What is the difference between different types of hernias of the spine

Intervertebral hernia is a disease accompanied by a characteristic bulging of the intervertebral disc, "squeezing" it between the bodies of two vertebrae. Often it is accompanied by compression of the structures of the spinal canal. Doctors distinguish different types of hernias of the spine, based on several classifications.

For an accurate diagnosis and selection of optimal treatment tactics, it is important to understand which of the different types of vertebral hernias is found in a patient. If therapy is selected without taking into account the characteristics of the disease, it may turn out to be completely ineffective or even harmful.

Influence of location

What are spinal hernias? The classification by location is the most popular in medicine and among patients. In itself, it does not represent anything complicated, relying on the vertebral sections identified by anatomists.

According to the location of the protrusion, they are divided into:

• cervical (affecting the cervical spine), indicated by the letter C in diagnoses and detected in 30% of patients seeking help;
• thoracic (the thoracic spine is affected), denoted by the letters Th and diagnosed only in 6% of those who visit doctors (it is believed that thoracic hernias are the least common);
• lumbar (the lumbar spine is affected), are indicated in diagnoses with the letter L, and are most common, in about 64% of cases.

The percentage distribution of pathologies is explained by the loads on the vertebral sections and their mobility. So, there is a small load on the cervical and thoracic regions, while their mobility is maximum and is maintained even if a person is sitting or lying, therefore protrusions rarely appear there.

With the lumbar region, the picture is completely opposite - at maximum loads, mobility in this part of the back is very limited, which explains the high incidence of the disease in this area.

Degrees of protrusion

Another important classification of intervertebral hernias is their division according to the degree of protrusion. This division system plays a big role in medicine, since depending on how much the protrusion goes beyond the boundaries of the spine, complications are often predicted, and the question is whether the pathology can be treated with minimally invasive techniques, or whether a large-scale surgical operation will have to be applied.

According to the degree of protrusion of the hernia beyond the spinal column, there are:

• protrusion , in which the hernia exit does not exceed 2.5-3 mm (in most cases, the disease at this stage is diagnosed completely by accident, the patient does not complain of any discomfort, and treatment can be carried out conservatively without resorting to surgical intervention);
• prolapse , in which the hernia exit is already 3.1-5 mm (at the stage of prolapse, the first complaints of a person for any discomfort generally appear, an intermittent pain syndrome is formed, but therapy can still be conservative if you consult a doctor in a timely manner) ;
• developed hernia , in which the size of the protrusion is often more than 6 mm (the symptoms during this period are already obvious, the person is forced to undergo conservative treatment and decide with the attending physician on the need for surgical intervention).

Classification according to the degree of protrusion is relevant in any case, regardless of whether the patient is diagnosed with a lumbar, cervical or thoracic hernia. It is only important to remember that, depending on the spine, protrusion in the lumbar and cervical can vary significantly in the clinical picture.

Some doctors distinguish only two main categories according to the degree of protrusion:

• local hernia, in which the output is not more than 25% of the total disc circumference;
• diffuse , in which the output is from 25% to 50% of the total circumference of the damaged disc.

This classification is controversial, since not all doctors agree that the disc can only bulge 50% of its circumference, but, nevertheless, it is sometimes used in medicine.

Landmark - anatomy

Another common way to classify hernias is to use their anatomy.

There are several types of pathology, based on this criterion:

• free , in which the protruding structure and the intervertebral disc are still connected;
• sequestered (wandering), in which the relationship between the bulge and the intervertebral disc is lost, it begins to actively move in the spinal canal, which can lead to unforeseen consequences due to trauma to the surrounding structures;
• moving , characterized by the possibility of alternate displacement and return to the previous position.

The anatomical classification of intervertebral hernias is necessary for doctors in order to foresee possible negative consequences in the absence of proper treatment. So, for example, any specialist knows that a sequestered hernia poses the greatest health hazard, as it easily moves along the spinal canal and can compress the nerve trunks at the most unforeseen moment with the formation of life-threatening symptoms.

The anatomical division of hernias into several types also allows the doctor to imagine how the disease will develop in the future, and what methods of therapy are most applicable in order to stop the transition from one type to another.

