What is the difference between Schmorl's hernia and the usual in the understanding of most of us intervertebral hernia? Firstly, here we are talking not so much about the disease as about the radiological term, which was first proposed by the German physician Christian Schmorl. In the picture, the scientist saw the cartilaginous tissues of the end plates being pushed into the body of the lower or upper vertebra, right into the cancellous bone. This pathology is attributed to the genetic nature of origin, therefore it is most often formed in early childhood against the background of active release of growth hormone.
How is it different from an ordinary intervertebral hernia
When a child grows, his soft tissues stretch faster, and the bone tissues do not always keep pace with the pace of development of muscle mass and ligamentous apparatus, so their size may lag slightly behind. As a result of this process, voids are formed insideevery vertebra. As time passes, the end vertebral plates are pressed into the spongy bodies, which in fact are these voids. Schmorl's hernia differs from the usual intervertebral formation:
- location;
- pathological reaction that does not involve the neurovascular plexus;
- lack of compression of the cerebrospinal substance and roots;
- the paucity of clinical manifestations due to the formation of pathology involving only the vertebral bodies and intervertebral discs;
- occurring predominantly in childhood and adolescence.
Is this disease dangerous
First of all, the Schmorl's hernia found on the x-ray can be considered a harbinger of the formation of an intervertebral hernia in the future, since without appropriate therapy, as it progresses, it quickly thins the vertebrae, makes them unprotected and weak to the effects of physical factors (blows, long walking, heavy lifting). The consequence of this pathology may be a compression fracture of the spine.
Given that the intervertebral disc is involved in the development of the disease, over time it falls into the hernial sac, and this significantly interferes with the depreciation functions of the spinal column. In severe cases, this factor can lead to disability. In addition, Schmorl's hernia of the vertebrae of any of the departments (lumbar, thoracic, cervical) causes an increase in compression on the intervertebral joints. In young patients with this disease, oftendiagnose degenerative changes in the joints, which indicate the initial stage of arthrosis.
Actually, such a pathology as Schmorl's hernia is dangerous for its complications. Neglecting the need for therapy in the absence of clinical manifestations, the patient risks facing irreversible consequences. In most cases, such a problem is detected by an accidental X-ray examination, which can be considered a huge stroke of luck for patients.
Causes of pathology
Modern medicine still finds it difficult to explain why Schmorl's hernia occurs in the lumbar, thoracic or cervical segment of the spine. But still, most experts agree on the causes of the disease, which may well be:
- Genetic predisposition of the patient.
- Features of the structure of the end plates.
- The rapid growth of a child in early childhood or adolescence, accompanied by a lag in bone growth with satisfactory cartilage growth. As a result, the resulting voids in the vertebrae are filled with cartilage.
- Calcium deficiency in bone tissue or insufficient absorption of this trace element by the body.
- Violation of metabolic processes in the intervertebral disc.
- Excessive physical activity leading to microtrauma of the spine (during professional sports).
- Pregnancy. During the period of gestation, a woman increases the load on each section of the spinal column, but most of all sufferthoracic and lumbar.
Schmorl's hernia is a completely natural consequence of a fall from a great height or a sharp rise in weight. In old age, the cause of the development of pathology of the spine can be the deformation of the bone and cartilage structures against the background of the progression of osteoporosis. By the way, this disease, associated with a high risk of fractures, also occurs in middle-aged women in menopause.
In the lumbar spine, Schmorl's hernias can occur due to poor blood supply, which leads to loss of strength of the vertebrae, which are simply pressed through by intervertebral structures. Violation of the blood supply to the ridge occurs as a result of the development of stoop, kyphosis, scoliosis, Scheuermann's disease - Mau. But most often, a lack of full-fledged physical activity and sedentary work lead to such a problem.
Clinical picture
Symptoms of Schmorl's hernia are usually mild or absent. The paucity of the clinical manifestations of the disease can be explained by the fact that this formation:
- does not affect nerve roots and blood vessels;
- does not provoke inflammation;
- not accompanied by muscle spasm.
As mentioned at the beginning, this pathology is more of an x-ray sign and is diagnosed by chance. Patients rarely experience pain, but even if an unpleasant symptom appears, it is of a local short-term nature. For example, discomfort can be felt during exercise and disappears during rest, so patientsoften complain of decreased performance and physical activity.
In the lumbar region
When palpation of the area of the affected vertebrae, the patient may feel slight soreness and muscle spasm. At the same time, other neurological and vascular changes, as a rule, are completely absent. Therefore, the treatment of Schmorl's hernia of the lumbar spine is not symptomatic, i.e. aimed at eliminating the clinical manifestations of the disease.
Pathology in the lower segment of the spinal column usually does not manifest itself in any way, rarely accompanied by muscle hypertonicity and tension in the lumbar region, discomfort and poor flexibility of the back. In isolated cases, Schmorl's hernia causes lower back pain radiating to the legs. The onset of symptoms is often preceded by increased physical activity. By the way, such a symptom can sometimes indicate a complication of the disease. As the pathology progresses, the intervertebral disc can completely fall into the spongy bone, which, in turn, will serve as the basis for dysfunction of the lumbar vertebrae. If we take into account that the affected area is significantly weakened, the risk of a compression fracture increases. Especially dangerous for patients with Schmorl's hernia is:
- significant lateral load on the spinal column;
- strong backstab;
- squeezing the ridge along the axis.
