Herniated thoracic : causes, diagnosis , treatment , complications
Diseases Of The Spine / / April 29, 2016
Herniated (or more precisely - the intervertebral) disc occurs when the damaged outer fibers of the intervertebral disc (the ring), and the soft, gelatinous inner material - the nucleus pulposus (semi-solid structure of the connective tissue fibers and gelatinous substance chondrin) breaks hisfamiliar space - an oval annulus.Nucleus pulposus with age loses its elasticity, which leads to greater vulnerability of the disc and damage the fibrous ring.If the ring is broken near the spinal canal, the nucleus pulposus material flowing down through the cracks outside of the disc can press on the spinal canal, forming a disc herniation.In the chest area there is very little extra space around the spinal cord.intervertebral disc herniation in the thoracic spine can be extremely serious.In some cases, the first sign of herniated disc is a paralysis from the waist down.Fortunately, hernia of intervertebral discs in the thoracic region is not as often as in the lumbar spine.
Brief spine anatomy
Intervertebral discs - cushions that act as shock absorbers between each of the vertebrae in the spine.There is one disc between each vertebra.Each disc has a strong outer fibrous ring and a soft, jelly-like center (nucleus pulposus).The ring is the outer layer of the disc and its strong areas.Annulus - strong ligaments that connect all the vertebrae together.Soft core ?? disc serves as the main damper.
reasons herniated thoracic
herniated disc may occur in children, although this is rare.Typically, herniated nucleus pulposus is most common among the young and among middle-aged adults.As for the elderly, it is less likely that the degenerative changes that occur with aging in the spine, in fact, will cause herniated disc.
discs can rupture suddenly due to too much pressure liquid core.For example, a fall from a ladder and landing in a sitting position can cause a lot of pressure on the spine.If it is large enough, or the spine may break or burst disc.If the patient flexes and try to lift something too heavy, it can lead to the rupture disc.
Also discs can rupture and from a small amount of pressure - as a rule, due to the weakening of the ring disk repeated injuries over time.When the ring becomes weaker at some point, the patient raises something or bend so that it leads to an excessive pressure on disc.Weakened disc ruptures at the time when the patient is doing something that five years ago would not have caused any problems.This is the aging spine.
intervertebral disc hernia causes problems in two ways.Firstly, the material that flows from the broken and nucleus pulposus in spinal canal, can cause pressure on nerves in the spinal canal.There is also evidence that the material the nucleus pulposus causing chemical irritation of the nerve roots.And the pressure on the nerve roots, and chemical irritation can lead to problems with the functions of the nerve roots.It can cause pain, weakness and / or numbness, severe body.
symptoms of herniated thoracic
symptoms of herniated disc may not include back pain.It depends on the pressure on the nervous system nerves, and irritation.In the thoracic spine may include a complete paralysis of the legs.The symptoms of herniated disc in the thoracic region usually include:
- pain, wandering all over the body, one or both legs;
- numbness or tingling in one or both legs;
- muscle weakness in certain muscles of one or both legs;
- increased reflexes in one or both legs, which can lead to spasticity (movement disorders caused by increased tone of muscles, increasing tensile muscles and causing its resistance to the implementation of passive movements, resulting in difficulties and stiffness of muscles and interferes with normal movements) in the legs.These symptoms depend on which nerves are affected in the thoracic spine, and whether sufficient rupture disk to put pressure on the spinal cord.The symptoms help doctors with the definition of the diagnosis - or rather, a disk has a gap.
Diagnostics herniated thoracic
Diagnosis "herniated nucleus pulposus" begins with a complete history and physical examination question.The main issues the doctor to the patient will be the following:
- Did you have him (her) personal injury?
- Where does it hurt?
- Is there numbness?Where?
- Is there a weakness?Where?
- Were this problem (or something like that) before?
