Low back pain is, in fact, a modern-day pandemic. Chronic back pain, most often manifested in the lumbar region, is the second leading cause of temporary disability and disability in the adult population.
From the point of view of pathomorphology, the following variants of the pathology of the intervertebral disc are distinguished:
- disc herniation;
- rupture of the intervertebral disc;
- degenerative disease of the intervertebral discs.
Despite the prevalence of herniated Neurology CRO changes in the intervertebral discs in the lumbar region, they are often found in the cervical and thoracic spine. For a better understanding of the pathology, it is useful to refer to a brief overview of the structure of the intervertebral disc.
Definition of intervertebral hernia (herniated nucleus pulposus)
Disc herniation is the inability of the distensible annulus fibrosus to hold the internal nucleus pulposus, causing it to become herniated, resulting in subsequent clinical symptoms.
Disc herniation is the inability of the distensible annulus fibrosus to hold the internal nucleus pulposus, causing it to become herniated, resulting in subsequent clinical symptoms.
The symptoms caused by a herniated nucleus pulposus can ultimately be attributed to the significant inflammatory response it causes within the spinal canal. Damage to the disc leads to an increase in the content of pro-inflammatory molecules involved in almost all stages of the immune response:
- interleukin (IL)-1 (a cytokine responsible for inflammatory responses);
- IL-8 (pro-inflammatory type protein);
- tumor necrosis factor (TNF)-α (a specialized protein designed to protect the body from foreign intervention (antigens) that increases inflammation).
Macrophages (professional phagocytic cells for maintaining and protecting tissues, detecting and absorbing foreign agents, initiating [if necessary] pro-inflammatory reactions) react to this displaced foreign material and seek to clear the spinal canal. Subsequently, a significant scar is formed and substance P is found, which is associated with pain.
In addition to the emerging cascade of inflammatory processes, a herniated disc also leads to a certain mechanical compression of the nerves, compression of the nerve root.
Herniated discs often result from degeneration of the intervertebral discs. After thinning, the nucleus pulposus leaves the central cavity in the direction of the nerve root. Intervertebral discs begin to degenerate by the third decade of life and develop in about a third of adults. However, only 3% of them are symptomatic. The most common sites of hernia are the vertebral regions - L4, L5 and S1
Symptoms
The beginning of the development of intervertebral hernias, as a rule, does not manifest itself in any way - it is latent. Subsequently, pain occurs in the affected area of the spine, where degenerative processes intensify, hernial bulging is localized.
The initial dull transient pains intensify over time, especially during exercise, movement, becoming constant, even in a state of complete rest in a lying patient.
Instinctively, the patient strives for sparing movements, protecting himself from possible excessive loads on the spinal column, limiting mobility. Along with pain, there are tonic muscle tensions. As the pathology progresses, these processes intensify, motor dysfunctions increase, further limiting mobility.
The pain becomes chronic, constant, there may be distortions of the spine, respectively, and the whole body, due to pronounced muscle tension from the formed hernia. As a result, an additional load on the spine and worsening of the clinical manifestations of the pathology.
Depending on the location - the vertebral section, where the intervertebral hernia has formed, it may have specific features, its clinical manifestation:
- with hernias of the cervical region, pain occurs in the neck, descending down the arm, up to the hand, a complex set of symptoms manifests itself due to narrowing (stenosis) of the lumen of the vertebral arteries, it is possible that the neck is curvature, a number of other characteristic manifestations that indicate the doctor to the true problem;
- with hernias of the thoracic spine, manifestations of symptoms similar to angina pectoris, stomach ulcers, and other somatic diseases are possible. Psychiatry CRO Possible gastric disorders (dyspepsia, intestinal dyskinesia, dysphagia (difficulty swallowing). Disorders associated with the pancreas, in particular, with limited secretion of enzymes, etc .;
- a hernia of the lumbar spine is characterized by lumbar pain shootings that constrain movement, interfere with a person’s motor activity (walking, tilting, etc.), a feeling of heat in the lumbar region or cold against the background of pain (lumboischialgia).
Symptoms may be motor (weakness, muscle tension, etc.) or sensory (numbness/paresthesias). In severe cases, there may be a loss of control over urination, bowel movements. Further progress of the disease causes complications.