Protrusion of the intervertebral discs, the symptoms, the treatment of which will be described later in the article, is a condition characterized by bulging elements without breaking through the fibrous rings. The violation is not considered an independent disease. Protrusion is one of the stages of osteochondrosis, and is also recognized by experts as the initial stage of the formation of a hernia in the intervertebral disc. Next, we consider this state in more detail. Particular attention in the article will be paid to protrusion of the lumbosacral spine.
Frequency of occurrence
According to statistics, protrusion develops in more than half of the population older than forty years. More often, the pathology is detected in men. The main risk group should include people engaged in physical work, as well as leading an inactive lifestyle, combined with sedentary work. In patients at an advanced age, protrusion, in connection with the development of degenerative processes, often provokes the appearance of an intervertebral hernia.
Localization
The most likely are two areas in the body. There is protrusion of the intervertebral disc of the lumbar spine. There are five elements in the segment (L1-L5). About 80% of cases are protrusions of the discs of the lumbar spine L4-L5, as well as L5-S1. The latter is a boundary element. In the region of seven cervical vertebrae, pathology is detected in C3-C4, as well as C4-C5. In other elements, lesions are detected much less frequently. As for the thoracic region, here violations develop between the D5-D6 and D6-D7 vertebrae.
Causes of pathology
A number of reasons determine the development of dystrophic changes in the fibrous ring and pulpous nucleus. These processes influence the structure of elements. As a result, the elasticity decreases and the quality composition deteriorates. Due to the wear of the hyaline cartilage , the flattening of the disc occurs, in connection with which the nucleus protrudes beyond the boundaries of the fibrous ring while maintaining its integrity. These processes may be the result of the following:
- Pathology of the musculoskeletal system of an innate nature (in children, for example).
- Osteoporosis.
- Bruises, bumps and other injuries.
- Changes in the intervertebral discs of a degenerative nature.
- Burdened by heredity.
- Kyphosis, scoliosis.
- Weak muscle corset.
As factors that provoke protrusion of the lumbosacral spine, it should be mentioned:
- Metabolic disorders.
- Overweight, improper diet.
- Hypodynamia (low mobility).
- A number of infectious pathologies.
- Chronic microtrauma.
- Excessive exercise.
- Pathologies of the organs of the nervous and endocrine systems.
Classification
Protrusions are divided according to the nature of the protrusion of the nucleus. In particular, the following types are distinguished:
- Circular. In this case, there is a bulging portion of the disk in a circle evenly. A pathological disorder often provokes pinched nerve roots. It is characterized by a chronic course.
- Diffuse. In this case, the protrusion is uneven, in one direction. With diffuse protrusion of the lumbosacral spine, a breakthrough in the fibrous ring is often noted. In the absence of adequate and timely therapy, the condition threatens with disability.
Depending on the direction in which the disk swells, protrusion types such as:
- Side. In this case, the protrusion occurs to the right or left of the spinal column. Most often provokes compression of blood vessels and nerves. At the initial stage, the condition may not be accompanied by any manifestations.
- Central. In this case, protrusion of the intervertebral disc occurs in the direction of the spinal cord. The main danger of this violation is the likelihood of contact with its roots.
- Posterolateral. In this case, the disk bulges first back, then sideways relative to the spine. The condition may not be accompanied by severe symptoms.
- The back. In this case, the disc protrudes backward. The condition is accompanied by severe pain and a violation in the innervation of organs in the small pelvis or chest (depending on the location of the damage).
Clinical picture
Depending on the localization, disc protrusions are distinguished:
- Lumbar spine.
- Thoracic area.
- Cervical.
Signs of a violation in the chest area:
- Sore back under the ribs.
- Tingling in the liver and heart.
- Weak muscles of the press.
- Soreness in the area of the shoulder blades or chest.
How is protrusion of the lumbosacral spine manifested? Symptoms of the condition are as follows:
- Limited back movement.
- Tingling, numbness and lower back pain.
- Lumbago in the leg.
- Weakness of the lower extremities.
- The spread of pain to the toes, legs, hips.
- Sensory disorder in the pelvic organs.