- whether the weight loss was, fever, or other diseases in recent years?
doctor will be interested in the fact that the patient had no problems with defecation and urination.It is important to make sure that the patient's body is no pressure from the herniated disc on the nerves that go to the intestines and bladder.If such a situation occurs, it could be an emergency and requires immediate surgical intervention.
doctor may suggest an X-ray middle back.X-rays will not show herniated disk, but it will give your doctor information about how frayed spine, and can reveal other causes of the problem.
most common today test for the diagnosis of herniated disc - MRI (magnetic resonance imaging).This test is painless and very accurate, he did not find any side effects, and it is almost completely replace these tests as myelogram and CT (computed tomography) as a first test after x-rays, if the suspected disc herniation.Sometimes the MRI does not give a complete picture of the disease.Then it may be proposed, and other tests.Myelogram, usually in combination with CT can be necessary to provide as much information as possible.However, when it was not confirmed that the pain comes from the herniated disc, additional and more specialized tests may be conducted.Electrical testing (eg, EMG and MSP) can confirm that the pain in the leg, in fact, because of the nearest of the damaged nerve.These tests may be required before a decision on the need for surgery.
Treatment herniated thoracic
c Disc hernia does not necessarily mean that the patient needs surgery.Treatment of herniated disc depends on the symptoms - symptoms become worse or getting better.If the symptoms are getting worse and worse, the more likely that the doctor will suggest surgery.If the symptoms improve, then he has to offer and wait to see whether the symptoms disappear.Many people who initially have problems with herniated disc, believe that they are fully solved in a few weeks or months.
- Observation. patients do not need any treatment, except for inspection to ensure that the problem does not progress.If the pain is tolerable and no progression of weakness or numbness, your doctor may suggest a wait.
- Rest. If the pain is more severe, you may need some time to take a break from work, reduced activity.After that, the patient should begin to mobilize themselves, carefully carrying out the program and increasing the pedestrian walking distance.
- Painkillers. Depending on the severity of the pain, can be used various approaches to control pain with medication.Such painkillers prescription as Ibuprofen, Tylenol, and some of the new anti-inflammatory drugs can help reduce the pain.If these types of medications do not control the pain, your doctor may prescribe stronger painkillers - narcotic or non-narcotic analgesic.Drugs are very strong, but very addictive.Non-narcotic pain relievers at least capture the patient's will, but somewhat less effective.Most doctors do not like to prescribe the drug for more than a few days or weeks.
Means, used for back pain
Soft painkillers can reduce inflammation and pain when taking properly.Medications will not stop the degeneration, but they will help with the pain.
- Aspirin. Links Aspirin - more painkillers, which can help relieve minor back pain.The main potential side effect of aspirin - stomach problems, particularly ulcers with or without bleeding them.Do not take aspirin to pregnant women.In fact, the patient should not take any medication, if he did not discuss it with your midwife.
- NSAIDs (non-steroidal anti-inflammatory drugs).NSAIDs include stronger painkillers - Ibuprofen or Naproxen.These drugs are very effective in relieving pain associated with muscle tension and inflammation.They block the inflammatory response in the joints.However, NSAIDs can reduce renal function in elderly patients.Their excessive use can lead to kidney problems.You also can not take them during pregnancy.
- Non-narcotic pain medications as prescribed. Non-narcotic analgesics.Pain at the site of injury.Analgesics are ideal for the treatment of mild to moderate chronic pain.Tylenol and Aspirin - the most commonly used analgesics.Analgesics that require a prescription from a doctor, include NSAIDs such as: Carprofen, fenoprofen, ketoprofen and Sulindac.To reduce the side effects do not go through 15-30 minutes after taking the medication, avoid direct sunlight, wear protective clothing and sunscreen.Women should avoid the use of these drugs, if they are pregnant, have recurrent ulcers or liver problems.
- Narcotic pain relievers. If a patient experiences severe pain, his doctor may prescribe narcotic pain relievers - such as codeine and morphine.Drugs relieve pain by acting as numbness and pain relief in the central nervous system.The strength and duration of pain for the different purpose of each drug.Drugs can cause side effects - nausea, vomiting, constipation, sedation or drowsiness.These side effects are predictable and can often be prevented.General preventive measures: Do not take sleeping pills or antidepressants in combination with drugs, give up alcohol, increasing fluid intake, a diet high in fiber, use laxatives to treat constipation.Remember that drugs can be addictive if used excessively or incorrectly.
