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Discopathy – symptoms and treatment

Discopathy – symptoms and treatment

Discopathy is the most common disease of the nervous system and it takes second place after colds as a cause of temporary disability. Discopathy is also the most common surgical disease of the spine, spinal cord and roots of the spinal nerves. In most cases, disc disease occurs as a result of multiple, often repetitive microtrauma or physical stress, but sometimes there are congenital abnormalities, which favor damaging of the spinal cord and nerve roots. It occurs also at a young age. Usually this is a ”normal” process of wear and premature ”aging” of the structures of the spine.

The discopathy  may develop at any level of the spine, but is most common in the cervical and lower lumbal segments. These are the transitions between mobile (cervical, lumbal) and fixed (thoracal, sacral) sections of the spine.

 

Discopathy

Discopathy

Pathology
The intervertebral disc is composed of a central core pulp, peripheral fibrous ring and cartilaginous plates. Its function is to serve as a physiological shock absorber to the individual elements of the spine and to protect of a direct contact the bone bodies of the vertebres. At young age the pulp core is gelatinous and its water content exceeds 80%. The elasticity of intervertebral disks is supported by a fibrous ring, composed of 10-12 concentric layers of collagen fibers, located in a diagonal direction and attached to the cartilage plates. With the age, chronic microtrauma and loading, intervertebral disc changes.

Exercises for Discopathy

Fibers of the inner layers of fibrotic ring are tearing and grow through the pulp core, the disc becomes structureless and is progressive fibrosing, ruptures and defects of fibrotic ring are developing and also of the cartilage plates of the vertebral bodies. Prolonged pressure of the disc over the surrounding tissues leads to hypertrophy of neighboring bone edges - etc.”Spikes” or osteophytes and the intervertebral joints and connections are calcinating. These processes modify the shape and size of the bone channels of the spinal cord and its nerve root.  The initial stage of a discopathy is expressed in the blowing the disc because of migration of pulps nucleus and protrusion of fibrotic ring. After that comes an incomplete rupture of fibrotic ring and leaving of a part of the core pulps outside the disc. Herniated disc is formed in migration of greater or lesser part of the pulps core outside the disk space with complete rupture of fibrotic ring and an inability to ring-back. Depending on the direction of herniating (moving, going out of place) are distinguished:

• Front disc hernia;
• Vertical disc hernia (in cartilage plates in the vertebral body - so called nodules or bodies of Shmorl);
• Back disc hernia - leads to compression of the spinal cord or roots, depending on the level of the disc.

 

Symptoms of discopathy 
Acute advanced displacement of the intervertebral disc in lateral part of spinal channel gives a typical clinical picture - severe pain spreading in the area of the affected nerve root, possibly with motor or sensory disorders. The beginning of the the process may be associated with trauma, sudden movement or atypical position of the body for a long time.

In other cases, the beginning may be slow, gradual and unnoticed, especially in the neck and occurs with headaches (cervical migraine), dizziness, unsteadiness when walking, etc.. In the acute period pain decreases or even disappears when resting in bed, but is exacerbated when coughing, sneezing, straining during defecation, due to the sharp increase in CSF pressure. Added to pain are also muscle stiffness on the side of the spine, limited mobility and curvature of the spine - scoliosis.

Decreased sensation in the skin area, formication and weakness of muscles innervated by corresponding nerve root are also typical signs. Muscle atrophy (decreased size of the muscle) is indicative of a longer root compression.
Front and front-lateral disc hernias are much more rare and at the lumbar region occur with back pain, which is spreading to the inguinal folds and thighs and in the neck can cause dysphagia - swallowing disorders.

Lateral disc hernias usually do not cause disturbances in pelvic reservoirs, but because of the severe pain urination and defecation may be difficult or impossible. Diagnosis is confirmed from a review radiographs of the spine, scanner (CT), magnetic resonance imaging and myelography.


Treatment of discopathy
The type of treatment for discopathies is one of the most contentious questions in modern medicine. The first manifestation of discal hernia - local pain in the neck or waist of a temporary nature and variable duration can be diagnosed by a variety of conditions, and to pass with or without treatment (restbed for 5-7 days, analgetic medication, anti-inflammatory medication, massage, physiotherapy, etc.).
Conservative treatment (home or hospital) includes rest, adequate program for motoractivity, regime of physical activity, strengthening of musculature, analgetic medication, physiotherapy.

It should be applied necessarily enough time (at least 10-15 days) and should be with intense character, depending on the severity of symptoms and neurological symptoms. In over 90% of the cases this treatment has effect. About local injection of analgetic, steroid and anti-inflammatory drugs currently it is accepted that the risks exceed the beneficial effects and it is not recommended by most experts.

If the pain is uncontrolled or there is an appearance of neurological deficits, the possibility of surgical treatment should be discussed. The main indications for surgery are emergent and planned. Emergency indications are available in acute severe neurological symptoms - sphincter disorders (urinary incontinence and involuntary defecation), motor deficits (often paresis of the legs). In planned order are operated patients with severe or persistent pain unresponsive to drug therapy, gradually progressing neurological disorders - motor deficits, sensory disturbances, scoliosis because of forced posture.

The immediate postoperative results in discopathy may be excellent, with disappearance or relief from the pain in more than 90% of the operations. At a later stage, however, in about 15-30% of operated patients remains in varying degrees residual pain, the character of lumbalgiya (lumbago - pain in the lumbar region) or ishialgiya (sciatica -pain along the sciatic nerve, radiating to the lower limbs).

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