Symptoms and treatment of foraminal herniated disc

Foraminal herniation of the intervertebral disc is a disease that appears as a pathological protrusion of a part of the intervertebral disc into the region of the foramen. The latter is a narrow passage through which the roots of the spinal cord and veins exit, and the arteries supplying the nervous structure enter. As a result of such a protrusion, the intervertebral disc exerts significant pressure on the outgoing nerve fibers, which leads to their constant compression.

This disease is rare - only up to 10% of all spinal hernias. However, it is not devoid of a specific clinical picture and complications.

spinal diseases

Foraminal disc herniation can affect any level of the vertebra, but most often the disease is diagnosed at the level of the lumbar and sacral (due to the fact that these areas receive the greatest pressure), less often at the level of the cervical and thoracic.

Reasons for education

This pathology belongs to the class of multifactorial diseases, that is, those that are caused by many factors.

The most common reasons include:

trauma to individual vertebrae or the entire spine, such as: blows, falls;
background diseases: osteochondrosis or osteoporosis, in which there is a violation of metabolic processes in the body, as well as scoliosis, kyphosis or lordosis;
uncontrolled constant physical activity, leading to the destruction of the structures of the spinal column;
age over 30 years;
gender - women suffer from such a hernia more often than men;
lack of physical activity: over time, the muscles lose their tone and are no longer able to play the role of a supporting corset;
overweight: excess body weight puts additional stress on the vertebrae;
disease-provoking factors: sudden movements, a push in the back, smoking, hypothermia, the effect of vibration for a long time;
hereditary predisposition - determined by a defect in the group of genes responsible for the synthesis of collagen fibers;
malnutrition, in particular the use of small amounts of fluid.

Varieties of pathology

There are several classifications of the disease.

Depending on the exit side:

left-sided (more common);
right-sided.

Classification by location in the spine:

cervical;
chest;
lumbar;
sacral.

Depending on the location in relation to an individual vertebra:

median (medial) - located at the entrance to the intervertebral space;
lateral or lateral - located at the exit of the same place;
intraforaminal - located directly in the intervertebral foramen;
extraforaminal - a hernia is located outside the boundaries of the intervertebral foramen.

Clinical picture of foraminal hernia

Pain is the leading symptom in this pathology.

The pain syndrome has the following characteristics:

sudden appearance;
strong in intensity and expression;
manifested by the type of lumbago;
indefinite localization: pain may appear in the neck, then go to the chest and end in the lumbar region;
sometimes it is not removed by simple painkillers - in such cases, doctors prescribe anesthetic drugs of a narcotic nature.

back hurts

Other symptoms include:

The forced position of the patient - this helps him feel the least discomfort.
Weakening of muscle strength , resulting from a violation of innervation by "crushed" nerve fibers. There is also asymmetry in muscle contraction.
Violation of the sensitive sphere . This manifests itself in the form of a deterioration in the perception of temperature, tactile or pain sensations. Decreased normal tendon reflexes.
The patient experiences difficulty when lifting on toes , it is also difficult for him to fully stand on his heels.
The presence of bulging in the cervical region contributes to the deterioration of the performance of sensory systems , such as hearing or vision.
chronic headaches.
The location of the hernia also affects the specifics of the symptoms : left-sided bulging provokes the development of signs on the left side of the body (left leg or arm), the right-sided location of the hernia is the opposite.
Violation of the genitourinary system: in men, worsening of erectile function, decreased libido, in women - a violation of the menstrual cycle. Both may experience difficulty urinating.
Sleep disturbance, irritability, loss of concentration.

Depending on which department the hernia is located in, the clinical picture has its own specific signs.

Among them:

Herniated lower cervical discs:

weakness of the muscles of the neck and partially upper limbs;
numbness of the fingers;

Foraminal hernia of the lower lumbar vertebrae:

leg tremor;
weakness of the muscles of the lower extremities;
deterioration in the performance of the pelvic organs (bladder, sections of the large intestine and rectal sphincter);
severe pain in the lumbar region.

Diagnostic principles

The process of researching a disease consists of several stages:

Examination by a doctor . The specialist examines the patient: he studies the anamnesis of life, the anamnesis of the disease, examines tendon reflexes and asks the patient about his complaints. At this stage, a preliminary diagnosis is made.
Instrumental research methods , the gold standard of which is magnetic resonance imaging. This method provides visualized information about the condition of hard and soft tissues, the location and size of the protrusion, the prospects for further development of the pathology and treatment options. At this stage, the final diagnosis is made and the therapy process begins.

Foraminal hernia treatment

As in the clinic of any hernia, treatment occurs in two ways - conservative therapy and surgical intervention.

The first option acts as only a facilitating method, but does not eliminate the cause.

The task of conservative treatment is an attempt to achieve the following goals:

Elimination of pain syndrome , removal of any discomfort from the patient. Elimination of inflammatory processes, restoration of normal blood and lymph circulation. For such purposes, non-steroidal anti-inflammatory drugs and drugs that relieve muscle spasm are prescribed.
Restoration of tone and strengthening of muscles . This is achieved by undergoing a course of physiotherapy exercises, massage sessions and various methods of physiotherapy, such as water procedures, acupuncture - all this helps to strengthen the muscular corset of the back.
Reducing the size of the hernia . To do this, doctors prescribe electrophoresis, spinal traction exercises and local administration of medications.

spine

Indications for the appointment of a hernia treatment surgically:

protrusion size of 10mm or more;
complications in the form of paresis or paralysis of the limbs;
pronounced pain syndrome, not relieved by painkillers;
lack of effect from conservative treatment.

Types of surgical interventions aimed at removing a hernia:

Laminectomy . This manipulation involves the removal of the outgoing part of the intervertebral disc, as well as part of the bone structures of the vertebrae, which have an aggravating effect.
Microdiscectomy . During this operation, the removal of the intervertebral disc, which compresses the nerve fibers emerging from the spinal cord, is performed.
Interspinous spacers . This is a modern method in surgery, the essence of which is to place implants between the processes of the vertebrae, which would reduce the pressure of the hernia on the spinal cord.
Transforaminal endoscopic removal. This method is aimed at removing the pathological protrusion through the foraminal opening of the spinal column.

Rehabilitation after treatment

Preventive and restorative measures are prescribed a few days after surgery. A number of rehabilitation measures are aimed at restoring the patient's physical strength, restoring his working capacity and returning the patient to his usual, but modified way of life.

For the first few days, the patient must wear a brace. In the future, the rehabilitation period includes the restoration and strengthening of the muscular corset of the back. These points are carried out by performing a set of first recovery and then strength exercises.