Herniated disc (disc prolapse)

21 October 2017

© iStock

To the common symptoms count with a herniated disc:

When the back hurts suddenly strong, many think a little premature to a herniated disc. But in fact, is a herniated disc rarely known locally as lumbago - the cause of sudden back pain in the lumbar spine. 

In general: A herniated disc can, but does not necessarily cause symptoms.

If complaints arise and if so, which depends on between which two vertebrae is the disc affected and how severe the disease is. A slight herniated disc in which the nucleus expresses neither the nerves nor the spinal cord, is often only coincidentally discovered.

A herniated disc is a mostly wear-related Disease of the spine, in which a portion of the viscous core of the disc comes out. Thus, the disc deforms and can press might of the surrounding nerves or the spinal cord. 

Normally, the spinal discs serve as elastic buffer between the individual vertebrae of the spine. There they begin as small shock absorber Vibrations from. Inside there is a jelly-like core. Outer enclosing a cartilaginous fiber ring with adjacent longitudinal bands (anterior and posterior longitudinal ligament), this core.

With age, the elasticity of the spine decreases. Cracks occur in the cartilaginous fiber ring comprising the nucleus pulposus. persists burden (E.g., when lifting heavy loads) or by a one-sided load Poor posture the gelatinous core pushes from the inside of the disc into the cracks before and pushes them apart - the disc deforms.

the fiber ring remains intact, there is a disc bulge (Protrusion): You is the precursor of the herniated disc. Penetrates the nucleus fibrocartilage ring completely, one speaks of a disc prolapse (Prolapse). Both the protrusion and the incident can cause pain ..

The image shows a disc with shifted nucleus

Typical of a herniated disc: The viscous nucleus inside a disc has shifted to the outside and now presses on the spinal nerve.

Basically, a herniated disc may in each area the spine occur. However, most disc disease (more than 90 percent of cases) concern the Lumbar spine - medically known as lumbar disc herniation or lumbar disc herniation. Less frequently the discs of the cervical spine down before (HWS). A herniated disc in the thoracic spine (BWS) is very rare.

Viewed from top to bottom is the spine of

Between the individual vertebrae total of 23 discs: only the joint between the first and second cervical vertebrae (C1 / C2) has no disc.

Each herniated disc can be located precisely on the basis of segments between two vertebrae: On common are the intervertebral discs

affected by a herniated disc. 

The picture shows the anatomy of the spine. Particularly frequently occurs a herniated disc in the lumbar spine - fachsprachlich herniated lumbar spine. © LifeArt image / 2001 / Lippncott Williams & Wilkins all rights rese

Overall, the spine of man from 24 free vortices which are movably connected discs 23 consists. Particularly frequently occurs a herniated disc in the lumbar spine - fachsprachlich herniated lumbar spine.

Sits between two vertebrae each have a disc - even intervertebral disc or medically Discus invertebralis called. The unit consisting of two vertebrae, the intervening intervertebral disc and the intervertebral holes, from which the nerve roots exiting denote as physicians motion segment.

The disc serves as a kind shock absorberYou buffers the shock of the spine, caused for example when walking or running. In addition, the discs for the mobility of the spine care. The disc is the fact that the involved vertebrae to a limited extent can move in all directions to each other.

The intervertebral disc consists of connective tissue with a relatively rigid outer fibrous ring (annulus fibrosus) and a soft gelatinous core (nucleus pulposus) inside. This core can store water and makes the disc elastic. The water content decreases with stress, so the distances between two vertebrae in the day out. Therefore, the height during the day can to up to two centimeters lose weight.

Overnight take the intervertebral discs liquid on the surrounding cartilage layer and the vertebral bodies. Blood vessels and nerves do not exist in the nucleus pulposus. Only the outer fiber ring is supplied by nerve.

Behind a herniated disc usually puts one years of age-related wear of the disc - in rare cases, a violation of the cause. 

With increasing age of man, the disc is aging. she is less elastic as at a young age and can store water worse. The risk that the fiber ring of the disc tears - so a herniated disc - rises. Therefore, especially people suffering from middle-aged and younger people under rare disc problems and herniated discs.

In addition to age, there are other factors, the intervertebral disc also enforce. These include:

Normally, the abdominal and back muscles support the spine and stabilize them. If these muscles are not sufficiently trained, that loaded the disc in addition.

Also incorrect lifting heavy weights is poison for the disc. Therefore, make sure, Heavy only with a straight back to raise. With rounded back as the eight to twelve times the weight bearing down on the discs. In a case of beer corresponding to, for example, 80 to 120 Kg, which load the spine.

