I. What is protrusion drives
Intervertebral disc protrusion – pathological process in spine, at which intervertebral disc protrudes into the spinal canal without breaking the fibrous ring. It is not an independent disease, but one of the stages of osteochondrosis, followed by a hernia. Most often localized in lumbar and less often – cervical divisions.
In fact protrusion from the hernia distinguishes the state of the fibrous ring, which limits and suppresses the pulpous nucleus of the intervertebral disk. If this ring maintains integrity and structure disk not broken then takes place protrusion. If the ring is broken and part disk fell out – this is a hernia.
There are many reasons for the destruction of the fibrous ring – weight lifting, lack of physical exertion, physical and psychological overload, nervous stress, overwork, lack of trace elements (chondroitin, glucosamine, calcium …), osteochondrosis, scoliosis, kyphosis other
Protrusion intervertebral discs (PMD, from the Latin protrudere – to speak for.) Is called protrusion intervertebral disc beyond the limits spine without breaking the annulus.
Protrusion disk is one of the most common forms of dystrophic disorders and the initial stage of the formation of a hernia in the intervertebral disk. At all stages of the development of the disease, the internal fibers in the fibrous ring are damaged. But there is no gap in the outer shell. The ring goes beyond intervertebral disc, forming a ledge. The size of the protrusion is from 1 to 5 mm. A bulge of 1-3 millimeters is still considered harmless and most often does not give symptoms. But when the pulpous nucleus protrudes beyond the fibrous ring to a distance of 5 millimeters or more, protrusion causes the patient discomfort. As a result, irritation (compression) of the nerve roots occurs and pain occurs, which is non-permanent (intermittent) in nature, which is explained by the varying degree of nerve irritation at different body positions. Because the main danger of bulging, or prolapse disk consists in the compression of the spinal cord, and the magnitude protrusion may be significant, it is almost as dangerous as a hernia.
Ii. Causes protrusion disk
Most often this pathology (PMD – protrusion intervertebral disk) occurs in lumbar department spine, which is explained by the fact that this department accounts for the biggest burden. Education mechanism protrusion consists primarily of dystrophic changes in the fibrous ring disk, which leads to its gradual cracking, loss of elasticity and flattening. Violations affect the pulpous nucleus, which dehydrates and loses volume, and then under the pressure of bodies. vertebrae begins to go beyond its normal position. The bottom line is that the intervertebral discs do not have blood vessels, they get all the nutrients through diffusion from neighboring tissues. If for some reason diffusion does not occur (for example, due to the absence of physical exertion), then the intervertebral disk begins to "starve", which becomes the cause of the emergence of degenerative processes.
The reason for which appears protrusion disk spine, first of all is osteochondrosis, when there is a lack of water, trace elements and amino acids. In its general sense, protrusion formed as a result of osteochondrosis and leads to a deterioration of the elasticity of the disks and reduce their height.
The following factors can provoke the development of PMD:
- Osteochondrosis, caused by age changes – this is the main reason protrusion discs;
- Injuries spine;
- Curvature spine – hyperkyphosis, scoliosis, kyphoscoliosis;
- Genetic predisposition;
- Excess weight;
- Inadequate, excessive loads on spine;
- Wrong position when lifting weights;
- Wrong posture;
- Insufficient development of the muscular frame;
- Violation of metabolic processes in the body;
- Age changes;
- Severe infectious processes in the body.
Stress on spine depends largely on the position of the body. For example, when lifting in a bent position, its pressure on lumbar department 10 times its weight. And if you think that the maximum pressure on lumbar spine happens in a standing position, you are mistaken! In fact, with an average weight, in the standing position, it is 70-80kg, and in the sitting position – 140 kg, that is, twice as much! The pressure on the edge disk increases by 11 times! This shows how harmful a sedentary lifestyle is and how much it contributes to the formation protrusion disk.
Iii. Symptoms protrusion disk
As a rule, many cases protrusion are asymptomatic, especially at the very beginning of its formation. But in the absence of due attention, this is fraught with serious consequences. Protrusion represents an early stage of development of a herniated intervertebral disk. How to determine the symptoms of "asymptomatic" disease?
As we said protrusion may develop for a long time without showing symptoms. Only at that moment when protrusion “Gets” to the nearest nerve endings, symptoms characteristic of this disease will appear. In this case, at first the pain can be quite weak, and the patient will “ignore” her “successfully”. But after a day or two, the pain will intensify and start seriously bothering the person.
Symptoms of the disease "protrusion"Depend on its size and location. It is the intensity of the symptoms that indicate the true cause and severity of the disease.
Characteristic symptoms that make one suspect the presence of protrusion:
- acute or chronic pain in the neck, lower back or in the area thoracicspine;
- radiating or migrating pains;
- weakening of the muscular system and loss of muscle elasticity;
- disturbances of sensitivity in the upper and lower extremities (tingling, "crawling goosebumps", etc.);
- stiffness and burning sensation in the cervical, thoracic, or lumbar department spine;
- headaches, dizziness, decreased vision and hearing.
BUT. Symptomatology protrusion disk is quite individual. It depends on the location and cause of damage. disk. Therefore, for effective treatment, an accurate diagnosis using neuroimaging techniques (MRI or CT) to differentiate from other diseases that give similar symptoms.
There are the following manifestations protrusion, which is largely due to its localization and the nature of the protrusion:
one. Protrusion disk at cervical spine
Cervical spine It is very mobile and is responsible for the stability of the position of the head and the elasticity of movements in the neck. In this department spine seven vertebrae, between which are intervertebral discs. When wearing discs appear protrusion, which can cause compression of the spinal cord or roots. Protrusions at cervical prone to the development of complications, provoke overload spine and the development of multiple protrusions (and subsequently – intervertebral hernia).
