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Disc herniation: what it is and what it consists of

Discal hernia is the displacement of part of the intervertebral disc from its position, which usually causes nerve compressions . Due to the anatomy of the spine, it usually occurs at the lumbar level, being the main cause of low back pain .

It is a very common pathology in our environment, being one of the main reasons for pain consultation. In addition, since it usually affects adults of working age, it is one of the main reasons for absenteeism at work .

Anatomy of the spine

Between the vertebrae of the the intervertebral disc. It is a cartilaginous pad , which allows the articulation between the vertebrae and, therefore, the movements. This intervertebral disc is formed by:

  • The fibrous ring , external, like a capsule.
  • The nucleus pulposus inside the ring. Its chemical composition (mucopolysaccharides, water …) give it a gelatinous nature.

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How is it produced?

Disc herniation: what it is and what it consists of

First, note that, naturally and as a result of the passage of time, the intervertebral disc degenerates . Over the years, the disc becomes dehydrated and suffers small fissures, which may not evolve, or lay the foundations of a hernia.

When this capsule fragments and breaks, it usually does so at the weakest points of its anatomy. These are the points near the exit of the nerve roots. For this reason, when the nucleus pulposus herniates, it does so at these points and presses the nerves. As a consequence of this pressure, the characteristic symptoms of pain and numbness occur.   In most cases, although not all, hernias are a result of:

  • Repetitive activities in the same position.

The herniated discs are produced by the displacement of the nucleus pulposus, which compresses the nerves. This is what causes the symptoms of herniated disc.

Who is affected?

  • It can affect both sexes, and appear at any time of adult life. Even so, it is typical of males around the age of 40-45. This is because, generally, it is during this period that people reach their maximum work.
  • Some factors such as obesity or smoking influence their development, increasing the chances of suffering it. Another important factor is the job that is performed, being more frequent in people who spend many hours standing or in forced positions.
  • It is more common in people with connective tissue diseases , such as hypermobility and Ehlers-Danlos syndromes .

Clinical manifestations of the herniated disc

Disc herniation: what it is and what it consists of

Facing clinical manifestations, there are two facts that should be highlighted:

  • Not all herniated discs produce symptoms. Likewise, in cases where they do appear, they do not have to be the same in all people.
  • The symptoms that appear depend on the point of the column in which the hernia occurs, being more severe in the lumbar area than in the rest of the spine.

What symptoms are the most frequent?  

Hernia in the lumbar vertebrae

  • Pain in the lumbar region (low back pain) that usually extends to the buttocks, legs and feet ( sciatica ). The intensity is very variable, as is the degree of disability it causes. Even so, it is one of the main causes of both absenteeism and consultation in our environment.
  • Nervous compression at this point often causes sensations of tingling and numbness in the legs and feet.
  • Very often it is accompanied by muscle weakness in the lower extremities (feelings of “not standing up”).

Hernia in the cervical vertebrae

  • Pain in the neck and shoulders, extended to the arms and hands. In the same way, the intensity and the degree of disability are very variable from one person to another.
  • It is usually accompanied by numbness and tingling in the hands and fingers , even loss of sensation.
  • Headache and dizziness are relatively frequent (“cervical dizziness” and not “ear dizziness”)

Hernia in the vertebrae of the thorax

  • Pain in the back and chest, accompanied by tingling and numbness.
  • Loss of strength and sensitivity in the lower extremities.
  • Alterations when defecating , urinating or in the sexual area.

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Diagnosis

Apart from the clinic referred by the patient, as well as a detailed history (habits and employment, especially), magnetic resonance has proved to be the most useful tool for the confirmation of the herniated disc.

In many cases, with the referred symptoms and the situation of the patient is sufficient to make the diagnosis. However, if confirmation is required, magnetic resonance imaging provides the best perspective. This is because it allows to observe and analyze nerve structures in detail, confirming or ruling out possible pathologies.

  Treatment

Disc herniation: what it is and what it consists of

Fortunately, many of the cases are solved with pharmacological treatment and rehabilitation, without the need for surgery. As for the conservative treatment (non-surgical), this is based on different rehabilitation techniques. Some of them are:

  • Ozone therapy and combination magnetotherapy have shown very beneficial results for patients. The evidences obtained in the studies encourage to continue with the investigation of both as a possible therapeutic.
  • Physical therapy, usually combined with some other rehabilitative method.

Regarding surgical treatment, it will depend on the location, the age of the patient, associated pathologies, etc. In recent studies, microsurgery has had great results.

Bibliography

  1. Aroche Lafargue Y, Pons Porrata LM, De la Cruz De Oña A, González Ferro I. Pathogenesis, clinical picture and imaging diagnosis by magnetic resonance of herniated discs. 2015. Available at Scielo:
  1. Spine Health (internet). Available at:
  1. Medtronic (internet). Available at:
  1. Herrera Santos MB, Valenzuela Fonseca L, Álvarez Cortés JT. Ozone Therapy and Magnetotherapy in patients with herniated discs. MEDISAN 2016. Available at Scielo:

 

Disc herniation: what it is and what it consists of

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