How is a herniated disc? Our video shows it to you!

When a herniated disc symptoms depend on the location and extent of the incident. It also plays a role, which affected the neighboring neural structures (spinal cord, spinal nerves, etc.). Often it also happens that a herniated disc long time causes no symptoms.

A herniated disc between two Lumbar vertebrae (LWS herniated disc) can

Disk protrusions and prolapses in the Cervical spine (disk herniation the cervical spine) cause against it

In rare cases, a herniated disc causes symptoms such as disturbances in defecation and urination, with a numbness are connected in the anal and genital area and on the inside of the thighs (so-called. saddle anesthesia or cauda syndrome). These symptoms are considered emergency - in this case the doctor has to remove the herniated disc tissue in an operation to relieve the nerves.

Video: How does the wear of the disc noticeable?

To make the diagnosis with a herniated disc, is an in-depth neurological examination necessary. This sheds light on the affected pain-causing nerves and enables targeted treatment.

The examining doctor can determine if the nerves are damaged and recommend appropriate therapy. He will consider the reflexes, sensitivity, mobility and possibly the nerve. Depending on whether and where to radiate the pain, the doctor can draw conclusions as to which nerve roots are affected by the herniated disc.

In addition, the doctor checks the pulse in the legs in order to prevent a circulatory disorder in this area - such as peripheral arterial disease (PAD), also claudication (intermittent claudication) called. This disease can cause pain that are similar at first glance, the pain associated with spinal conditions such as a herniated disc.

The person concerned will during the X-ray examination different positions, so that the X-rays show the spine in different postures: for example, curvature and extension (so-called functional images.). So the doctor can assess the mobility of the spine. Recording in so-called oblique beam path provide information about a possibly present abnormal mobility of the vertebrae. However, only the bones (vertebrae example) can thus be seen with any wear-related variations.

Imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI) or myelography make it possible to represent the spinal cord and nerve roots. Only the two so-called cross-sectional imaging computed tomography and magnetic resonance imaging make the spinal cord and nerve roots directly visible. An additional contrast medium into the vein it easier for the doctor in these two methods to demarcate a herniated disc from flammable altered tissue or a tumor.

In the myelography the doctor filled with a cannula X-ray contrast agent into the spinal cord bag (thecal sac). Thus it can detect the lying in the spinal cord and nerve roots as a contrast agent recesses indirectly in the radiograph. Unlike the cross-sectional imaging myelography is however today rarely used.

Video: myelography - which this happened?

In most cases initially takes place at a herniated disc conservative treatment, with the aim to ease the pain. In the acute stage, the spine should be immobilized and relieved. For this, the doctor may prescribe a short bed rest (less than 48 hours), combined with painkillers and possibly muscle relaxants (medicines that relax muscles).

Also recommendable are

About one to two weeks later, when the pain has subsided, individuals consider using movement therapy and physiotherapy exercises strengthen their capacity to train the back muscles will change to a back-friendly way of life over the long term.

In an acute herniated disc, it is important to relieve the back (or rather the pinched nerve or). For this purpose, the so-called ideal Raised leg position - this exercise can easily perform at home. For this you lie down flat on your back on a hard mattress as possible and store his lower legs at right angles to a thick cushion or a cube.

Did the pain subsided after a few days, should isometric exercises are to stabilize and strengthen the back muscles on the program. Isometric means that these exercises the muscles are tense, but not change its length. 

A typical example is the forearm support, both the headfirst and laterally. 

The picture shows a young woman in the forearm support. © iStock

The forearm support is a good and simple exercise for a strong hull. This helps prevent further herniated disc.

The picture shows a young woman who runs the lateral forearm support. © iStock

For a workout of the lateral trunk muscles, the forearm support is on the left and right side.

For the Forearm support headfirst initially puts you on your stomach. From this position, we focus on the upper body by bearing on the forearms. The elbows are below the shoulders. Loosen the legs off the floor now. tighten the abdomen and back and decides to hold the position for a few seconds. 

Of the lateral forearm support works very similarly. First you take a lateral position (preferably on an exercise mat) a. Then one rests on a forearm so that the upper body and pelvis float in the air. The head is straight. Again, be careful that the belly and the back are screwed down tight. 

these exercises go step by step into a Muscle training program as part of a movement therapy about. Also, regular exercise such as swimming or cycling can help to prevent another herniated disc. 

Disc surgery: yes or no?

only about two out of ten sufferers with a herniated disc need surgery. An OP is only necessary if nerves have been damaged or if the pain does not subside even after several weeks of conservative treatment. In such cases, the doctor removes the herniated part of the disc. 

