Intervertebral hernia - prolapse (lat. prolapsus nuclei pulposi, discus prolaps) is a disease of the spine, in which parts of the intervertebral disc clamp the channels of the spinal nerves or spinal cord.
As opposed to protrusion intervertebral discs (protrusion), prolapse is a disease in which the annulus fibrosus, as well as the posterior longitudinal ligament, is completely torn.
The reasons are mostly overload and damage to the intervertebral discs. The beginning of treatment is carried out in the form of reducing the load and taking painkillers.
In the process of treatment, physiotherapy and careful sports activities are necessary and, accordingly, rational for muscle recovery. An urgent operation of the intervertebral discs is recommended only in case of manifestation of severe neurological diseases (paralysis, incontinence of the stool and urine, loss of sensation in the lower extremities).
Herniated discs occur in most cases due to long-term damage to the intervertebral disc (discus intervertebralis), i.e. tissue of its fibrous ring (anulus fibrosus). The so-called nucleus pulposus of the intervertebral disc consists of a jelly-like tissue and can take on the function of a hydraulic ball when loaded. As a result, an overall high mobility of the spine and its high stability are achieved.
The human spine is made up of 23 vertebrae. If you count from top to bottom, then you can establish that there is no intervertebral disc between the first vertebra (lat. atlas) and the second vertebra (lat. axis). As a result, the necessary freedom of movement of the head is achieved when tilting (atlas) and when turning (axis). In addition, the main bundles of nerves and vessels of the head blood supply pass there.
There are different causes of the disease: genetic predisposition, unilateral load during work or in free time, or poorly developed muscles (also lack of paravertebral, i.e. located near the spine, muscles). Damage caused solely by accidents or other mechanical influences has not yet been proven as a chain of cause and effect. Healthy tissue of the intervertebral discs, if it breaks out of the spine, then already with a part of the bone tissue adjacent to it.
A herniated disc also occurs during pregnancy. At the same time, one should not forget about the straight gait and the force of gravity. There are many elderly people over 90 years of age who, in their entire working life, have never had complaints of pain in the spine and, accordingly, pain in the intervertebral discs. And vice versa - there are children who already at an early age suffer from diseases of herniated discs. Possible reasons for the rapid increase in the incidence of herniated discs today: lack of movement and poor posture, especially in people with a sedentary type of work. It cannot be categorically stated that being overweight is a risk factor, since in obese people, due to the weight of their abdomen, there is a tendency for the spine to curve forward, and thus preventing the occurrence of intervertebral hernias.
The average statistical age of the disease falls on the age group of about 40 years, in which most often damaged vertebrae are located in the lumbar region. Cases of damage to the cervical vertebrae are much less common, and injuries of the thoracic vertebrae are very rare.
Due to the fact that the so-called increased weakness of the connective tissues is primarily a hereditary disease, it is possible to carry out prophylaxis to prevent herniated discs only to a limited extent: by strengthening the muscles and the medicines indicated for this disease (vitamin C, green shell extract (English: GREEN LIPPED MUSSEL EXTRACT), glucosamine, etc.). It is also not always possible to completely avoid accidents. Thus, everyone is advised to gradually build muscle through gymnastic exercises or bodybuilding; You should also try to avoid heavy lifting. There are special lifting techniques that do not affect the spine as much, but again, this is not possible in every profession - for example, when caring for the sick. Bodybuilding and fitness can be a problem in the sense that not every gym has qualified staff, so their advice is of little use.
Worthy of mention are also the "orthopedic sports": swimming, dancing, running (or Nordic walking), horseback riding and cycling. After the disease, however, certain sports, such as horse riding or running on cement or asphalt road surfaces, as well as cycling, will have to say goodbye due to the constantly bent position of the body.
Symptoms of a herniated disc are severe, often radiating pains (sciatica), numbness, and paralysis in the lower extremities with failure of reflexes, often shooting into the lower extremities.
A herniated disc may appear without obvious symptoms and may not be immediately detected. If you conduct a survey of people who have never had significant complaints about the spine, using magnetic resonance imaging - MRI or CT - studies (computed tomography), then 25-28% of these "healthy" people find cases of damage to the intervertebral discs. Ultimately, one must beware of considering a simple irritation of the sciatic nerve as damage to the intervertebral discs and consider this the source of all troubles and diseases, insisting on surgical intervention.
The most common symptoms are severe pain (both in the back and shooting into the lower extremities), sometimes also sensory disturbances (paresthesia) and/or paralysis. The latter are often expressed in lesions of the lumbar vertebrae with a feeling of numbness in the legs and shins and unsteady gait. The musculature responsible for lifting the leg, the toes, or the outside of the legs is often affected. Pain (slightly) lets go if you return to a position that does not strain your back. Weakening pain with progressive paralysis is a bad sign; this means that the sensory nerve fibers have already been destroyed, followed by the destruction of strong, motor fibers. A neurosurgeon, orthopedist, or neurologist can make the diagnosis. Often the diagnosis is supported by various types of X-ray studies. Prompt treatment can minimize harmful effects (eg weakening of the leg muscles over time), so a visit to the doctor is essential in any case.
Both conservative treatment (physiotherapy - manual methods - stretching devices), and the less common removal of parts of the intervertebral discs that press on the nerve roots through surgery, can lead to a good result in terms of unloading the nerve roots. Also included are the so-called minimally invasive interventions and microsurgical procedures, which are called "nucleoplasty" in this regard. Even less often, intermediate vertebrae are fixed with metal materials (spondylodesis). Whether surgery is required in each individual case remains debatable: more than 80% of intervertebral disc surgeries are estimated to be unnecessary and could have been avoided. In general terms, a “well-founded survey” is rational.
Severe neurological damage, confirmed by electromyographic studies of paralysis, the so-called. horsetail syndrome are indications for the fastest possible operation of the intervertebral discs, also called "nucleotomy". Pain treatment during surgery is mostly disappointing, not giving the desired result.
In Germany alone, approximately 30,000 spinal disc surgeries are performed annually. Intervertebral disc surgery is also the most common neurosurgical intervention worldwide. However, there are no significant differences between the results of treatment through surgery and conservative (non-surgical) treatment, such as acupuncture (acupuncture), medications or physiotherapy. This is the result of the largest clinical study on 1,244 patients with intervertebral disc problems worldwide (Spine Patient Outcome Research (SPORT)). However, in certain specific cases, there are still compulsorily necessary reasons for the operation.
As a rule, it is always necessary to identify the causes of herniated discs: incorrect posture, overload, weak muscles of the trunk (in this case we are talking about the “muscular corset”), etc. Many hospitals and some private clinics offer so-called schools for strengthening the back, to minimize the load on the spine in everyday life (correct weight lifting, positions to reduce stress, increase muscle mass).
Here are some of the many therapeutic and diagnostic treatments: Alexander technique, Hatha Yoga or McKenzie concept.
Acupuncture treatments often show good results.