Symptoms of protrusion of the cervical spine:
- Darkness in the eyes, dizziness.
- Soreness in the neck and neck.
- Numbness in the upper limbs.
- Tight neck mobility.
- Spread of soreness to the shoulder, fingers and hand.
- Weakness in the upper limbs.
Common signs of pathology
At first, the manifestations of the patient’s disturbance are disturbed by soreness against the background of increased physical activity, staying in an uncomfortable position for a long time. With the initial appearance of protrusion of the lumbosacral spine or its other region, it is accompanied by vertebral (sciatica, lumbago, for example) and radicular (compression of nerves) manifestations. In the course of progression, the state of pain becomes more intense, acquires a aching, twitching character, and can manifest itself in the form of lumbago with sudden movements or during coughing. When tapping or palpating the damaged area, an increase in soreness, often giving in the leg, is noted. Muscle weakness gradually develops, marked dystrophy is noted.
Stages of formation
If the protrusion of the lumbar spine was not timely treated, then the pathology intensively progresses. Manifestations go through three stages:
- Violations in the functioning of the nucleus. At the same time, his position begins to change. There is a gradual destruction in the fibers of the fibrous ring with the formation of cracks in it.
- Bulging the core a short distance. It extends beyond the edges of the fibrous ring while maintaining its integrity and not more than three millimeters.
- Further bulging of the nucleus. The process is accompanied by compression of vessels adjacent to the disk, nerve roots, pain, backache. At this stage, a fibrous ring rupture often occurs. As a result, prolapse (hernia) is formed in the intervertebral disc.
Effects
Treatment of protrusion of the lumbar spine should be carried out in a timely and competent manner. Otherwise, the likelihood of developing complications is high. In particular, the mobility of the back or neck can be significantly limited, the physiological bending of the spine can be disturbed. In this regard, kyphosis or lordosis develops. Soreness can become permanent chronic. This, in turn, significantly reduces human performance. Prolapse (hernia) and complete destruction of the disc are considered a rather serious complication. In this condition, surgical intervention is necessary. If the operation is not performed on time, the person may remain disabled. With protrusion of the lumbosacral zone, there is a high risk of compression of the nerve roots in the pelvis (horse tail syndrome). This, in turn, can lead to a sensitivity disorder in the organs of this zone, the appearance of inflammatory processes.
Diagnostics
The main research methods include:
- Inspection and assessment of the sensitivity of zones of the limbs and back, the use of motor and neurological tests.
- Roentgenography.
- Collection of anamnestic data, including family.
- CT or MRI. These studies can identify the degree of atrophy of muscle fibers and assess the state of blood vessels.
- Electromyography. This procedure is used to examine root compression.
- Puncture of cerebrospinal fluid (in special cases).
In the course of differential diagnosis, it is necessary to exclude pathologies such as bone tuberculosis, ankylosing spondylitis, circulatory disorders in some arteries, and oncology.
Treatment of lumbar protrusion
The choice of a complex of therapeutic measures depends mainly on the neglect of the process. In other words, the distance that the intervertebral disc has shifted is crucial when choosing a treatment. If it is up to 4 millimeters (and for the cervical region no more than 1 mm), then bed rest and therapy in stationary conditions are recommended. Conservative methods are aimed at stopping the pain syndrome, eliminating puffiness, inflammation. Treatment helps improve blood circulation, relieve vascular spasm and restore muscle function. The following drugs are recommended for this:
- NSAIDs. These include, in particular, such medicines as Xefocam, Ortofen, Ketoprofen, Indomethacin, Naproxen, Movalis and others.
- Muscle relaxants. This category includes drugs such as Diazepam, Metaxalon, Midokalm, Orphenadrine. With the elimination of muscle spasm in many cases, the intensity of pain is significantly reduced.
- Glucocorticosteroids. These drugs include Methylprednisolone, Phlosterone, Diprospan. This category of drugs is used for the ineffectiveness of NSAIDs and muscle relaxants as a second therapeutic line. The most effective method is the introduction of drugs into the soft tissues.
- Chondroprotectors (Aflutop, Structum and others) and blood circulation improving drugs (Actovegil, Trental) are also recommended.