- local pains in the neck of an acute or chronic nature;
- headaches, dizziness;
- mobility restriction neck;
- pain radiating along arm;
- tingling, numbness in the hand;
- muscle weakness in the shoulder and arm.
Patients can be treated for years from other ailments, and not identified in time. protrusion will gradually progress, and may lead to disability.
2 Protrusion disk in the thoracic region spine
Protrusions in the thoracic region spine quite rare. The point is mobility vertebrae in the thoracic region is significantly lower than in the cervical or lumbar, therefore, the possibility of excessive exposure to the discs is much less. But, nevertheless, a certain amount of movement is still there, and during disc degeneration protrusion.
The following symptoms are possible:
- stiffness in the back or soreness;
- discomfort, acute or chronic pain in the area thoracicspine;
- intercostal space pain or between the shoulder blades, intercostal neuralgia;
- sensitivity disorders (numbness, tingling in the chest and abdomen);
- disruption of the organs located in the chest and abdominal cavity (liver, heart, etc.);
- weakening of the abdominal muscles.
Symptoms of the disease depends on the location protrusion and the extent of its impact on nearby nerve fibers and roots.
3 Protrusion disk at lumbar department spine
Most often protrusion arise in lumbar department spine. This spine suffers most often due to a large load (the center of gravity of the body is in lumbar department) and a large amplitude of movements. As a result, lumbar discs are more prone to damage and the appearance of protrusions. The situation is aggravated by age-related degenerative processes.
With bulging intervertebral disc there is an irritation of nearby spinal structures and characteristic symptoms occur:
- acute or chronic back pain;
- back pain turning into buttocks and leg;
- stiffness and soreness in the lumbosacral area;
- lumbosacral radiculitis;
- weakness in the calf muscles and thighs;
- irradiation of pain in one or both legs;
- cold feet;
- violation of sensitivity (numbness, tingling, feeling of "crawling goosebumps") in the lower extremities, in the pelvic region and groin;
- in rare cases – disorders of the urinary and reproductive organs.
As you can see, most of the symptoms are neurological in nature and are associated with compression of the roots of the spinal cord. This is what causes pain along the entire nerve, which is compressed.
Iv. Stages of protrusion formation
Protrusion intervertebral disk (PMD) in clinical practice is much more common than a hernia (prolapse), because, in fact, is its intermediate stage after which, following the ejection of intervertebral disk, the fibrous ring ruptures and the elements of the pulpal nucleus fall into the spinal canal.
Disk formation protrusion is rather long and consists of three successive stages:
- At the first stage, as a result of degenerative processes, up to 70% of the structure is destroyed. intervertebral disc. It flattens, loses elasticity, cracks appear in the fibrous membrane. The resistance in the disk gradually increases, and its base – the pulpal nucleus – slowly moves to the side with less resistance. At this stage, the person experiences pain, however, the discomfort is local, there is a moderate muscle spasm, static-dynamic changes can occur.
- In the second stage, the formation of the protrusion begins. disk – this and the network itself protrusion intervertebral disk. The pulpous core moves from the center to the edge, because of what happens stretching fibrous ring fibers. Prolapse reaches 2-3 mm, causing intense pain and marked discomfort in the area of the damaged disk. In this case, there is a violation of sensitivity, a slight asymmetry of the reflexes. Pain syndrome becomes more intense, unpleasant sensations are spreading not nearby areas. The musculo-tonic syndrome and disorders of motor activity are moderate.
- The third stage is characterized by a significant protrusion of the contents. disk. This is the last stage, preceding the rupture of the fibrous ring and the formation of intervertebral hernia. Characterized by acute, radiating pain and minor neuralgic disorders (eg, numbness of the extremities).
V. How to recognize protrusion
Protrusions intervertebral disc can occur in both children and adults. Age-related degenerative-dystrophic changes in spine actually lead to the fact that true hernia intervertebral disc in people older than 40 years develops quite rarely (they are more common protrusion disk, which is often equated with hernia). Intervertebral disc protrusion causes problems in two ways. In addition to the mechanical effects on the nervous structures through microcracks from disk There are inflammatory mediators that cause their chemical irritation. The combination of these factors leads to pain, weakness, numbness of the part of the body that this nerve innervates.
It is very important to pay attention to painful symptoms in the back. After all, as it happens, we have pain in the back can often occur after a busy day or after physical exertion, and therefore is perceived as something habitual and commonplace. It seems to us that this is just at the end of the working day something somewhere pulls and whines, hurts the back. We think that we were just tired at work, we were overworked in the country, we sat a lot or stood for a long time. For this reason, we independently diagnose and self-medicate as confidently. At the same time, unfortunately, we forget that if you seek help from a specialist in time, you can get by with simple methods of treatment and avoid many problems. After all, the final diagnosis can only be made by a specialist after passing a thorough diagnosis.
Diagnostic research methods aimed at differentiating protrusion from other diseases that have similar symptoms, and to identify the cause of the disease. First of all, a detailed history is collected and a physical examination of the patient is carried out. The use of special manual tests allows to determine the violation of the functions of the vertebral motor segments, the violation posture, altered muscle tone and impaired limb sensitivity. If you suspect protrusion or intervertebral hernia, the patient is assigned additional methods of examination: MRI, CT, X-ray, ultrasound and some others – at the discretion of the doctor. X-ray studies help to establish the degree of degenerative and deformation changes. Magnetic resonance imaging (or CT) allows you to clearly visualize the compression of the nerve bundles. The degree of damage to nerve fibers can be assessed using electromyography (EMG).
Vi. Classification of intervertebral protrusions disk
Traditionally protrusion classified according to their type, type of protrusion and location.