The herniated disc (lat. Prolapsus nuclei pulposi, Discusprolaps) is a disease of the spine, where parts of the intervertebral disc in the spinal nerves or the spinal canal forward. This is in diagnostic imaging as a protrusion (Vorwölbung) or prolapse (incident) dar.

Causes are often overloaded during the pre-vertebral. Symptoms of herniated disc are strong, often in the ausstrahlende leg pain (sciatica), numbness and even paralysis of the legs with loss of reflexes. At the beginning, the treatment consists in sparing and analgesic drugs. In the course of physiotherapy and sports is the muscle necessary. An immediate spinal surgery is only upon the occurrence of severe neurological failure (paralysis, stool, and urine, Reithosenanästhesie) is recommended.

CAUSE

The herniated disc usually is caused by many years of pre-disc (Discus intervertebralis), i.e. fibrous ring of tissue (Anulus fibrosus). The so-called jelly core (nucleus pulposus) of the intervertebral disc is composed of a gelatinous tissue and can load the function of a hydraulic ball take. This results in the high mobility of the entire spine, but also their high stability.

At the human spine, we have 23 discs. Between the first vertebra (atlas lat.) – counted from the top – and the second vertebra (Axis) we do not have the disc, but articular cartilage conditions. This is for the head nods and heads turners important because it is a lot less “wear” can give.

There are several causes for a herniated disc: genetic weaknesses, unilateral pressures at work and / or leisure, or a muscular weakness (or insufficiency of the paravertebral muscles). The only accident-related injury or damage to the intervertebral disc is not yet as a cause-effect chain of evidence. Healthy spinal tissue tears, if at all, then with a piece of bone from the vertebrae together. Often there is a herniated disc also during pregnancy. Not to forget also the upright gait and gravity. There are many old people with over 90 years, in their busy lives will never complain to the spine, or had slipped. Other hand there are children who have a herniated disc had.

Possible causes for the rapid increase of herniated discs at the present time are lack of exercise and the poor routine activity, especially for office people. Obesity is not a risk factor, rather the opposite. People tend thickness due to the stomach weight to a strong Vorwölbung the lumbar spine.

The average disease age is 40 years; the most commonly affected vertebrae are located in the lumbar area. Less frequently affected bone and rarely the thoracic vertebrae.

Diagnostic

This is a CT image of a worn spine area. Right at the bottom of the screen is on inclusion of all the registered location of the cut. The bones appear white on this analysis, the muscle is dark gray, and the fabric slipped a bit brighter. The jagged, black spot is called “vacuum phenomenon” refers to the destroyed spinal tissue is replaced by gas. Depending on the location of the cut image is the dorsal area of the vertebral body with raised. The light gray fabric slipped over the rear edge of the vertebral body and the afflicted Duralsack. The roughly triangular cross-section of the spinal area is in the rear of the ligamentum flavum; the “Yellow Band” lined. Degenerative changes may cause this “Yellow Band” thickens and narrows the spinal addition.
NMR image of a herniated disc, the spinal appears in this analysis technique light coming from the left, dark Vorwölbung is the incident of the spinal abklemmt.
Herniated disc symptoms can occur, and may not even discovered. Power to people who never significant trouble with the spine had MRI or CT examinations, are found in 25 to 28% of these “healthy” people herniated discs. Conversely, beware you have written before, one in a mere irritation Ischia found herniated disc as the source of evil and to operate. The most common symptoms are severe pain (both in the back area as well as radiating to the legs, in the case of the lumbar spine) and sometimes sensory disturbances (paresthesia) and / or paralysis. This react in the lumbar spine is often affected by numbness (furred) in the feet and lower legs and corridor of uncertainty. Frequently the foot, the toes or the outer edge of the foot lifts affects the muscle. The pain can be (somewhat) after if you are in the closed position moves back. Decreasing pain in ongoing paralysis is a bad sign, then the sensory (pain-conducting) fibers already destroyed and the more robust, motor fibers follow. A neurosurgeon, orthopedist or neurologist can make the diagnosis. Often imaging procedures supports this. A rapid treatment may result in adverse consequences (such as a permanently weakened foot lifter) minimize, a doctor should therefore in any case to be visited.

Treatment

Both conservative treatment (physiotherapy – Chiropractic – Stretch devices) as well as the elimination of the rare to the nerve root spinal oppressive part of an operation can succeed within the meaning of the discharge of the nerve roots lead. So-called minimally invasive procedures and microsurgical procedures are called in this context. Even rarer is a fusion of adjacent vertebral bodies brought in by metal material (Spondylodese). Whether operative measures are necessary in individual cases remains controversial: there are estimates that over 80% of the disk operations are superfluous and could be avoided. This is generally the “strict indications” useful. Severe neurological damage, paralysis in EMG proven, to be called cauda equina syndrome, requires a rapid spine surgery, also called Nucleotomy. Operative pain treatment is often frustrating path.

Alone in Germany every year about 30,000 operations on the intervertebral disc made. Even the worldwide spine surgery is the most common neurosurgical intervention. The bottom line, however, there is no significant difference between the treatment results of this operation and the conservative (non-operative) approach, such as acupuncture or medication or physiotherapy. This is the result of the world’s largest clinical trial of 1,244 patient’s spine (Spine Patient Outcomes Research (SPORT)). Still, there are reasons in some cases, operate them.

Basically, there should always be the causes of a herniated disc of the therapy to be: poor posture, excess stress, weakness of the trunk muscles, one speaks here of “muscular corset”, etc. Many hospitals and some private institutions offer so-called back schools to track the load on the spine in the (working) life to minimize (Correct lifting, discharge positions, muscle strengthening). Among the many therapeutic and diagnostic approaches are the Alexander Technique, Hatha Yoga or the McKenzie approach.
Acupuncture treatment often shows good results.

Prevention

Since the connective tissue known, as the primary cause is hereditary, it is a herniated disc only by muscle and appropriate medication (vitamin C, Grünlippmuschelextrakt, glucosamine, etc.) to prevent. Also, the avoidance of accidents is not always achieved. So for each individual in any event, the possibility of a consistent Muskelaufbaus by gymnastic exercises or bodybuilding or sports, and to avoid lifting heavy loads. There are techniques to learn, heavy loads “just move” to cope, but the avoidance of such actions is not in any profession (eg nursing) is possible. Bodybuilding and fitness training can be problematic, some studios have fewer trained personnel, so that the instructions are not may be helpful.

Notable here is the “orthopedic sports, swimming, dancing, running (or jogging, Nordic walking), horse riding and cycling. After one incident, however, are sports such as horseback riding or walking (on paved / cemented underground) as well as road bike riding in heavily stooped posture must be avoided.