What is the difference between Schmorl's hernia from the usual in the understanding of most of us intervertebral hernia? Firstly, here it is not so much about the disease, but about the radiological term, which was first proposed by the German physician Christian Schmorl. In the picture, the scientist saw a pushing of the cartilaginous tissues of the locking plates into the body of the lower or upper vertebra, directly into the cancellous bone. The genetic nature of origin is attributed to this pathology, therefore it is formed most often in early childhood against the background of active secretion of growth hormone.
What is the difference from an ordinary intervertebral hernia
When a child grows, his soft tissues elongate faster, and bone tissue does not always keep up with the pace of development of muscle mass and ligamentous apparatus, so their values may slightly lag behind. As a result of this process, the formation of voids inside each vertebra occurs. With the passage of time, spongy vertebral plates are forced into the spongy bodies, which essentially these voids are. Schmorl's hernia differs from usual intervertebral education:
- location
- a pathological reaction in which the neurovascular plexuses are not involved;
- lack of compression of the cerebrospinal substance and roots;
- the paucity of clinical manifestations due to the formation of pathology involving only vertebral bodies and intervertebral discs;
- occurrence mainly in childhood and adolescence.
Is this disease dangerous?
First of all, the Schmorl hernia found in an X-ray can be considered a harbinger of the formation of an intervertebral hernia in the future, since without appropriate therapy, as it progresses, it quickly thinns the vertebrae, makes them unprotected and weak to the effects of physical factors (shock, long walking, weight lifting ) The consequence of this pathology can be a compression fracture of the spine.
Given that the intervertebral disc is involved in the development of the disease, over time it fails in the hernial sac, and this significantly interferes with the depreciation functions of the spinal column. In severe cases, it is this factor that can lead to disability. In addition, Schmorl's hernia of the vertebrae of any of the departments (lumbar, thoracic, cervical) is the cause of increased compression on the intervertebral joints. Young patients suffering from this disease are often diagnosed with degenerative changes in the joints, which indicate the initial stage of arthrosis.
Actually, due to its complications, such a pathology as Schmorl's hernia is dangerous. Neglecting the need for therapy in the absence of clinical manifestations, the patient risks facing irreversible consequences. In most cases, this problem is detected by random x-ray examination, which can be considered a huge luck for patients.
Causes of pathology
Modern medicine still finds it difficult to explain why Schmorl's hernia occurs in the lumbar, thoracic or cervical segment of the spine. But still, most experts agree on the causes of the disease, which may well be:
- Genetic predisposition of the patient.
- Structural features of the locking plates.
- Rapid growth of a child in early childhood or adolescence, which is accompanied by a lag in bone growth with satisfactory rates of cartilage growth. As a result, the formed voids in the vertebrae are filled with cartilage.
- Deficiency of calcium in bone tissue or insufficient assimilation of this microelement by the body.
- Violation of metabolic processes in the intervertebral disc.
- Excessive physical exertion, leading to microtrauma of the spine (during professional sports).
- Pregnancy. During the period of gestation, the woman's load on each section of the spinal column increases, but the chest and lumbar regions suffer most.
Schmorl's hernia is a completely natural consequence of a fall from a great height or a sharp increase in weight. In old age, the cause of the development of pathology of the spine can be the deformation of bone-cartilage structures against the background of the progression of osteoporosis. By the way, this disease, associated with a high risk of fractures, is also found in middle-aged women in the menopause.
In the lumbar spine, Schmorl's hernias can occur due to a deterioration in blood supply, which leads to a loss of strength of the vertebrae, which are simply forced through the intervertebral structures. Violation of the ridge blood supply occurs as a result of the development of stoop, kyphosis, scoliosis, Scheuermann-Mau disease. But most often, a lack of full-fledged motor activity and sedentary work lead to a similar problem.
Clinical picture
Symptoms of Schmorl's hernia are usually mild or absent altogether. The scarcity of the clinical manifestations of the disease can be explained by the fact that this formation:
- does not affect nerve roots and blood vessels;
- does not provoke an inflammatory process;
- not accompanied by muscle spasm.
As was said at the beginning, this pathology is more likely a radiological sign and is diagnosed by chance. Patients rarely experience pain, but even if an unpleasant symptom appears, it is local short-term in nature. For example, discomfort can be felt during physical exertion and disappears during rest, so patients often complain of decreased performance and physical activity.
In the lumbar
When palpating the area of the affected vertebra, the patient may feel slight soreness and muscle spasm. However, other neurological and vascular changes, as a rule, are completely absent. Therefore, the treatment of Schmorl's hernia of the lumbar region is not symptomatic, i.e. aimed at eliminating the clinical manifestations of the disease.
Pathology in the lower segment of the spinal column is usually not manifested in any way, rarely accompanied by muscle hypertonicity and tension in the lumbar region, discomfort and poor back flexibility. In isolated cases, Schmorl's hernia causes lower back pain that radiates to the legs. The appearance of a symptom is often preceded by increased physical activity. By the way, such a symptom can sometimes indicate a complication of the disease. As the pathology progresses, the intervertebral disc can completely fall into the cancellous bone, which, in turn, will serve as the basis for the dysfunction of the lumbar vertebrae. Given that the affected area is significantly weakened, the risk of a compression fracture increases. Especially dangerous for patients with Schmorl's hernia is:
- significant lateral load on the spinal column;
- strong stab in the back;
- compression of the ridge along the axis.
