Schmorl's hernia of the lumbar spine
The content of the article:
- Causes and risk factors
- Forms of the disease
- Symptoms of Schmorl's hernia of the lumbar spine
- Diagnostics
- Treatment of Schmorl's hernia of the lumbar spine
- Possible complications and consequences
- Forecast
- Prevention
- Video
Schmorl's hernia of the lumbar spine - pushing the own tissue of the intervertebral disc into the cancellous bone of the vertebral body (intraspongy protrusion) through the border hyaline plate that separates the base of the vertebra from the body of the disc.
Manifestation of Schmorl's hernia of the lumbar spine
This is the so-called X-ray pathology (due to the absence of obvious symptoms due to a peculiar localization). The disease is usually diagnosed in the course of x-ray or tomographic examination for other conditions and is often an accidental finding.
A herniated disc is understood as the protrusion of its jelly-like center through defects in the dense form-forming connective tissue ring located along the periphery. In this case, the jelly-like substance of the central part of the disc, breaking through, squeezes the sensory or motor roots of the spinal cord, which lie in pairs between the vertebrae, and provokes the development of specific symptoms.
The phenomenon of Schmorl's hernia consists in the fact that the elements of the disc or fibrous ring are squeezed out not outward, but inside the body of the nearby vertebra. Since the main manifestations of disc herniation are associated with compression of the spinal roots, in this case, active symptoms are usually absent.
Despite the fact that the reliable prevalence of the pathology has not been established, it is assumed that Schmorl's hernias of various localization are present in approximately 40% of the population. The disease often affects the lumbar spine, which is associated with a local intense load on the axial skeleton.
Synonym: Schmorl's nodules.
Causes and risk factors
The main reason for the development of Schmorl's hernias of the lumbar spine is considered to be the pathology of the connective tissue that occurs during the formation of the structures of the axial skeleton. Defects often form during the second acceleration of the child's growth, when uncharacteristically thickened cartilaginous nodules appear, which are more dense than the structure of the connective tissue ring of the intervertebral disc. In the process of development, these structures, putting pressure on the nearby vertebral bodies, push them, forming Schmorl's hernias.
Causes of the disease:
- congenital connective tissue pathology;
- traumatic injury to the border hyaline plates;
- dystrophic changes in the bone tissue of the vertebrae;
- inadequate loads on the lumbar spine.
Provoking factors:
- prolonged forced position of the body with a load on the lumbar region of the axial skeleton;
- the intensive growth of the child during adolescence;
- elderly age;
- wearing shoes with excessively high heels;
- professional weightlifting, acrobatics, parachuting and other sports that can provoke skeletal microtrauma;
- work in production related to weight lifting;
- posture disorders;
- pregnancy;
- metabolic diseases.
Weightlifting is a provoking factor in the development of Schmorl's hernia
Forms of the disease
Depending on the prevalence of the process, single and multiple Schmorl's lumbar hernias are distinguished.
Symptoms of Schmorl's hernia of the lumbar spine
The disease is usually asymptomatic or with very few symptoms. Patient complaints are non-specific:
- feeling of discomfort or aching non-intense pain in the lumbar spine;
- increased discomfort during exercise and their weakening (up to their complete disappearance) at rest;
- decreased mobility of the lumbar spine.
An objective examination may reveal insignificant pain on palpation in the projection of the defect, local muscle hypertonia.
The defeat can occur in any of the 5 lumbar vertebrae; the pathological process does not have a favorite localization.
Patients with Schmorl's hernia complain of aching pain in the lumbar spine
In severe cases, when a significant volume of the intervertebral disc is pushed or completely sank into a nearby vertebra, the symptoms of Schmorl's hernia of the lumbar spine become much more intense:
- severe pain during exercise;
- violations of mobility (inability to perform flexion and extension movements in the lower back in full);
- dull aching pains in a position with an inclination forward, with prolonged standing or sitting;
- increased fatigue of the lumbar spine, a feeling of stiffness;
- impaired sensitivity or motor activity in the lower extremities.
Diagnostics
The main diagnostic methods are instrumental studies:
- X-ray of the lumbar spine;
- computed or magnetic resonance imaging.
Schmorl's hernia of the lumbar spine on an X-ray
Using laboratory research methods, it is not possible to confirm the presence or absence of pathology.
Treatment of Schmorl's hernia of the lumbar spine
Treatment of Schmorl's hernias is complex: physiotherapeutic and medication methods are used.
Groups of drugs used in the treatment of the disease:
- muscle relaxants of central action;
- non-steroidal anti-inflammatory drugs;
- vitamin and mineral complexes.
Physiotherapy activities:
- physiotherapy;
- acupuncture;
- massage;
- electrophoresis with medicinal substances.
With Schmorl's hernia, therapeutic exercises are shown under the supervision of a doctor
In severe cases, with the ineffectiveness of conservative treatment of Schmorl's hernia of the lumbar spine and a high risk of complications, surgery is performed.
Possible complications and consequences
Complications of Schmorl's hernia of the lumbar spine can be:
- the formation of a hernia of the intervertebral disc of the lumbar spine;
- compression fracture of the affected vertebra;
- dystrophic degeneration of Schmorl's hernia with limited mobility of adjacent vertebrae.
Forecast
With timely diagnosis and complex treatment, the prognosis is favorable.
Prevention
Preventive measures are as follows:
- Systematic preventive examinations in case of risk factors.
- Timely comprehensive treatment of the disease if it is detected.
- Refusal of excessive loads when diagnosing Schmorl's hernias of the lumbar spine.
Video
YouTube video related to the article:
Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
