Sequestration of the hernia of the intervertebral disk treatment. Sequested disk hernia (L4-L5, L5-S1) - than dangerous and what it looks like on MRI

The sequest-end hernia of the spine develops due to an intervertebral disk injury.

Pathology can be localized in any department of the spinal column, but most often develops in lumbar and breast departments (the cervical department more often suffers from osteochondrosis).

1 What is a sequested spinal hernia?

What is the "sequestrized hernia of the spine" (abbreviated "sequestration")? This is a hard-following intervertebral hernia, which is developing either as primary pathology (immediately), or as a complication of classical intervertebral hernia.

The specificity of this species is that the sequestration process occurs, that is, the fibrous ring is ruptured, followed by the loss of the pulp nucleus from the intervertebral disk in the spinal channel. In fact, the sequest-end hernia is the last stage of the development of intervertebral hernia.

The disease is extremely dangerous to health and with an incorrect treatment approach often leads to the disability of the patient. It makes sense to expect independent "resorption" of sequestration.

Approximately 85% of all cases, conservative treatments do not give impressive results, and have to perform an operation - removal of the sequestration. Operate or not - it decides not one, but, as a rule, several doctors (medical consultation).

At the same time, the Operation itself is a certain threat to the health of the patient, since in some cases heavier complications are observed. For example, a strong neurological deficiency or partial / complete paralysis of the lower or upper limbs is possible.

1.1 Reasons for development

There are several reasons for the development of sequestrated vertebral hernia. There are both direct causes of disease development and predisposing factors creating "favorable soil" for the appearance of pathology.

List of direct causes:

1. Long-flowing osteochondrosis of the spine.
2. Congenital anatomical defects and anomalies of the structure of the vertebral post.
3. Excessive body weight (obesity).
4. Lifeline lifestyle, hypodynamine, poor physical form.
5. Systematic incorrect and unbalanced nutrition.
6. Excessive static or dynamic load on the vertebral pole.

List of predisposing to occurring sequentrated hernia reasons:

• strong supercooling of the body;
• lifting weights (a sharp, forced rise is especially dangerous);
• prolonged uncomfortable body position;
• excessive emotional stress, chronic stress;
• occupation by professional sports (at which the spine gets a larger load);
• the injuries of the spinal column.

1.2 What is the danger?

The most terrible complication of sequestrated hernia is a disability. After the disease appeared (stage of manifestation), it progresses. After a few months, the sequestration may lead to compression (transmitting) of the spinal channel.

Against the background of the compression of the spinal channel, the development of a number of complications is possible, but the most terrible of them is the full paralysis of the lower or upper limbs. The compression of the spinal vessels is also possible, which is fraught with the deficiency of the nutrients of the spine and the development of degenerative-dystrophic processes in it.

It is also dangerous to enter the nuclei of intervertebral discs in the spinal channel. Due to the fact that protein compounds are in disk kernels, their ingun in the spinal channel leads to the development of a local inflammatory response.

This is fraught not just a long severe inflammatory process in the spinal cord, but also by the development of autoimmune diseases. Including this can be a predisposing factor in the emergence of psoriasis with psoriatic arthritis and even focal (nest) alopecia.

1.3 Sequest hernia: General information (video)

1.4 Where does it occur most often?

The favorite place of the sequest end hernia is the lumbar spine. This is due to the fact that the greatest load when lifting weights accounts for this in the back of the back, and approximately 30-40% of all sequestration cases are just associated with physical overvoltage.

Approximately 48% of cases lumbar vertebrae L4-L5 and S1 (sacral region) are affected. Significantly stronger vertebrae L3, and is usually associated with a severe injury of the lumbar back area. Of the entire lumbar spine segment specifically, these discs account for the greatest load.

Much less often suffers the chest department of the spine. Why is he so resistant to the disease? The fact is that the breast is dense and monolithic, it is fixed in contrast to the lower back, which means more durable. In most cases, the sequestration in the chest arises as a result of severe injury (for example, in an accident).

The cervical spine suffers very rarely, in this segment, other diseases of the spine are usually flowing - degenerative-dystrophic (spondylosis, osteochondrosis). The sequestration in the cervical department most often occurs due to a whip injury or with an excessive one-time axial load.