- Muscle relaxants. If the patient has any muscle spasms, muscle relaxants can relieve pain, but they are marginally effective.They also offer significant drowsiness and depression.Prolonged use of them (more than 3-4 days) is not recommended.
- Antidepressants. Pain in the back, in fact, is a common symptom of depression, and it may be an indicator.Antidepressants can relieve emotional stress, which leads to symptoms of back pain.It is important to note that the same chemical reaction in the nerve cells that cause depression and controlling pain pathways in the brain.Some antidepressant drugs to relieve pain are likely to affect the chemical reactions in nerve cells.Antidepressants can have several side effects such as drowsiness, loss of appetite, constipation, dry mouth, tiredness.
- Epidural steroid injections (EIS). EIS is usually needed for more severe pain due to herniated disc.They are usually not prescribed, if the operation does not give a quick reduction of pain in the patient.EIS is likely to have success in reducing pain from herniated disc in only about half of the cases.
Surgical treatment of intervertebral hernia thoracic
- laminotomy and discectomy. Traditional methods of treating intervertebral disc herniation surgically - laminotomy (. The letters "to make a hole in the plate") and discectomy (literally "to remove the disc.") - This procedure is performed through an incision in the center of the rear area of the herniated disc.Once the incision is made through the skin, the muscles are moved aside so that the surgeon can see the back of the vertebrae.During the operation may require X-rays to make sure that the correct vertebra selected.A small hole is made between two vertebrae - where the drive is broken.This allows the surgeon to view the spinal canal.When laminotomy usually a small amount of bone plate must be removed to make room for a good view of the spinal canal.Once this is done, the surgeon moves the nerve roots to see the intervertebral disc.The surgeon locates a disk material which has a gap in the spinal canal and removes it.This eliminates any pressure on the spinal nerves irritation.Using small instruments that are placed within the drive, it also removes much of the nucleus pulposus within the disc as possible.This is done to prevent a hernia surgery.Once completed, the back muscles are returned to their normal position around the spine.The skin incision is repaired sutures or metal staples.
- Microdiscectomy. recently been improved tools available for the spinal surgeon when performing laminotomy and discectomy.Procedure substantially - the same as the traditional method of removing rupture disk, but it requires a much smaller incision.The advantage of this procedure compared to the traditional approach - minimal damage to normal spine sections during operation.Also, the patient can recover faster.
In order to see through a smaller incision, the surgeon uses a surgical microscope.A small incision is made in the back wall above the area where the herniated disc.Once the muscles are moved aside, and the vertebra can be seen, the microscope is used to complete the operation.The rest of the operation is the same as traditional.
Complications treatment of intervertebral hernia thoracic
With any surgery there are risks of complications.When surgery is performed near the spine and spinal cord, these complications (if they occur) can be very serious.Complications may include: follow-pain disorders and the need for additional surgery.But this is not the whole list of possible complications.Only a doctor can assess the patient's condition and inform it of any risks of treatment.Patients should discuss with your doctor the complications associated with surgery, even before the operation.
Before surgery. may be complications from thoracic spine herniation of intervertebral disk before the operation.The most serious complication - the development of complete paralysis below the waist, causing the disc material is torn fragment into the spinal canal.The pressure on the spinal cord, causing permanent damage to the nerves traveling in the lower body and legs.In this case, the patient may lose the ability to control their bowel and bladder.This is a serious problem, but fortunately, rare.If the doctor sees that this happens, it will probably recommend surgery immediately to try and remove pressure from the spinal cord.
during operation. Many complications can arise during surgery.Always during any operation there the risk of complications due to anesthesia.
Complications are possible during the removal of herniated disc:
- nerve damage. removal of herniated disc requires working around the spinal nerves.During the operation, these nerves can be injured.If that happens, it can cause permanent numbness, weakness or pain.