Sequestered Hernia Of The Spine: Symptoms, Treatment, Causes

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Sequestered hernia of the spine

The content of the article:

What is pathology
The reasons
How can a sequestered hernia manifest?
Possible complications and consequences
Diagnostics
Treatment
1. Conservative therapy
2. Surgery
Video

A sequestered hernia of the spine is one of the least favorable variants of this disease. Most often, hernias develop in the lumbosacral spine, less often in the cervical, extremely rarely, pathology occurs in the thoracic spine.

Sequestration of an intervertebral hernia is the last, advanced stage of the disease

What is pathology

Sequestration is a piece of dead tissue that is freely located among living tissues. Hernia sequestration is a violation of the integrity of the intervertebral disc with rupture of the annulus fibrosus and prolapse of the nucleus pulposus into the spinal canal, i.e., in the location of the nerves and hard membranes of the spinal cord. This is the last stage in the development of a herniated disc.

The reasons

The reason for hernia sequestration is the lack of treatment for the disease in its earlier stages. The reason for the development of intervertebral hernias may be the presence of congenital anomalies of the spine, osteochondrosis, overweight and obesity in the patient.

Risk factors include malnutrition, a sedentary lifestyle, excessive stress on the spine, hypothermia, frequent stressful situations.

How can a sequestered hernia manifest?

The main factors that determine the presence of clinical signs during sequestration of a herniated disc include:

the age of the patient;
sequestration localization;
localization of the hernia.

If the impact on the nerve roots and the spinal cord does not occur, the pathology may not appear in any way for a long time.

Symptoms depend on the location of the pathology.

Localization of hernial protrusion	Manifestations
Lumbosacral region	Patients usually experience pain in the back and lower extremities (buttocks, thighs, feet, and toes). The pain can increase with a change in body position, as well as with prolonged stay in one position, especially sitting. In addition, patients may experience a change in gait, a decrease in tendon reflexes, tension in the muscles of the spine, and convulsions.
Cervical	The patient may experience pain in the neck, headache, dizziness, weather dependence, numbness and tingling sensation in the fingers. The pain can radiate to the upper limb.
Chest	There is chest pain (aching or sharp), which can be aggravated by coughing, sneezing, trying to take a deep breath, or a change in blood pressure. With this type of pathology, symptoms may occur that mimic those of pneumonia, pancreatitis, cholecystitis, an attack of angina pectoris.

In the case when the prolapse of the nucleus occurred due to sudden movements, lifting weights and compression of the spinal cord and / or nerves with sequestration occurred, difficulties in movement (up to the inability to walk), autonomic disorders may be observed.

Possible complications and consequences

Against the background of this disease, chronic inflammatory processes can develop. With prolonged circulatory disorders, a change in the shape of the muscles can occur. In the case of the development of pathology in the lumbosacral region, antalgic scoliosis may occur.

In trauma, sequestration can be accompanied by complete destruction of the intervertebral disc. The most dangerous consequences of this condition include:

painful shock;
spinal shock;
cessation of breathing;
loss of sensitivity, paralysis of the limbs;
severe disorders of the pelvic organs.

With a severe course of the disease, there is a risk of the patient developing a cauda equina syndrome, which is characterized by:

disorders of the intestines, bladder;
numbness and paralysis of the lower limbs;
severe back pain that can radiate to the legs on one or both sides;
erectile dysfunction in men.

In some cases, neurological symptoms persist after the operation, which can occur with prolonged compression, which led to the development of irreversible changes in the structure of nerve fibers.

Diagnostics

To make a diagnosis, you need:

collection of complaints and anamnesis;
neurological examination;
laboratory tests (general blood and urine analysis, biochemical blood test, etc.).

The following methods are of high diagnostic value:

magnetic resonance imaging (MRI) - performed to visualize a hernia and detect compression of nerve structures;
electroneuromyography (ENMG) - allows you to determine the state of the peripheral nervous system.

If necessary, computed tomography, scintigraphy and other diagnostic methods are prescribed.

Treatment

Conservative therapy

Depending on the existing symptoms, the patient may be assigned:

anti-inflammatory drugs;
decongestants;
muscle relaxants;
drugs that improve local blood circulation;
analgesics;
neurometabolic stimulants;
vitamin and mineral complexes.

With severe pain, an epidural block may be necessary.

Epidural block allows to relieve severe pain syndrome during hernia sequestration

From physiotherapy methods are used:

magnetotherapy;
ultrasound therapy;
treatment with diadynamic currents.

Patients may be prescribed physiotherapy exercises, while exercises should be selected exclusively by the attending physician, and classes should be supervised by a specialist.

In the acute stage, bed rest is shown, sometimes wearing a bandage is required.

It is necessary to avoid bending the body forward and lifting heavy objects throughout the treatment period.

In the absence of effectiveness from conservative therapy, the question of surgery is considered.

Surgery

Indications for surgery:

sequestration size more than 10 mm;
strong compression of the nerve root and / or spinal cord;
spinal stenosis;
numbness of the limbs;
disorders of urination and / or defecation.

Contraindications;

exacerbation of a chronic disease;
heart disease in the stage of decompensation;
acute infectious and inflammatory processes in the body.

Types of operations for sequestered hernia:

Operative intervention	Description
Discectomy	Removal of an intervertebral disc together with a hernia using a minimally invasive (endoscopic) or open method
Percutaneous nucleoplasty	Impact on the nucleus pulposus of the intervertebral disc with cold plasma
Spinal fusion	Surgical intervention, in which the adjacent vertebrae are immobilized by fusion

After the operation, the patient may need to spend several days in the hospital. After the end of the course of treatment, rehabilitation and lifestyle changes are required. In the future, a person is advised to visit the pool, spa treatment. It is necessary to maintain a normal body weight.