2 Symptoms of sequested hernia

The clinical signs of the sequential hernia are numerous, and at first they are completely reminding the symptoms of more harmless diseases ( spondylolisthesis, osteochondrosis, classic intervertebral hernias back).

After some time (usually 4-6 months), pronounced clinical signs develop, often interfering with a person in everyday life (including even fall asleep).

The most frequent symptoms of sequested hernia:

1. Strong painful pains in the area of \u200b\u200bthe back, where the disease is localized. If the disease is localized in the thoracic spine, there is a chance of developing additional intercostal pain.
2. The pain syndrome is enhanced when lifting weights or with a supercooling (enough to go out without a warm jacket in a rainy autumn day).
3. The character of pain is quite specific - the pain is felt with a stitching and burning, as if the back burns. Often the pain "goes" to the hip joints and feet feet.
4. There is a so-called coughing push: during coughing or silence, the patient has a sharp and severe pain in one or two legs.
5. In the lower or upper limbs (depends on the localization of the disease), numbness, the feeling of cold and burning is felt.

2.1 Diagnostics

There is no single method for detecting and confirming the sequested hernia of the spinal column. A combination of several diagnostic techniques is used (usually biochemistry + visual research methods).

Sequest hernia on MRI

A complete list of diagnostic techniques used to confirm the sequest-end hernia and to identify all its characteristics (location, size, complications):

• anamnesis of the patient is collected on the primary examination of the doctor: the duration of pain, symptoms and their character, duration and provoking aggravation factors (in which situations pain appear or enhanced);
• urine analysis, advanced blood test (27 points), biochemical blood test;
• instrumental research methods (used in some cases);
• radiography - only at first (primary inspection), since its informativeness is extremely low to diagnose such a disease;
• magnetic resonance tomography or, if it is impossible to conduct it, computed tomography - the best methods for the diagnosis of sequestred hernia;
• electronomyography (ENMG) - used to determine the degree of damage to nerve fibers, with the help of ENGG also predicts the potential benefit of treatment;
• bones (introduction of radioactive isotopes to study bone damage).

3 Conservative treatment

By itself, the sequest end hernia does not "dry" and does not "overgrow", even if it proceeds extremely favorably and without strong pain. This disease remains for life, if you do not try to cure it. At the same time, if the sequestration is not complicated and the patient's well-being tolerable is the first to do conservative therapy (with its inefficiency - operation).

Formation of sequestrated hernia

Conservative treatment of sequestrated hernia implies the use of oral and injection drugs, and primarily to reduce the symptoms of the disease (pain, edema).

Non-steroidal anti-inflammatory drugs are used, non-nucleic painting preparations. A long course of physiotherapy and massage procedures is appointed. Sometimes it is prescribed to perform physical exercises from a particularly prepared for treatment specifically this type of hernia.

Will these methods help with sequestrized hernia? Alas, only in 15-20% of cases, no more. In other cases, it is possible to effectively treat it only with the help of surgical intervention. There are several types of surgery for this hernia.

3.1 Operational treatment

For the operational treatment of sequested hernia, the spine is used microsurgical techniques. Microdisktomy, dischactomy and percutaneous nucleoplasty are effective. In some cases, it is possible to carry out endoscopic sequestration removal, followed by the prosthetics of intervertebral discs.

Microsurgical treatment of sequest-end hernia

The efficiency of the operation is extremely high. Approximately 90% of cases after surgery about the sequentrated hernia, it is possible to strongly or completely reduce the severity of symptoms and restore the lost function of the spinal column.

After the operation, the patient proceeds to rehabilitation. In the rehabilitation period, he is prohibited excessive physical activity, running, sharp and deep slopes or axial load on the back.

The duration of the rehabilitation period depends on the type of operation, which was carried out and from the complexity of the disease. On average, rehabilitation lasts 2-10 weeks in the hospital and 2-8 months in domestic or outpatient conditions.

The sequested hernia disk is the last, fourth stage of the development of the intervertebral hernia. Sequetras appear in 10% of patients. They are subject to compulsory treatment.

