Back pain is felt by millions of people around the globe and this problem is facing the medicine of almost any state. Very often, pain manifestations are directly related to changes in the intervertebral disc, which lead to the appearance of hernias. One of these diseases is the Schmorlja hernia .
For the first time this disease was described by the German pathologist Hubert von Lushka in 1858, and was rediscovered and finally described by Schmorl in 1927.
A hernia( or nodules) of Schmorl appears when the substance of the intervertebral disc is pressed into the spongy substance( body) of the vertebra through the locking plate located between them.
The end( lock) plate is a thin hyaline cartilage of round shape that separates the intervertebral disc from the vertebral body and is a kind of joint surface in the intervertebral articulation.
Depending on the location of the hernia relative to the center of the plate, it is possible to distinguish the anterior, posterior, lateral and central Schmorl's hernia.
The most common localization of the hernia is the thoracic and lumbar spine.
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Why can a hernia of Schmorl?
Several causes of this disease can be identified. Thus, theories about the origin of the pathological Schmorl's nodule include:
- Embryonic developmental defects of , such as ossification of the spongy substance of vertebral bodies or the presence of vascular channels in them;
- Aging of and associated degenerative processes, in which there are weak spots in age-thin cartilage closure plates or cavities in vertebral bodies;
- Diseases that weaken the structure of the intervertebral disc and / or vertebral body.
How can I know if there is a hernia?
Schematic picture of Schmorl's hernia
As a rule( and especially in the early stages), the disease proceeds asymptomatically ( especially characteristic for the central and anterior variants, in which the hernial protrusion of adjacent neural trunks is excluded) and is detected accidentally when the planned x-ray diffraction ormagnetic resonance imaging of the thoracolumbar spine.
Less common are chest or waist pain( either muscular, caused by muscle overload, which "protect" a weak spot with prolonged exercise, or caused by compression of nerves with large lateral hernia size) or simply increased fatigue.
However, there are times when Schmorl's nodes cause a completely different clinical symptomatology. This happens after traumatization of the vertebrae, when the so-called giant Shmorl's cysts are formed in their bodies, which can lead to pathological vertebral fractures, intense pains and the appearance of pathological neurological symptoms.
Sometimes the process affects several vertebrae at once, which is associated with the systemic degenerative process of the spine bones, for example, Scheuermann-Mau disease. In such cases, the manifestations of the disease are also significant: severe pain, progressive posture curvature, the appearance of various pathological symptoms( goosebumps, numbness, changes in sensitivity in the hands or feet).
Primary diagnostics
Any of the methods of radiation diagnosis( be it radiography, computed tomography or magnetic resonance imaging) can be used to diagnose the disease.
Typical radiographic manifestations of Schmorl's nodules are the appearance of unevenness of the cartilaginous occlusal plate and( or) the presence of small radiopharmaceutical pockets in the body of the vertebra that pass into the disc.
Tactics of treatment of Schmorl's hernia at different stages of
It is quite enough to perform simple preventive recommendations that include:
- maintaining a constant and adequate level of physical activity , which implies both daily( or 2-3 times a week) exercise, for example, charging, and reasonable dosing of axial loadswearing in the hands or on the shoulders of weights to limit the weight of 10 kilograms);
- rejection of bad habits of , which lead to disruption of trophism of body tissues in general and bone-sutava in particular;
- body mass control , since a significant excess of it significantly increases the passive static load on the spine;
- abstention from those activities that could potentially trigger a worsening state of the disease( mainly professional sport , as well as its kinds, in which large additional axial loads are created - weightlifting, wrestling);
- , among other things, will benefit from the passing of the curative gymnastics courses, gymnastics and swimming classes, as well as a wellness massage session.
In cases when the course of the disease is accompanied by a noticeable increased fatigue of the back muscles and pain symptoms, the appointment of analgesics from the group of non-steroidal anti-inflammatory drugs, vitamin D and calcium preparations, if necessary peripheral muscle relaxants( to relieve spasm of strained muscles), glucocorticosteroids.
Surgical treatment for Schmorl's hernia
Surgical treatment of usually becomes necessary only in cases where there are intense back pain and significant changes in the neurological status, which, among other things, lead to loss of efficiency.
Scales of surgery can range from percutaneous injection of cementitious substance to anterior corpectomy with spondylodesis( fusion of the bodies of adjacent vertebrae) and various laser treatments.
Recently, new high-tech methods for restoring the integral structure of the closure plate have been developed, so there will be more options for how to treat Schmorl's hernia in the near future.
It should be noted that early diagnosis, prevention and treatment of any type of Schmorl hernia will avoid serious complications, and also use the most conservative, natural and safe methods.
