the lumbar spine, you should understand the causes of its occurrence and the problems that this seemingly harmless, at first glance, change in the structure of the cartilage tissue of the vertebrae causes.
In the article we will try to find out the circumstances pushing for the development of the mentioned pathology, as well as the methods of its treatment and prevention.
What is the intervertebral disc? How is Schmorl's hernia formed?
The depreciation and mobility of the spine, due to the features of its structure, provides the intervertebral disc. It consists of a pulpous nucleus, which has a jelly-like consistency, and a fibrous ring that closes it.
If for some reason the system of uniform load distribution in the human spine is disrupted, then its individual motor segments begin to work for wear. Due to prolonged overvoltage, microcracks appear in the fibrous ring, and it can no longer hold the pulpous nucleus in the correct central position. As a result, different types of hernia are formed.
Most often, degenerative changes in the spine occur in the fourth and fifth intervertebral disc, since they are subjected to the greatest load. If in this case a disc is pressed into the vertebra, then this is a lumbar Schmorl hernia. If the core of the disc bulges outward, squeezing the nerve roots, they speak of an intervertebral hernia.
What is the difference between Schmorl's hernia and conventional intervertebral hernia?
The main difference between Schmorl's hernia from the usual intervertebral is that the nodules of the first of the above pathologies do not go beyond the spinal segment and do not appear in the lumen of the intervertebral canal. And this, in turn, does not cause pain from squeezing the nerve processes and spinal cord and does not lead to a serious restriction in movements, as with a normal intervertebral hernia.
But in this situation, there is a downside. Absolute painlessness and the absence of other symptoms in Schmorl's hernia in the vertebral bodies does not allow detecting it on time, although this disease quite often turns out to be a harbinger of kyphosis, the development of protrusion of the intervertebral discs, osteochondrosis or early intervertebral arthrosis.
In addition, the described pathology greatly increases the risk of compression fractures of the spine during heavy loads on it. Especially when it comes to its location in the front of the vertebrae.
More about the causes of Schmorl's hernia
Schmorl's hernia of the lumbar spine, as well as its other parts, as you probably already guessed, is caused by a decrease in bone density (this is possible with osteoporosis). But spinal injuries, vertical loads, posture disturbances or scoliosis can also provoke the appearance of this hernia, which, as a rule, is detected only by accident, during an X-ray or computed tomography examination of the spine in connection with other complaints.
By the way, adolescents are most exposed to it during the period of intensive bone growth. In them, as a result of lagging bone synthesis, voids can form into which the end plate falls, and behind it the intervertebral disc. The risk group also includes athletes with a constant vertical load on the spine.
Osteochondrosis, Schmorl's hernia - can they be connected?
Developing osteochondrosis can also be the cause of Schmorl's hernia. Osteochondrosis in medicine means the natural aging of the spine, that is, the degenerative-dystrophic process that occurs in its tissues. Naturally, the destruction of these tissues can lead to the appearance of such a pathological change as Schmorl's hernia of the lumbar spine or its other part.
The functions of the discs during this process are severely disrupted, which causes uneven distribution of the load on the bone structures and ligaments. This leads to forced compaction of the bone at the border with the disc and the formation of marginal bone growths, which are called osteophytes. They appear compensatory, to increase the area of the vertebra and reduce the load on it. This process is characterized as spondylosis.
But osteophytes also lead to back pain caused by irritation of the fibrous ring and ligament of the spine, which has many nerve endings. As a result of these changes, the already difficult blood supply to the structures of the spine is disrupted and venous stasis forms . And in the intervertebral joints in such cases, osteoarthrosis develops.
Varieties of Schmorl's hernia
Depending on how the disk is affected and where the hernia is located, it is divided into single, multiple, as well as front, center, side and back.
- A single lumbar hernia is more characteristic of the elderly and adulthood. True, in some cases, it can also develop in young people, as a consequence of the individual structural features of the whole body or separately vertebrae. In such cases, diseases are usually referred to as congenital pathologies.
- Multiple Schmorl's hernias are often associated with a violation of calcium metabolism in the bone tissue and hormonal changes, which can also lead to a decrease in its amount. The causes of this pathology include the development of osteoporosis. By the way, unlike a single hernia, multiple hernias can manifest themselves in an unclear pain syndrome, aggravating in a standing or sitting position.
What could be dangerous Schmorl's hernia?
As already mentioned, the described lumbar hernia most often does not cause pain, but can cause a deterioration in the condition of the spine and the whole organism as a whole.
As a result of Schmorl's hernia, the disc can almost completely fall into the spongy bone of the adjacent vertebra, which will lead to serious violations of its shock-absorbing function. In addition, this can cause bone growths called osteophytes, as a result of which compression of the nerve endings will nevertheless occur, and, as a result, the functions of the muscles or organs that they innervate will be impaired.
How to treat Schmorl's hernia?
Methods of treating Schmorl's hernia are selected by an orthopedist or therapist. If it is small, then there is no need for medical treatment. And in order to prevent possible complications, the patient is offered massage, therapeutic exercises, manual and physiotherapy.
At the same time, great importance is attached to physical therapy, which is carried out initially in the most sparing mode, for which swimming in the pool and gymnastics in water are used. And then, after strengthening the back muscles, reducing the load on the spine and improving its mobility, the intensity of the exercises increases and allows the patient to return to their previous physical activities.
With multiple hernias or their large sizes, chondroprotective drugs are prescribed. They prevent further changes in the spine, restoring the normal composition of its cartilaginous tissue. These drugs include Alflutop, Teraflex and Stoparthrosis.
Schmorl's hernia is a conditionally safe condition
As you already understood from the article, Schmorl's hernia of the lumbar spine is a condition that cannot be classified as completely safe. After all, in fact, this process is a specific warning about the weakening of bone tissues and their susceptibility to fractures, which, you see, is very serious.
Therefore, the presence of Schmorl's hernia can be safely considered a prerequisite for other, more severe and irreversible changes in the spine. So, the advice of the doctor who discovered this pathology in you should be followed, and the procedures prescribed by him should not be ignored, even if at the moment you do not feel pain or discomfort. Be healthy!