Identified pathology in the lower back requires serious and responsible treatment. Education can form on any segment of the spine. There are five vertebrae in the lumbar region. Compared with the vertebrae of other departments, these have the largest size. This is due to physiological characteristics: it is the lower weight that accounts for the maximum weight load. The doctor establishes a radiological diagnosis based on the localization of the occurrence of a hernia at the level of the vertebrae L1, L2, L3, L4 or L5.
Thoracic affection
Schmorl's hernia in the thoracic spine can form at any level, but pathology is much less common in this part of the spinal column than in the lower back or in the neck. Most often, it develops within the Th8-Th12 vertebrae and is asymptomatic, since only bone tissue is affected, and nerve roots are not affected at all.
At first, the pain syndrome may be completely absent, but as the hernia formation grows, the patient may notice increased fatigue of the whole body, tension in the thoracic region.
Treatment of Schmorl's hernia boils down to the elimination of secondary signs of pathology - disorders of the internal organs. With an increase in its size, often there is a rapid heartbeat, shortness of breath. After some time, back pain joins, which becomes noticeable during any motor activity and decreases, as soon as the patient relaxes, takes a lying position. Pain can be given into the hands, manifested by numbness and tingling in the shoulder, elbow.
Schmorl's hernia in the cervical spine
In this area of the spinal column, pathology often develops due to the softness of the cervical vertebrae. With small sizes, the formation in the cervical spine may not appear, but as soon as the pathology begins to progress, the patient will develop weakness, decrease working capacity, and pain in the neck-shoulder collar will become permanent. Most often, the development of the disease is due to a change in the size of the hernia or the addition of additional complications associated with impaired cerebral circulation. Patients with Schmorl's hernia in the cervical region often complain of severe headache and drowsiness.
How to recognize a disease
The primary diagnosis of Schmorl's hernia is based on the principles of:
- a detailed description of patient complaints - the presence of a pain syndrome, its exact or approximate localization, the relationship of symptoms with physical activity or being at rest;
- medical history - it is important to find out if one of the close relatives of the hernia suffers, whether the patient had previous spinal injuries, etc .;
- visual examination and palpation along the ridge - the doctor assesses the condition of the spinal column, including possible curvature or swelling of the soft tissues.
Compulsory examination methods in cases of suspected spinal disease include radiography. By the way, this is a fundamental method for making a diagnosis. A more informative alternative to it is MRI, CT. A vertebrologist can also refer a patient to an orthopedist and a neurologist for advice.
Schmorl hernia treatment
The spine with identified usurative defects requires complex therapy, taking into account the gender, age of the patient, the characteristics of his professional activity, the severity of the pathological process. The course of concomitant chronic diseases is also taken into account. Starting treatment for Schmorl's hernia of the thoracic or lumbar spine, the doctor sets the following tasks:
- Eliminate pain (if any).
- Run metabolic processes in the bone tissue.
- Improve blood circulation in the muscles of the back.
- To restore the flexibility of the spinal column.
- Eliminate muscle spasm by taking muscle relaxants.
- Prevent the development of complications.
In the predominant number of cases, the treatment of spinal diseases is carried out conservatively. The goal of treating Schmorl's hernia of the lumbar is to strengthen the musculoskeletal system, which can be achieved with a number of recommendations and medical prescriptions.
Special medicines that are intended for the treatment of this disease of the spine do not exist. However, symptoms can be controlled with anti-inflammatory and pain medication. With Schmorl's hernia, patients are prescribed:
- Dicloberl;
- "Nimesil";
- Movalis
- Diclofenac
- Ibuprofen
- "Dolarn."
In addition to these drugs, sometimes tools are used to strengthen the bone skeleton. These include calcium-containing agents (for example, "Calcitonin", "Alostin", "Miacalcic"), fish oil. It is important to consider that medications that strengthen bone tissue can adversely affect the work of the kidneys, so before treating Schmorl's hernia of the lumbar, you should make sure that there are no contraindications, consult with your doctor.
With a hernia of this type, surgical treatment is not carried out, but in case of a complication, which is a direct indication for surgery, the final decision on the operation is made by the patient. If Schmorl's hernia was transformed into an intervertebral hernia or a compression fracture of the spine occurred, as a result of which the patient's condition worsened significantly, surgery will be the only way to prevent disability.
Additional measures of therapy and prevention
In addition to drug treatment, a balanced and balanced diet is of no small importance for the patient. A diet aimed at strengthening bone tissue should consist of protein products. It is necessary to consume fermented milk drinks, milk, low-fat varieties of meat and fish, tofu cheese. In this case, the intake of salt into the body must be minimized. In diseases of the spine, including Schmorl's hernia, you should keep your weight under control, since excess body weight is an additional burden on the vertebral back. In addition, for the patient it is important:
- Do not engage in sports involving riding a motorcycle, diving, lifting and carrying heavy loads.
- Regularly perform supporting exercises from the physical therapy complex. This method allows you to strengthen the back muscles and improve its flexibility.
- Take a course of therapeutic massage. With each session, the patient will be able to feel better, as the massage normalizes blood circulation and pain, relieving spasm of the back muscles.
- To lead a healthy lifestyle that does not allow smoking and drinking alcohol. Bad habits lead to impaired blood circulation and tissue trophism.
Treatment of Schmorl's hernia with folk remedies is ineffective, but in some cases, doctors recommend supplementing drug therapy with the use of natural compounds for muscle relaxation and eliminating uncomfortable sensations in the affected spine.