The identified pathology in the lower back requires serious and responsible treatment. Education can be formed on anysegment of the spine. There are five vertebrae in the lumbar region. In comparison with the vertebrae of other departments, these have the largest size. This is due to physiological characteristics: it is on the lower back that the maximum weight load falls. The doctor establishes an X-ray diagnosis based on the localization of the hernia at the level of the vertebrae L1, L2, L3, L4 or L5.
Thoracic lesion
Schmorl's hernia in the thoracic spine can be formed at any level, however, in this area of the spinal column, pathology is much less common than in the lower back or in the neck. Most often, it develops within the Th8-Th12 vertebrae and is asymptomatic, since only the bone tissue is affected, and the nerve roots are not affected at all.
At first, the pain syndrome may be completely absent, but as the hernial formation grows, the patient may notice increased fatigue of the whole body, tension in the thoracic region.
The treatment of Schmorl's hernia is reduced to the elimination of secondary signs of pathology - violations of the internal organs. With an increase in its size, palpitations, shortness of breath often occur. After some time, back pains join, which become noticeable during any physical activity and decrease as soon as the patient relaxes, takes a supine position. The pain may radiate to the arms, manifesting as numbness and tingling in the shoulder, elbow.
Schmorl's hernia in the cervical spine
On thisin the area of the spinal column, pathology often develops due to the softness of the cervical vertebrae. With a small size, the formation in the cervical region may not manifest itself, but as soon as the pathology begins to progress, the patient will experience weakness, decrease in working capacity, and pain in the region of the cervico-shoulder collar will become permanent. Most often, the development of the disease is due to a change in the size of the hernia or the addition of additional complications associated with impaired cerebral circulation. Patients with a hernia of Schmorl in the cervical region often complain of severe headache and drowsiness.
How to recognize the disease
Primary diagnosis of Schmorl's hernia is based on the principles:
- detailed description of complaints by the patient - the presence of pain syndrome, its exact or approximate localization, the relationship of symptoms with physical activity or being at rest;
- taking an anamnesis - it is important to find out if one of the close relatives suffers from a hernia, whether the patient had a previous spinal injury, etc.;
- visual examination and palpation along the ridge - the doctor assesses the condition of the spinal column, including possible curvature or swelling of the soft tissues.
The obligatory methods of examination in case of suspicion of this disease of the spine include x-rays. By the way, this is a fundamental method for making a diagnosis. A more informative alternative to it is MRI, CT. Also, the vertebrologist can refer the patient toorthopedist and neurologist for consultation.
Schmorl's hernia treatment
The spine with identified usurative defects requires complex therapy, taking into account the gender, age of the patient, the characteristics of his professional activity, and the severity of the pathological process. The course of concomitant chronic diseases is also taken into account. Starting the treatment of Schmorl's hernia of the thoracic or lumbar, the doctor sets himself the following tasks:
- Relieve pain (if any).
- Start metabolic processes in bone tissue.
- Improve blood circulation in the back muscles.
- Restore the flexibility of the spinal column.
- Relieve muscle spasm by taking muscle relaxants.
- Prevent complications.
In the predominant number of cases, the treatment of spinal diseases is carried out conservatively. The goal of the treatment of Schmorl's hernia of the lumbar is to strengthen the musculoskeletal system, which can be achieved by following a number of recommendations and medical prescriptions.
There are no special drugs that are designed to treat this disease of the spine. However, the symptoms can be managed with anti-inflammatory and pain medications. With Schmorl's hernia, patients are prescribed:
- "Dicloberl";
- "Nimesil";
- Movalis;
- "Diclofenac";
- "Ibuprofen";
- "Dolaren".
Besides these drugs, sometimesmeans are used to strengthen the bone skeleton. These include calcium-containing agents (for example, Calcitonin, Alostin, Miacalcic), fish oil. It is important to consider that medications that strengthen bone tissue can adversely affect kidney function, so before treating a lumbar Schmorl hernia, you should make sure that there are no contraindications by consulting a doctor.
With this type of hernia, surgical treatment is not performed, but in the event of a complication, which is a direct indication for surgery, the final decision on the operation is made by the patient. If Schmorl's hernia has transformed into an intervertebral hernia or a compression fracture of the spine has occurred, as a result of which the patient's condition has significantly worsened, surgery will be the only way to prevent disability.
Additional measures of therapy and prevention
In addition to drug treatment, a balanced and rational diet is of no small importance for the patient. A diet aimed at strengthening bone tissue should consist of protein products. It is necessary to consume sour-milk drinks, milk, low-fat varieties of meat and fish, tofu cheese. At the same time, the intake of s alt in the body must be minimized. In diseases of the spine, including Schmorl's hernia, you should keep your weight under control, since excess body weight is an additional load on the spinal back. In addition, it is important for the patient:
- Do not engage in sports that involve riding a motorcycle,diving, lifting and carrying weights.
- Regularly perform supportive exercises from the therapeutic and physical training complex. This method strengthens the muscles of the back and improves its flexibility.
- Take a course of therapeutic massage. With each session, the patient will be able to feel better, as the massage normalizes blood circulation and pain, relieving spasm of the back muscles.
- Keep a he althy lifestyle that does not allow smoking and drinking alcohol. Bad habits lead to impaired blood circulation and tissue trophism.
The treatment of Schmorl's hernia with folk remedies is ineffective, but in some cases, doctors recommend supplementing drug therapy with the use of natural compounds for muscle relaxation and eliminating discomfort in the affected spine.
