Contents
Sequestration of a herniated disc is the prolapse of a disc outside the spinal canal. In this case, the nucleus pulposus hangs from the intervertebral fissure, like a drop. Most often, the sequestration of the hernia leads to the fact that the fibrous capsule is torn and the nucleus flows out. Damage to the spinal cord and the development of compression myelopathy are not excluded, since the hernia reaches a very impressive size (12 mm or more).
Sequestration of a herniated disc in 80% of cases leads to disability of the patient. Sequestration of a hernia is the terminal stage of the formation of herniated discs according to the Decolux AP classification, which was proposed in 1984 and remains relevant at the present time.
Depending on the direction in which the sequester falls, the following types of hernias are distinguished:
Anteriolateral hernia. In this case, the prolapsed nucleus pulposus is located outside the anterior semicircle of the vertebral body. The sequester detaches or perforates the anterior longitudinal ligament of the spine, causing neurological symptoms.
Posterolateral hernia. Such a hernia exits through the posterior half of the annulus fibrosus.
Median and paramedian hernia. The first hernia is sequestered in the midline, and the second hernia is located in the immediate vicinity of the midline.
Foraminal or lateral sequestered hernia. Such a hernia is located on the side of the posterior longitudinal ligament.
Causes of sequestration of a herniated disc
Sequestration of a herniated disc is the result of the destruction of the intervertebral disc, which most often occurs against the background of osteochondrosis.
Possible reasons for the formation of a sequester and prolapse of the nucleus pulposus are as follows:
Anomalies in the development of the spinal column, including: Klippel-Feil syndrome, fusion of the vertebrae, wedge-shaped vertebrae, etc.
Excessive load on the spine.
Spinal injury. Severe bruises of the spine, its fractures and other injuries are dangerous.
Lifting weights.
Obesity.
Intense physical exercise or hard physical work.
Metabolic disorders. These include diseases such as diabetes and hypothyroidism.
Hereditary predisposition.
Deterioration of the nutrition of the fibrous ring due to the presence of bad habits.
Features of labor activity. At risk for the formation of a sequestered spinal hernia are motorists, accountants, people working at a computer, etc.
Curvature of the spine (lordosis, kyphosis, etc.), uneven load on the spinal column, which, for example, can occur with hip dysplasia.
However, the main risk factor for sequestered hernia is early osteochondrosis. Due to the degenerative-dystrophic changes occurring in the spine, the disc begins to lose moisture. This negatively affects its elasticity. Over time, the disc decreases in height and becomes unable to withstand the loads that are placed on it, namely, increased pressure on the vertebrae. As a result, even minor physical efforts can injure the disc, leading to its displacement, followed by the formation of a sequester.
Symptoms of sequestration
Symptoms of sequestration of a herniated disc are expressed quite intensely, so it is simply impossible not to pay attention to them:
Patients complain of severe back pain, which they most often characterize as a backache. The pains are very intense, they force a person to quickly seek medical help.
The movement of the limbs is limited. If the hernia is located in the cervical or upper thoracic region, then the hands suffer, and if in the lower back or sacrum, then the legs.
As the disease progresses, paralysis of one or both limbs develops.
Numbness of the extremities is another symptom that indicates a sequestered hernia.
On the arm or leg, from which the nerve bundle was pinched, a decrease in temperature is observed. The skin may become drier, or, on the contrary, there will be an increase in sweating.
As the disease progresses, provided that adequate medical care is not provided to the patient, atrophy of the muscle tissue of the affected limb will increase.
Since the immune system begins to produce antibodies to fight the resulting sequester (the immune system perceives it as a foreign body), there will be symptoms of intoxication. There is general weakness, joint and muscle pain, nausea.
In addition, the symptoms of a sequestered herniated disc largely depend on where exactly it is located: in the cervical, thoracic or lumbar region. First of all, this concerns the place of localization of pain (in the lower back, in the sacrum, headaches, chest pains). Secondly, different limbs will suffer: arms or legs. Thirdly, there are complications that provoke sequestered hernias of one or another part of the spine. So, if the pathological focus is located in the lumbar region, then the patient may develop cauda equina syndrome, and if the hernia is in the cervical region, then complete paralysis and respiratory arrest are not excluded.
Treatment of a sequestered hernia
Treatment of a sequestered hernia can be both surgical and medical. Definitely it will not be possible to avoid surgical intervention with the development of complications: radicular syndrome, discogenic myelopathy, vertebral artery syndrome with TIA. However, doctors are in no hurry with surgical intervention, as there are high risks of postoperative complications (bleeding, spinal cord infection, injury to the spinal root, etc.). As a rule, the operation cannot be abandoned only in 10-15% of cases, and in 90% of cases, medical correction of the existing disease is possible.
The patient is prescribed myelorelaxants, drugs from the NSAID group, hormonal glucocorticoid agents, vitamin-mineral complexes with an emphasis on B vitamins. Drug correction must necessarily be supplemented by physiotherapeutic methods, including: UHF, electrophoresis with Novocaine, diadynamic currents.
The prognosis for timely treatment is favorable, provided that the neurological deficit was quickly eliminated. With prolonged myelopathy, even the successful removal of a sequestered hernia will lead to the patient’s disability.