Alternative names: intervertebral hernia, disc herniation of the spine, a herniated disc, prolapse of the disc.
The spine consists of the vertebrae and disks. The intervertebral discs are located between the vertebral bodies. Their main function is the cushioning of the spine during physical activity and ensure the stability of the adjacent vertebrae in the spinal motion segment (SMS), in other words: functional spinal unit (FSU). In addition, owing to their elasticity, the discs are the major factor of determining the flexibility of the spinal column.
(SMS or FSU is a term denoting a functional unit of the spine and represents the articulation of two adjacent vertebrae with the disc between them plus the surrounding ligaments and muscles).
Human body has 23 intervertebral discs. The first is between the bodies of the second and third cervical vertebrae (C2-C3) and the last is between the bodies of the fifth lumbar vertebra and first sacral (L5-S1).
Anatomically, they are represented by fibrous and cartilaginous substance as a discoid shape (hence the name is). The disc's diameter is about 40 mm. The thickness of it depends on the part of the spinal column, (on average is 4-10 mm). The largest disc size is detected in the lumbar spine, the smallest is in thoracic spine.
The disc consists of three parts: a very strong fibrous ring (annulus fibrosus), inside of which is lying gelatinous (jelly-like) substance, which is called the nucleus pulposus. It is believed that the core is the main absorber of the spine. Inter-vertebral discs separated from the vertebral bodies by a thin hyaline cartilage (end plates of vertebra). They have a dual purpose: on the one hand, they protect the spongy bone of the vertebral bodies from excessive pressure caused by the nucleus pulposus during the load and on the another hand, the cartilage plates of the inter-vertebral discs receive nutrients and they continuously renew the liquid portion of nucleus pulposus.
It is considered that the core of intervertebral disc is the main shock absorber of the spine.
From the adjacent vertebral bodies, intervertebral discs are separated by a thin hyaline cartilage (end plates). These end plates have a dual purpose. On one hand, they protect the cancellous bone of the vertebral bodies from excess pressure coming from the nucleus pulposus when a heavy load is applied. And, on the other hand, through the cartilage plates in the intervertebral disc, nutrients are received, and there is a continuous update of the liquid portion of the nucleus pulposus. The chemical exchange in the disc visibly improves during movement of SMS by increasing blood flow to the surrounding muscles and ligaments as it doesn’t possess its own vascular system.
The innervation of the intervertebral disc happens due to the autonomic nervous system. Metabolic disorders have a negative effect on the connective tissue structure of the disc, reducing the strength of the fibrous ring. Herniated disc (HD) is a condition when there is a rupture of the fibrous ring of the nucleus pulposus and beyond its boundaries. With the loss of the liquid contents, the vertical size of the disc is reduced. This leads to the convergence of the vertebrae to strengthen the facet joints when there is a load put on the spine. Migration of the disc’s contents, as a rule, is usually accompanied by aseptic inflammation, muscle tension, swelling, and pain.
In cases where there is penetration of fragments of the nucleus pulposus through the damaged endplate in the vertebral body suggest hernia Shmorlya. With such a painful process, the disc is not displaced in relation to the above and below laying vertebral bodies, and has no effect on the nerves or the spinal cord.
The illness (HD) is preceded by a disc protrusion—a disc with one of its sides bulging. During this, the displacement of the nucleus pulpous doesn’t occur beyond the fibrous ring.
It is believed that the cause of the spinal disc herniation is osteochondrosis, spinal curvature (scoliosis, kyphosis, lordosis), weakness of the surrounding muscles, excessive heavy lifting, sedentary lifestyle, being overweight, and/or combination thereof. However, there is evidence (Bengus L.M., Dedukh N.V., 2012) that preceded the appearance of hernia degenerative changes of the fibrous ring due to the disturbance of the feeding of disc while a heavy load on the spine is the cause. In this case, the degree of the load may not exceed the typical amount for that person. Thus, the main causes of spinal disc herniation are: osteochondrosis, the trophic systems disorders of the disc, and chronic, local overload of the spine. Via localisation, you can distinguish different types of hernia in the cervical, thoracic, and lumbosacral parts of the spine. In some cases, the disc prolapse can be in several areas (e.g. in the cervical and lumbar), which isn’t so rare.
Hernia of the cervical spine, according to various sources, can appear 4-19%. It is believed that the cause of a cervical osteochondrosis is the prolonged stay in a static position with an offset head forward. This leads to increased cervical lordosis, long-term overload of the neck muscles, compensation of the nerve roots and intervertebral disc deformation (e.g. when working on the computer). Clinically speaking, the disease can manifest as a pain in the neck, stiffness of muscles, headaches, dizziness, unstable blood pressure, problems with the sensitivity in the upper limbs, etc. The symptoms characteristic of cervical osteochondrosis and “symptoms of loss” are observed during the compression of the nerve root.
The thoracic spine hernia appears 2-30% of the time. There are constant chest pains that increase during movement.
60-85% of lumbosacral hernia cases are associated with the highest load on the spinal column. It can manifest and form into lumbodynia—a dull, aching pain in the lumbar region that increases during exercise. The pain may spread to the buttocks area, back of thigh, and lower leg. This is characteristic to the sharp increase in pain when coughing and sneezing. To reduce the pain, patients were forced to adapt an antalgic posture (reflective scoliosis). In addition to these symptoms, there may be numbness in the lower extremities: numbness, tingling, burning. Trophic disorders manifest as loss of muscle mass and decreased muscle strength. The disturbance of innervation may be one of the causes of the disease of large joints (knee and hip) with development of deforming arthrosis (gonarthrosis and coxarthrosis). In severe cases, this impairs the function of the pelvic organs (Cauda equina syndrome, CES) with urination disorder, bowel movements, and can cause paralysis of the lower limbs. There is also a decrease of potency in men. To reduce pain, patients were forced to take a gentle pose or antalgic posture (reflexive scoliosis). Various clinical manifestations of intervertebral hernia of the lumbar spine.
To reduce pain, patients were forced to take antalgic posturegentle posture – (reflexive scoliosis.)
Various clinical manifestations of intervertebral hernia of the lumbar spine.
Additional pages:Intervertebral herniation (Hernia of intervertebral disk) Arthrosis deformans of the hip and knee joints (Gonarthrosis) Coxarthrosis
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