Causes

The sequest-end hernia of the spine is a consequence of the destruction of the hernia of the intervertebral disk. The reasons are as follows:

• chronic diseases of the spinal column, for example, rheumatoid arthritis;
• spinal development anomalies;
• displays of hip joints;
• excessive load on the vertex pillar, lifting weights;
• spinal injuries;
• violation of metabolic processes, including diabetes mellitus and hypothyroidism;
• genetic predisposition;
• obesity;
• age changes.

Osteochondrosis is the main reason for the appearance of sequesters. Due to degenerative-dystrophic changes, the disk loses moisture, becomes less elastic. As a result, under the slightest physical exertion, the pressure on the vertebrae increases. The disc is injured, and then sequesters are formed.

Sequest-end hernias in most cases appear in women after 55 years.

The predisposing factors for the emergence of sequesters are smoking, alcoholism, unbalanced nutrition, frequent stress, hypothermia, and a sedentary lifestyle. In the risk group are office employees and drivers.

The sequesting hernia may appear after 10 years (with adverse factors) from the moment of appearance.

Localization symptoms

Signs of illness depend on the department in which the sequester was formed and what size it is.

The sequester hernia of the neck department is manifested by such symptoms:

• headaches, dizziness;
• hand numbness;
• the weakness of the muscles of the neck, hands and shoulders;
• painful feelings in the shoulder area;
• blood pressure jumps;
• reduced hearing and vision.

Among all the symptoms, a violation of cerebral circulation is the most dangerous.

The sequesters in the neck area occur very rarely, most often diagnose the sequested hernia of the lumbar spine. It is manifested by such symptoms:

• sharp squeezing pain in the area of \u200b\u200bthe lower back, painful sensations arise in legs with the capture of stop;
• numbness of limbs, weakness in the legs, easy tingling;
• pain when changing body position;
• breach of gait;
• paresis and paralysis;
• violation of the functioning of a small pelvic organs.

Symptoms can be pronounced or weak, depending on the size of the hernia. Without treatment, the sequested hernia of the lumbar department leads to atrophy of the muscles of the back and limbs, as well as to limit mobility.

The hernia of the lumbar-sacrolling department is manifested in the form of pain in the area of \u200b\u200bthe lower back and the sacrum, muscle weakness, disorders of reflexes in the foot, as well as in the form of dysfunction of the organs of the small pelvis.

Symptoms of sequestles in the chest department can be confused with diseases of internal organs. Pains in the chest area are similar to heart disease, and painful sensations under the blade - to cholecystitis.

Signs:

• pronounced pain in the field of blades, ribs and belly, which is enhanced during exercise;
• numbness of the skin on the affected area;
• muscle weakness in the chest and abdomen;
• paralysis legs.

What doctor is engaged in the treatment of sequestred hernia?

The hernia causes not only pain, but also lead to violation of the work of the internal organs. To compile a clinical picture should turn to the therapist. After the initial inspection, the doctor will send to other professionals:

• orthopedic;
• neuropathologist;
• traumatologist.

If the sequested hernia cannot be cured by the conservative way without surgery, then the doctor will be the attending physician.

Diagnostics

For the diagnosis of hernia use such techniques:

• - The method allows you to reveal the hernia and see its size;
• - accurate technique to determine the size of the hernia and its location;
• - method that allows you to determine the degree of damage to the spinal cord, roots and nerves;
• electromiography - technique to determine the pinching of nerve endings.

Treatment

Treatment of hernia can be conservative or operational.

Conservative treatment is used in 90% of cases.

Conservative

Is it possible to cure hernia without surgery? Yes, it is possible, but you need to be prepared that the therapy is long, the result will have to expect more than 2 years.

Conservative treatment of sequestted spine hernia is effective only when the kernel has not yet occurred outside the disk. Otherwise, do not do without surgery.

Conservative therapy is also necessary to prepare the patient to the operation and during the rehabilitation period. Treatment looks like this:

• Medical therapy. Receiving NSAIDs (diclofenac, ibuprofen), chondroprotectors (chondroxide), Miorolaksanta (Tizanil, Baclofen).
• Physiotherapeutic procedures. The greatest efficiency gives magnetotherapy, acupuncture, massage and leaf, wearing corsets.

After the release of hernia, it is necessary to observe the bed regime. The first 6 months of treatment need to wear an orthopedic corset, it supports the vertebral pillar and prevents the pinching of the disks.