The direction of the protrusion of the hernia

Doctors distinguish different types of intervertebral hernias according to the direction in which the protrusion occurred. This method of division is important when choosing the optimal method of surgical treatment, since not every bulge, depending on the direction, can be corrected using minimally invasive methods.

According to topography, there are:

• anterior bulges , in which the intervertebral disc protrudes forward in relation to the vertebral bodies, the patient does not have complaints, and the course of the disease is the most favorable (anterior hernias are mostly diagnosed by chance when the patient goes to the doctor for another reason);
• lateral bulges occur laterally between the vertebrae, while the holes through which the spinal nerves pass are often involved in the pathological process (when the nerve is pinched, the patient has complaints that may vary depending on which nerve trunk was affected and how severe the pathology is);
• posterior hernia , in which the vertebra is behind the protrusion, and it itself goes straight into the spinal canal and can compress the spinal cord.

A hernia with bulging back is considered the most dangerous for human health and life.

In this case, the damaged intervertebral disc enters the spinal canal, which can lead to the development of a number of unpleasant symptoms, and in some cases to the patient's disability.

Type of tissue outside the intervertebral space

The type of tissue outside the intervertebral canal is also important to evaluate when making a full diagnosis and choosing the optimal treatment strategy.

According to this classification, doctors distinguish a hernia:

• pulpous , in which the nucleus pulposus is outside the intervertebral space, which could leave the intervertebral disc through defects in the fibrous ring, being in any position relative to the spinal canal;
• cartilaginous , in which the cartilaginous part of the intervertebral disc, which has lost its former elasticity due to the influence of adverse factors, is outside the intervertebral space, squeezing the surrounding structures and leading to the appearance of characteristic symptoms;
• bone , which is diagnosed mainly in older people due to active processes of spondylolisthesis.

To call a bone hernia a hernia in full is somewhat incorrect, as some doctors believe. This is explained by the fact that osteophytes are formed during spondylolisthesis, which are capable of compressing the spinal cord, but they still cannot be attributed to hernial protrusions, since the mechanism of their formation is different. Nevertheless, a bone hernia is still included in the classification of the disease according to the type of tissues that are outside the intervertebral space.

Schmorl's hernia

In the classification, doctors often separately distinguish Schmorl's intervertebral hernia. In this case, the protrusion does not occur away from the vertebra, but either above it or slightly below it.

Interestingly, in Schmorl's pathology, there is no displacement of the intervertebral disc itself, it is sufficiently preserved and can still perform its main shock-absorbing functions. The resulting hernia also does not have any adverse effect on the spinal nerves, does not compress them.

Despite the absence of any adverse symptoms and a good prognosis, the patient still needs a complex of therapeutic and preventive measures. The fact is that Schmorl's disease is formed due to insufficient bone tissue, which can progress and give complications in the future.

In most cases, its development leads to:

• pathological changes in the bone tissue of the congenital type, which led to the destruction of the endplate of the vertebra, causing the development of a defect;
• pronounced rarefaction of bone tissue with the loss of part of its functions, which is usually characteristic of the elderly, but can also occur in young people.

Schmorl's disease can develop into a full-fledged herniated disc if the patient ignores it. That is why it is recommended to deal with its detection and treatment in a timely manner, without delaying the start of therapy.

Sequestered hernia

Although a sequestered hernia is included in the classification according to the anatomical component, some doctors prefer to separate it into a separate species. This is due to the fact that such a disease often poses the greatest danger to a person.

As a result of the development of a sequestered hernia, the fibrous ring of the intervertebral disc ruptures, and the nucleus pulposus is directly in the spinal canal. This can lead not only to compression of the spinal cord itself and the nerve trunks that depart from it, but also to their atrophy and subsequent necrosis with loss of function.

A herniated disc is a complex disease. Most doctors give the patient a final diagnosis, based not on one, but at least on several classifications, each of which has its own characteristics and may affect the further treatment of the patient.

An appointment with a doctor is necessary so that the diagnosis, taking into account all the features of the disease, is made as correctly as possible. The approach to treatment often depends on the assignment of the pathology to the correct classification, and the life and health of the patient depends on the chosen method of therapy. Diagnosis must be taken as seriously as possible.