Surgery is only necessary in case of a herniated disc usually when nerves were damaged. Then the doctor removes the herniated part of the disc material.

Needed are operation in which the nerves which control the bladder and bowel emptying be affected, for example, herniated discs in the lumbar spine. When a herniated disc in the cervical spine surgical treatment is necessary if the disc squeezes the nerve canal. Also, in a side (lateral) herniated disc with paralysis, an operation is advisable.

Does the pain of a herniated disc even after several weeks of conservative treatment does not occur after or severe symptoms again and again, surgery is another treatment option. After an operation can occur, among others, to a renewed herniated disc or proliferating scar tissue, which in turn can press the spinal nerves.

Basically, you can at intervertebral disc surgeries between 

differ.

Minimally invasive procedures, including "Keyhole surgery" called, here are becoming increasingly important. This tissue-whose operations can be performed on an outpatient basis.

Open surgery of herniated discs are associated with risks and a longer stay in the hospital. Minimally invasive procedures have been developed to avoid open surgery with its possible disadvantages. They can usually outpatient under local anesthesia (Local anesthetic) perform or require only a very short hospital stay.

Special control X-ray procedures and review the therapeutic measures and clinical outcome. However, they are not suitable for all types of diseases. There are primarily simple and fresh disk protrusions and herniated discs without elimination of disc material (sequestration) into question. this method is not suitable for already operated concerned.

Upon dissolution of the nucleus pulposus (chemonucleolysis) the operator inserts a cannula into the affected space between two vertebrae (intervertebral disc) from the back and injects enzyme (Chymopapain) into it. The enzyme liquefies the nucleus by chemical means - after a certain waiting period, the doctor extracts the liquefied core ground through the cannula. The enzyme must not enter the area of ​​the disc - that this intervention will only be eligible if no Sequester has made - has thus replaced no disc tissue. Chemonucleolysis is rarely used in a herniated disc.

The laser ablation is only suitable for simple, fresh herniated discs. It is based on the principle of volume reduction in the intervertebral disc. The doctor carries while the disc with a medical laser, the light in the infrared region emits from. This light passes through fiber optic technology into the surgical field.

In the laser ablation of the doctor punctures a cannula into the affected area between the vertebrae and controls the position of the needle tip by means of computed tomography. Through the cannula it introduces the optical fiber and the laser vaporizes the nucleus by single flashes of light. By moving the optical fiber, it can slowly erode a larger disc surface.

The procedure is performed under local anesthesia and takes about 30 minutes. The person concerned must comply with a certain observation period and can leave the hospital after quickly.

Percutaneous discectomy is with him uncomplicated herniated discs or -protrusions, despite conservative treatment further cause discomfort. A particularly good chance of recovery have this person in which radiate back pain in the legs and in which the symptoms can be traced back to specific nerves. Very carefully, the surgeon causes using a computed tomography a cannula and pushes it forwards to the intervertebral disc space. Thereafter, he sucks the nucleus pulposus through the skin with a suction device in part on. The procedure takes about 30 minutes.

At a complicated slipped disc, already

treatment with minimally invasive methods is not an option.

In this case, the doctor chooses a open disc surgery. He removed the stabilizing belt located between the vertebrae to advance to the affected nerve roots. Under certain circumstances it is necessary as part of an intervertebral disc surgery to ablate parts of the upper and lower vertebral arch so-called peel and muscles and ligaments in part. The prolapsed disc can then be removed completely or partially.

As with many surgical procedures occurs at a disc surgery in the treated area scar tissue, can proliferate in the worst case and lead to renewed complaints. Under certain circumstances, additional surgery is then necessary to remove the scar tissue

When a herniated disc, the complaints in the course can worsen or it can chronic problems remain. Often remain herniated discs also unnoticed. In more than 80 percent of cases conservative treatment is already helping - a surgical procedure is not necessary in most cases. Therefore, it makes sense always to check thoroughly whether an operation is actually required.

on possible complications a conventional surgical procedure include damage to nerves and blood vessels, inflammation in the operation area, and general wound healing and bleeding.

Both following a conservative and a surgical therapy is an active treatment with

advisable.

For after-treatment of a herniated disc and occupational therapy, psychological and socio-medical counseling make sense in some cases.

A herniated disc, you can not prevent directly. Rather, you should strengthen your back and some measures to reduce the risk of a herniated disc. A back-friendly everyday can help prevent a herniated disc related.

Tips for a healthy back:

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The DieBandscheibe.de page aims to provide a network concerned. Here you will find information about herniated disc, its causes, symptoms and treatment options generally explained clearly and with a lot of pictures.


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