You can not lift gravity and make tilts forward.

LFC must be performed only under the control of the rehabilitologist.

Surgical

Operational intervention is the most effective method of treatment. With the development of such complications, the sequest-end hernia can be cured only with the operation:

• sequestration more than 10-15 mm;
• squeezing roots and spinal cord;
• discogenic myelopathy;
• stenosis of the spinal canal.

It is not necessary to delay with the operation at autoimmune inflammatory processes, impaired urination and defecation, with the numbness of the limb, as well as in the ineffectiveness of conservative treatment.

The numbness of the limbs is an alarming symptom that signals the occurrence of paralysis.

Types of operations in sequestrated intervertebral hernias:

• discectomy;
• laminectomy;
• endoscopic microdisquectomy.

The sequestration position can be difficult to access, therefore, after surgery, complications arise in the form of a violation of stability in vertebrae, bleeding, infection or injury of the spinal cord.

Rehabilitation

After surgery, rehabilitation is very important. It can be from several days to weeks. At this time, it is necessary to comply with all the recommendations of the doctors, namely:

• wearing dressings and bandages that fix the vertebral pole in the same position;
• prevention of load on the spine;
• proper nutrition that prevents the extra weight setting;
• rejection of bad habits;
• manual therapy and physiotherapy procedures.

The condition of the patient depends on these actions.

Complications

The disease can lead to such consequences:

• chronic autoimmune inflammatory processes;
• paralysis;
• discontinuation of the blood circulation of the spinal cord;
• violation of the functions of small pelvis organs, including impotence.

In the lightning destruction of the disc, for example, due to injury, the patient develops a spinal and pain shock, sensitivity is lost, the breathing stop is possible.

Prevention

To prevent sequetters appearance, such recommendations should be followed:

• to live an active lifestyle;
• perform simple physical exercises to strengthen the muscles of the back, make a warm-up;
• follow posture;
• completely eat, use vitamin complexes with calcium.

If the problems with the spine already arose, in no case cannot be engaged in self-medication.

Intervertebral hernia occurs due to damage to the discs. The most dangerous type of this disease is the formation of a sequest. The sequestration is a piece of a pulp nucleus, which as a result of the inflammatory process was outside the intervertebral disc. The beginning of this process is referred to as sequestration. Very often sequential spine hernia cares for the patient to the bed. The cut-off particle of the jade nucleus begins to squeeze the nervous roots, as a result, there is a violation of the blood circulation of nerve endings, which causes a violation of the functions of the internal organs. The sequestration is subject to immediate removal, otherwise it will lead to atrophing of the nerves and the offensive of disability.

Causes of the disease

The sequested hernia of the spine is formed due to the destruction of the fibrous ring, which is the basis of the intervertebral disk containing the core containing the core. The penetration of a part of the pulp core into epidural space does not occur by itself. The main reasons leading to this state are:

• improper nutrition;
• the presence of osteochondrosis diagnosis in the medical card;
• sharp raising of greater weight without preheating muscles;
• regular injury to the spinal column;
• sedentary lifestyle;
• too high loads of dynamic and statistical nature;
• permanent stay in an uncomfortable posture.

The formation of the sequest-end hernia of the lumbar contributes intensive physical work, sports personality is susceptible to this disease. Also, such a pathological condition arises as a result of the following factors: overweight, supercooling, genetic predisposition to the disease, violation of metabolism, abuse of alcoholic beverages, tobacco, drugs and other factors that can break the blood supply to the fibrous ring, due to the breaking of the hernia.

Main types of disease

Sequest-ended disk hernia is classified according to the place of the dropped kernel. The sequested hernia of the lumbar department is between the vertebrae L4- L5. This kind of hernia appears most often, because almost all load falls on the lumbar department. The sequest-end hernia of the lumbar department is hard to be treated, the victim will have to go through a long course of therapy after the operation was performed. Damage to the lumbosacral department, vertebra L5 S1, is found in 75% of all cases. This state leads to a decrease in sensitivity, which is due to nervous-root squealing. With the difficult course of such a disease in the lower back and the area of \u200b\u200bthe sacrum, there may be a violation of the functioning of the pelvis organs.

