How is Schmorl's hernia manifested and treated in the thoracic spine

Schmorl's hernia in the thoracic region is a disease that is characterized as an indentation of the elements of the intervertebral disc into the spongy body of the spinal bone. Such a hernia is common among people who have dystrophic changes in the skeletal system against the background of various diseases, such as osteochondrosis or osteoarthritis.

Normally, the spinal column consists of a series of vertebrae, between which there is an intervertebral disc. It performs the function of pressure absorption so that the vertebrae themselves do not touch each other. Usually, on the side of the vertebra tangent to the disc, there is a closing layer - cartilaginous plates, which are analogues of the articular surfaces of other joints.

In the case when such a layer is destroyed, the surface of the bone becomes vulnerable. In the future, the spongy tissue of the bone can be subject to various changes, including extrusion from the side of the intervertebral disc.

The hernia outwardly resembles a cone-shaped protrusion of cartilaginous tissue, the top of which is located inside the vertebra.

Reasons for development

Provocative phenomena include any factor that directly or indirectly affects the structure of cartilage tissue and its integrity.

These include:

• genetic predisposition : there are genetic diseases that are manifested by defective development of connective tissue;
• uneven growth process in a child: too fast or slow growth can adversely affect the spine;
• diseases of the endocrine system, where the leading link is a violation of metabolic functions in the body;
• individual features of the development of the musculoskeletal system;
• constant physical activity that exceeds the potential capabilities of the body, exhausting it, this includes strength work, irrational professional sports;
• violation of posture: scoliosis, kyphosis or lordosis;
• transferred injuries of the spinal column: direct blows, unsuccessful falls;
• transferred operations on the back or spine specifically;
• a sedentary lifestyle, leading to a weakening of the muscles of the back and, as a result, the muscular corset disappears;
• involutional changes in the end layer, intervertebral disc or the vertebra itself;
• malnutrition over a long period of time: insufficient intake of vitamins and elements (especially calcium).

Anyone can develop a hernia, however, more often than others get sick:

• elderly and old people who have a number of age-related changes in the body;
• athletes or people whose occupation is associated with constant power loads on the back;
• actively growing young children who develop soft tissues very quickly;

A hernia in the thoracic spine has a number of differences from others such:

1. Pathology is formed with the participation of intervertebral discs, destroying the vertebrae themselves.
2. Pain is not the leading symptom. Often in the early stages of the disease, there is no pain at all. However, pain appears in the later stages of the course of the disease.
3. A standard hernia is a bulge into a space where there is less pressure. Here there is a protrusion into dense tissue.
4. Often develops in adolescents or children.
5. Does not contact, does not compress and does not develop compression of the spinal nerves or vessels.

Clinical picture

It happens that in medicine the absence of any symptom is a sign of illness. This pattern is observed with Schmorl's hernia. The reason is explained as follows: a hernia does not put pressure on arteries, veins and nerve fibers. Also, the presence of protrusion does not cause muscle spasm and inflammation.

Often, a hernia begins to form in adolescence of a child, but the first signs are detected after a few years.

As the bulge increases, the following symptoms can be observed:

• posture is disturbed: it is bent to one side;
• there are pains in the chest area, pain can spread to the upper limbs;
• pain may appear after a long stay of the spine without movement, for example, a person works at a computer for a long time;
• painful sensations appear with sudden changes in the position of the body, especially when the torso is tilted forward or backward;
• in the elderly, numbness of the limbs is observed against the background of a deterioration in blood circulation;
• sooner or later, symptoms of a violation of the work of cardiac activity or respiration appear: the pulse may spontaneously increase, slow down, the patient complains of shortness of breath.

The danger of disease

Since at first the pathology is asymptomatic, a hernia over this long period has a devastating effect on the surrounding tissues.

Pathology develops the following processes:

1. Complications . A patient with insufficient attention may end up in a wheelchair.
2. "Erasing" the vertebrae. Against the background of the fact that the vertebra is constantly in close contact with another unit of the spinal column, its grinding occurs.
3. development of arthrosis.
4. Pathology of the heart and its activities . It develops from the fact that blood circulation and metabolism are disturbed. This leads to a violation of blood pressure and failures in the heart rate.

Diagnosis of Schmorl's hernia in the thoracic region

Research and diagnosis is based on the following sources of information:

• subjective complaints of the patient, the nature of pain, the time of their appearance and their location; it also takes into account the relationship between the occurrence of pain and physical activity;
• objective examination. The doctor draws attention to some external signs of the disease: redness, swelling, curvature of the spine, pain when pressed;
• life history: past injuries, operations, hernias in parents, presence of other diseases.

However, this information does not have confirmatory power, and only after a study of pain with the help of instrumental methods can a final diagnosis be made.

These methods include:

1. Radiography. It makes it possible to determine the attributes of the protrusion: size, localization, contact with neighboring tissues.
2. Magnetic resonance imaging. This tool makes it possible to visualize the hernia, to investigate the cause of the bulge. In general, MRI provides more accurate characteristics than x-rays.
3. CT scan.

Additional clinical studies:

• general blood analysis;
• biochemical analysis;
• general urine analysis.

Treatment of Schmorl's hernia of the thoracic spine

The scheme of therapeutic measures is determined by such factors as the current state of the patient, the presence of complications, the size of the hernia, the stage of its development. The main treatment for Schmorl's nodule in the thoracic spine is conservative therapy. How to treat?

There are three types of therapy:

• medication treatment;
• physiotherapy complex;
• physiotherapy exercises (LFK).

1. Medical therapy.

Such a line of treatment is prescribed when the patient's condition is stable - when the likelihood of complications is minimal. Otherwise, the patient is shown surgical intervention, but the operation is rarely prescribed. The goal of drug therapy is to relieve pain, spasms, inflammation and swelling. If there are none, they must be prevented. Common drugs are corticosteroids and non-steroidal anti-inflammatory drugs.

Popular means:

• revmaksikam: injected into the muscle up to two times a day;
• neurorubin: the drug is injected once a day;
• midokalm: it is recommended to take up to three times a day.

It is important to remember that vitamin preparations should be taken in parallel, namely: tocopherol, vitamins of group B. It is also effective to use NSAIDs in ointments that must be applied at the location of the hernia.

2. Physiotherapy.

This includes:

• massage sessions (help reduce muscle spasm);
• acupuncture (accelerates local blood flow, metabolism, promotes the regeneration of damaged tissues);
• electrophoresis with the use of drugs.

3. Therapeutic gymnastics and exercise therapy.

Its purpose is to restore, strengthen and create a strong muscular corset of the back. It is important to perform exercises under the supervision of a specialist. Physical education should not be difficult for the patient, it should be loaded in a dosed manner.