Schmorl’s hernia of the spine: symptoms and treatment
How to treat hernia Shmorlja spine?
Back pain afflicts millions of people around the globe, and this problem arises before the medicine any state. Very often the pain symptoms are directly related to changes in the intervertebral disc, which lead to the appearance of hernias. One of these diseases is schmorl’s nodule.
The disease was first described by the German pathologist Hubert von Loscoe in 1858, and finally rediscovered and described Smilem in 1927.
Hernia (or nodules) schmorl’s arises when the substance of the intervertebral disc is pressed into spongy substance (body) of the vertebra through the obturator plate located between them.
End (obturator) plate is a thin hyaline cartilage rounded shape, which separates the intervertebral disc from the vertebral body and resembles the articular surface of the intervertebral joint.
Depending on the location of the hernia relative to the center plate, you can select front, rear, side and Central schmorl’s nodule.
The most frequent localization of herniated thoracic and lumbar spine.
Why may occur schmorl’s hernia?
It is possible to allocate some reasons of occurrence of this disease. So, theories on the origin of pathological schmorl’s nodule include:
- Embryonic developmental defects, such as failures of ossification in the spongy substance of the vertebral bodies or the presence of vascular channels;
- Aging and related degenerative processes that appear weak spots in thinner with age, the cartilage zamechatelnyh plates or cavity in the vertebral body;
- Diseases that weaken the structure of the intervertebral disc and (or)of a vertebral body.
Another reason may be traumatic injury of the intervertebral disc and a fracture of the endplate and a breakthrough content in the tissue of the vertebral body (in this case, developing an acute schmorl’s nodule).
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Usually (and especially in the early stages), the disease is asymptomatic (especially true for Central and front variants, with the impact of hernial protrusion on the nearby nerve trunks excluded) and is found incidentally when performing routine radiographs or magnetic resonance imaging of the thoracolumbar spine.
Rarely can present with chest pain and low back pain (or muscle caused by overexertion of the muscles, which «protect» the weak point during long-term load, either caused by compression of nerves at larger sizes lateral hernia), or simply fatigue.
However, there are cases where the schmorl’s nodes cause very different clinical symptoms. It happens after trauma to the vertebrae, when their bodies formed the so-called giant schmorl’s cyst, which can lead to the emergence of pathological vertebral fractures, intense pain and the appearance of pathological neurological symptoms.
Sometimes the process involves several vertebrae, the bowl is associated with a systemic degenerative process of the bones of the spine, such as Scheuermann’s disease Mau. In such cases manifestations of the disease are also significant: expressed pain, progressive curvature of the posture, the appearance of a variety of pathological symptoms (tingling, numbness, altered sensitivity in the hands or feet).
For the diagnosis of the disease can be any of the methods of radiation diagnosis (whether it’s radiography, computed tomography or magnetic resonance imaging).
Typical radiographic manifestations of schmorl’s nodules is the occurrence of irregularities of the cartilage of the obturator plate and (or) the presence of a small radiolucent pockets in the vertebral body, turning into a disk.
Treatment of schmorl’s nodule at different stages
The treatment of this type of intervertebral hernia requires taking into account the gravity and severity of the disease. So in the easiest cases when some symptoms are absent and diagnosis is a godsend, no specific therapy is not required.
Enough perform simple preventive recommendations, which include:
- maintaining a constant and adequate level of physical activity, which involves daily (or 2-3 times a week) exercise class, for example, a charging and a reasonable dosage of axial loads (carrying in hands or on shoulders weight limit weighing 10 pounds);
- the rejection of bad habits that lead to violation of the trophic tissue of the body in General and bone-stavnoe in particular;
- the control of body weight, as significant excess passive greatly increases the static load on the spine;
- abstinence from those activities that have the potential to cause deterioration of the disease condition (this is mainly a professional sport, and its species, which creates large additional axial load – weightlifting, wrestling);
- among other things, will benefit the completion of physical therapy, gymnastics and swimming lessons and pampering massage.
In cases where the disease is accompanied by significant fatigue of the back muscles and pain symptoms, in the treatment of add appointment analgesics from the group of nonsteroidal anti-inflammatory drugs, medicines of vitamin D and calcium, if necessary, peripheral muscle relaxants (to relieve spasm of overused muscles), corticosteroids.
To make their own drugs is fraught with consequences, so the final decision on the appointment of medicines taking Doctor.
Surgical treatment typically becomes necessary only in cases in which there is intense pain in the back and significant changes in neurological status, which, among other things, lead to the loss of health.
The scale of the operation can vary from percutaneous injection of a cementing substance to the front of corpectomy with fusion (merge bodies of adjacent vertebrae) and different variants of laser treatment.
Recently conducted the development of new high-tech methods to restore the holistic structure of the endplate, so as to treat the schmorl’s nodule in the near future there will be more.
It should be noted that early diagnosis, prevention and treatment of any kind of hernia Shmorlja will allow to avoid serious complications and to avoid the application of the most conservative, natural and safe methods.