Less often encounters hernia of the cervical spine. However, the separation of sequesters in the cervical department may have terrible consequences. With sequential hernia, localized in this area, paralysis can also occur. The diagnosis of sequest-end hernia of the neck department is set when the sequestration is detected between C6-C7 vertebrae. With the hernia of the spine In this place, the pinching of nerve roots leads to the emergence of ischemia (acute or chronic violation of blood supply in a certain area of \u200b\u200bthe body).

Clinical manifestations of pathological condition

Symptoms During the diagnosis, the sequested hernia of the spine depends on the location of the disease. The clinical picture of the disease is most often pronounced, but sometimes the disease develops unnoticed for the victim. The hernia, accompanied by sequestration, causes the following signs:

1. The sequestration hernia of the lumbar spine causes strong attacks of pain, which have the ability to enhance with the slightest loads on the vertebral pole, in particular, to the lumbosacral region. Paints are given to the jagged muscles and the lower limbs of the patient. The sequest-end hernia causes the weakness of the leg muscles, it leads to the loss of tendon reflexes, the depletion of foot muscles. If it does not remove the separated piece of pulp nucleus on time, it can lead to lumbar stiffness and paralysis of the legs.
2. With a sequested hernia, the patient's cervical spine can disturb migraine. Among the first signs, irritability is distinguished, fast mood change. This is due to the movement of the sequest. When he stops in one place, the compression of the nerves occurs, the patient begins to fall vision, problems with hearing are appear. In addition, the victim feels numbness. If the treatment of the sequential hernia of the spine was not started on time, perhaps the paralysis of the upper and lower extremities, the respiratory stop is also possible.

To confirm the diagnosis, a survey should be conducted, which is to carry out computer tomography, myelography, electromyography, MRI and other visualization and laboratory tests, which doctors consider it necessary to fulfill.

Conservative pathology therapy

It is possible to treat the sequest-end hernia with drugs with medication, however, conservative therapy will help if the disease is at the Extrusion stage. The doctor prescribes medicines and manual therapy to keep the sequestration from falling out, which is possible to do, if you create conditions for education in its place of bone growths, which will be able to close the actual break place. The sequest-end hernia can pass without surgery, however, for this the patient will have to gain strength and patience, since conservative treatment can last up to two years. How to treat the disease? This treatment includes the following procedures:

1. Using non-steroidal anti-inflammatory drugs capable of stop pain, remove inflammation.
2. The patient will have to undergo a full course of treatment at the manual therapist. Massage should be carried out by an experienced and qualified specialist. Making therapeutic massage procedures are necessary for 6 months so that it has an effect.
3. To remove the swelling prescribe diuretic medicines. For example, "Furosemid", "Hypothiazid".
4. Since the nerve is greatly clamped and circulatory disruption was formed, it will be necessary to restore it. Restore the blood circulation of the vertebra and its constituents will help the drug "Aktovegin".
5. The attending physician is also assigned a course of vitamin therapy and novocaine blockades.
6. An integral part of the treatment is a postisometric relaxation. PIR is special statistical exercises that cannot be conducted independently.

With a sequential herniated spine, treatment should be carried out in compliance with the beddown, especially in the first half a year of treatment.

Surgical therapy disease

The operation to remove the sequestrized hernia is carried out if the size of the separated piece of the pulp nucleus exceeds 10-15 mm. Also indications for surgery are the stenosis of the spinal channel, squeezing the nerve roots, the appearance of numbness numbers. Operate necessarily if the patient did not apply for medical care for a long time. In the presence of hernia, the following types of operations are carried out:

• laminectomy;
• discectomy;
• microdisquectomy and endoscopic microdiscriptomy;
• nucleoplasty;
• hammonometolysis.

Surgical intervention is one of the most effective ways of therapy of sequested hernia, although it is a risky treatment method. The modern possibilities of neurosurgery stepped far ahead. Thanks to highly qualified neurosurgeons and surgeons, the operation is carried out with the minimum risk of complications. Also, the operational intervention ensures that recurrence will not arise after the operation.

Rehabilitation and prevention of pathology

An important step after operational or conservative treatment is rehabilitation. Conducting exercises cannot be carried out during the period of acute flow of the disease and immediately after surgery. After the patient has restored a little directly to the physiotherapist to determine the principles of the FFC needed by the victim for rapid recovery.

It is necessary to avoid physical overload, not to lift gravity until the doctor is allowed. LFC is part of therapy and prophylaxis. Physical culture is carried out under the supervision of the doctor, the first time it cannot be carried out independently, since the patient can harm the spine. The exercise complex is carried out to restore the functions of the spine, its flexibility, mobility. A properly carried out a complex of therapeutic physical culture will avoid the formation of a repeated sequestration. After passing the recovery course, the patient can assign hikes to the pool. Also, the patient with a diagnosis of the sequest-end hernia of the spinal column should be guided by an active lifestyle, observe posture, not overjugate the spine, and do not sit for a long time at a computer or TV. Patients whose work requires a perfection, should be able to get up to the workplace and do the exercises shown by the physiotherapist.

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Publication date of article: 06/03/2015

Article update date: 08.11.2018

When a person has intervertebral hernia, but it does not receive proper treatment, the back becomes a kind of "powder bar", which at any time can "explode": the hernia will become sequest. What it is? The sequest-end hernia means that the pulp nucleus of the intervertebral disc is not just a little squeezed into the spinal cord channel, and it fell into it, and some piece of the nucleus separated from its bulk. The precipitated area is called a sequestration, the process itself - sequestration.

Sequestrated intervertebral hernia in 80% of cases leads to disability. After all, the sequester very often squeezes the nerves that go to the limbs and internal organs: so the blood circulation of the nerve endings is broken, and they cease to "pass commands". The consequences are a violation of the work of the organs. If an emergency drop-down disc is not removed, then the nerves are atrophy and no longer will "work" at all.

Another danger during the sequestration of the hernia disk is the immune response: it begins to attack the foreign body in the spinal channel with the protein unusual for this department. As a result, inflammation and swelling of the channel shells, wrapping the spinal cord and nerves derived from it are aseptic meningitis, for a long time causing a person to bed.

Now good news. If it is timely to detect an intervertebral hernia, not to break the mode of work and the reception of drugs appointed by the doctor, then sequestration is unlikely to happen. If such a misfortune still happens - timely treatment will return to a person's ability to work.

Causes of the disease

The sequest-end hernia of the spine is the most pronounced degree of damage to the fibrous ring of the intervertebral disk. In most cases, sequestration is the "logical conclusion" of the destruction of the intervertebral disc, which arose due to osteochondrosis or vertebral hernia.

More reasons due to which sequestred hernia occurs	Factors predisposing to the development of sequestration disk hernia
Vertex development anomalies	Obesity
Permanent intensive load on the spine	Supercooling
Strong injury of the spinal disk, obtained when falling from the height on the back or when the spine	Intensive physical work
Sharp weight lifting without prior "warming up" muscles	Balance of calcium and phosphorus in the spine tissues
	Hereditary predisposition
	Broken metabolism in the body
	Smoking and alcohol abuse, which disrupts blood supply (nutrition) fibrous ring
	Incorrectly performed slopes and squats performed at the athlete, in which the vertebrae of the lumbar department is experiencing a shipping load

Characteristic symptoms of sequested hernia

Intensive back pain (it is often described as "striking" of such force that you can even lose consciousness from pain).

A person can exactly indicate the time of her occurrence. This painful syndrome usually provokes gravity, sharp body jerk, falling onto back. The pain spreads along the posterior surface of the thigh or the inner surface of the hand, is enhanced by changing the position of the neck or body.

Restriction of movements with limbs (with hands during sequestration of hernia of cervical and uppergrates, legs - if the pathology developed in the lower back or the sacrum). At the same time, the gait is disturbed or becomes extremely difficult to move his hand and even with his fingers.

When progressing the state, paralysis of one or more limbs is developing.

With damage to the cervical man can be paralyzed completely.

Numbness in hand, leg, foot, brushes or fingers.

A decrease in the temperature of the limb to which the nerve beam is transmitted by the sequester. Her skin can be landed or sweat stronger.

Atrophy of the muscles of the damaged limb arises, if a person does not appeal for medical help.

Inxication developing due to the immune "attack" of the sequestration causes: weakness, pain in all muscles and joints, nausea, lack of appetite.

As the sequested hernia of the spine manifests itself depends on the department where hernia originated, and on the degree of defeat by the resulting sequisode.

Most often, the disease occurs in the lumbar department. In 2/3 of cases, it develops between 4 and 5 by lumbar vertebrae (L4-L5 hernia), between the last lumbar vertebra and the sacrum (L5-S1), as well as between the cervical vertebrae (C6-C7). This is physiologically due: such sites are experiencing the largest loads.

Click on photo to enlarge

Symptoms of the most common localizations:

(if the table is not completely visible - leaf it right)

Department of Spine	The most frequent localization	Symptoms
Cervical	C6-C7 vertebra	Headaches; hand numbness; reduction of hearing; change of visual acuity; "Flies" before your eyes; sometimes: aggression or depression, fast mood change, plasticity. In the worst case, paralysis takes place of all four limbs and stop breathing.
Breast	In this hernia, it rarely arises	Pain in chest, increasing with deep breath, cough or sneezing. They develop after "striking" in the field of blades (which can be taken for severe pain in the heart).
Lumbar	Vertebrae L4-L5 and L5-S1	The pain in the lower back and / or the sacrus spreading from the buttock to the feet on the inner surface of the leg; weakness of the muscles of the legs; the "horse-tail" syndrome is the most dangerous symptom, which is usually manifested by spontaneous emission of urine and feces, less often - the inability to purle or shock; pronounced pain in the back, crotch and hips.

Treatment methods

The way you have to treat the disease sequest-end hernia depends on its localization and severity of symptoms:

• The hernia L4-L5 of the lumbar department in most cases requires surgical treatment. After it, a long period of rehabilitation is waiting for you under constant control of the neurologist and neurosurgeon. Doctors once a month examine the patient, often prescribe it to conduct computer or magnetic resonance tomography for early detection of possible postoperative complications.
• When squeezing the "horse tail", the sequested hernia of the L5-S1 disc operates urgently until the irreversible changes in the nerves coming to the intestines, the bladder, reproductive organs and legs occurred.
• With another localization of the sequested hernia (even in the lumbar department), the use of conservative treatment is possible.

Conservative therapy

(if the table is not completely visible - leaf it right)

Type of treatment	What includes	Effect
Medicate	Package preparations	Eliminate pain, reduce inflammation
	Hormonal glucocorticoid agents	Reduce the severity of the immune "bombing" of the sequest, followed by the absorption of the products of its decay in the blood
	Miorolaxanta	Relax pathologically "clamped" vertebrate muscles
	B. Vitamins B.	Improve the impulse on a sequisite nerve
Physiotherapy	Novocaine Electrophin, UHF, Diadynamic Toki	Reduce swelling and inflammation, with the result that the struggle with pain is more effective
Acupuncture	Exposure to special needles on biologically active points on the body	Improves the electrical pulse for the transmitted nerve fiber, not allowing paralysis

After stabilizing the state (reduction of pain, restoration of movements and sensitivity), manual therapy, massage, leafc, water procedures are used.

Operation

Surgical intervention is a very efficient and very risky treatment method. The operation is carried out urgently in the "horse-tail" syndrome and the planned in the ineffectiveness of conservative methods.

Modern operational assistance is endoscopic intervention using microsurgical instruments, during which the sequestration is retrieved and the intervertebral disk is stabilized. For such an operation, large cuts are not required, and the surgeon operation is controlled through the monitor screen.

If the vertebrae is movable (that is, they can be displaced relative to each other) - carry out an open operation, during which not only remove the sequestration, but also strengthened unstable vertebrae plates.

Owner and responsible for the site and content: Athenogenov Aleksey.

Sequestration of intervertebral hernia is the fourth and last phase of the disease. Some doctors consider sequestration with complication of intervertebral hernia. Sequestration is to complete the disk kernel and getting it to the cerebrospinal channel, to the spinal nerves. This state is developing after 50-55 years, after a long flow of intervertebral hernia, only 10% of patients. I am striking most often female floor. The lumbar spine is the most frequent location of sequesters.

Causes of occurrence

The main reasons for the development of sequestration of intervertebral hernia are:

• Violations of exchange processes
• Long-term Current Chronic Diseases of the Spine (Scoop, Lordoz, Kyphos, Bekhterev's Disease, Rheumatoid Arthritis, Osteochondrosis, Herrying of the Intervertebral Disc, etc.)
• Frequent and regularly repetitive loads on the spine (work by a loader, farmer, in summer cottages, etc.)
• Obesity and excess body weight
• Spine injuries (fractures, bruises, dislocation)
• Age-related changes

The risk of developing sequestrations of hernia is increasing when exposed to a patient with an intervertebral hernia of a number of predisposing factors:

• Alcohole smoking and abuse
• Diabetes
• Hypothyroidism
• Passive lifestyle
• Violations of the principles of proper nutrition (vegetarianism, lack of trace elements, etc.)
• Frequent supercooling
• Regular stress

Upon exposure to a person of one and more predisposing and causal factors, already in the presence of a hernial protrusion of the intervertebral disc, which is worried about the patient for several years (most often more than 10 years), the pulp nucleus completely comes out of the fibrous ring, ceases to hold down the spine binders and falls into the area of \u200b\u200bthe spinal supply Channel. At the same time, the spinal cord itself, roots and spinal nerves, and develop a bright clinical picture and disability in a patient developing.

Classification

On localization of the sequestration process, hernias are divided into:

• Sequestration of the hernia of the cervical spine
• Sequestration hernia of the thoracic spine
• Sequestration of the hernia of the lumbar spine

Symptoms of sequestration of intervertebral hernia

The symptoms of sequestration of intervertebral hernia depends on the department that is involved in the process:

Sequestration of the intervertebral hernia of the cervical spine

• Neck pain. The constant, strong, painful, is enhanced with certain positions of the head and after load. Puts to and head
• Neck and hand skin numbness
• Weakness in the muscles of the neck, hands, shoulders
• Gradual breach of gait, right up to full paralysis of legs and hands
• Gradual muscle atrophy
• Frequent headaches

Sequestration of the intervertebral hernia of the thoracic spine

• Pain. Located in the thoracic spine, between the blades and is lower, the pronounced, constant, gives it to the chest, stomach, ribs. When the load is enhanced and becomes not submitted
• Skin numbness in the area of \u200b\u200bthe affected area of \u200b\u200bthe back, chest and in the abdomen area
• Muscle weak back and press

Sequestration of the intervertebral hernia of the lumbar spine

• Pain in the lower back area. Worried constantly, pronounced, amplified under load and in an inconvenient position. Irradics in legs, buttocks
• Violation of the function of the pelvic organs (urinis and defecation disorders)
• Weakness in the legs
• Atrophy of the muscles of the foot
• Feeling stiffness in the lower back
• Lack of tendon reflexes on the legs
• Number of leather stop and fingers
• Gradual development of paralysis

Diagnostics

To diagnose sequestration of intervertebral hernia, several methods are used:

• CT (computed tomography) - allows you to determine the presence of hernia and its sequestration on indirect features: the narrowing of the intervertebral slot, a decrease in the lumen of the spindy channel
• MRI (magnetic resonance imaging) - allows with accuracy to a millimeter to determine the presence and location of sequestration of hernia, damage to the spinal cord and its roots
• Myelography - allows you to determine the degree of damage to the spinal cord and its roots and nerves
• Electromyography - determines the ability of nerve impulses to pass through fibers, diagnoses which of the roots and nerves is infringed

Treatment of sequestration of intervertebral hernia

The treatment of sequestration of intervertebral hernia is mainly surgical. Conservative methods are used mainly to prepare for the operation and in the postoperative period.

Operational treatment

Operation on the treatment of hernia and its sequestration is shown in cases where conservative treatment was not effective, the patient's condition deteriorates and visible signs of damage to the spinal cord. The main operation is discectomy when the affected intervertebral disk is removed, which dropped out of it with a pulp nucleus. After removing the disc, you can install the implant, after which the patient will be able to maximize the previous loads and return to a full-fledged life.

Medicia treatment

• NSAID: Diclofenac, Analgin, Ibuprofen - initially in injecting form (5-7 days), after which in a tablet form, up to 4 times a day for at least 2 weeks. Allows you to reduce pain, remove inflammation and swelling of tissues