home Boilers and equipment Flattened lordosis and features of its treatment. Dehydration of the intervertebral discs - we explain the concept. What does the height of the intervertebral discs mean?

Flattened lordosis and features of its treatment. Dehydration of the intervertebral discs - we explain the concept. What does the height of the intervertebral discs mean?

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Damage to the lumbar and thoracic intervertebral discs is much more common than is commonly thought. They arise from indirect exposure to violence. The immediate cause of damage to the lumbar intervertebral discs is heavy lifting, forced rotational movements, flexion movements, sudden sharp straining and, finally, a fall.

Damage to the thoracic intervertebral discs most often occurs with a direct blow or impact to the area of the vertebral ends of the ribs, transverse processes in combination with muscle tension and forced movements, which is especially often observed in athletes when playing basketball.

Damage to the intervertebral discs is almost never observed in childhood, but occurs in adolescence and adolescence and especially often in people in the 3rd-4th decade of life. This is explained by the fact that isolated injuries to the intervertebral disc more often occur in the presence of degenerative processes in it.

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What causes intervertebral disc damage?

The lumbosacral and lumbar spine are the areas where degenerative processes most often develop. The IV and V lumbar discs are most often affected by degenerative processes. This is facilitated by the following some anatomical and physiological features of these discs. It is known that the IV lumbar vertebra is the most mobile. The greatest mobility of this vertebra leads to the fact that the IV intervertebral disc experiences significant load and is most often subject to trauma.

The occurrence of degenerative processes in the fifth intervertebral disc is due to the anatomical features of this intervertebral joint. These features consist in the discrepancy between the anteroposterior diameter of the bodies of the V lumbar and I sacral vertebrae. According to Willis, this difference varies from 6 to 1.5 mm. Fletcher confirmed this based on an analysis of 600 radiographs of the lumbosacral spine. He believes that this discrepancy in the sizes of these vertebral bodies is one of the main reasons for the occurrence of degenerative processes in the V lumbar disc. This is also facilitated by the frontal or predominantly frontal type of the lower lumbar and upper sacral facets, as well as their postero-external inclination.

The above anatomical relationships between the articular processes of the 1st sacral vertebra, the 5th lumbar and 1st sacral spinal roots can lead to direct or indirect compression of these spinal roots. These spinal roots have a significant extent in the spinal canal and are located in its lateral recesses, formed in front by the posterior surface of the fifth lumbar intervertebral disc and the body of the fifth lumbar vertebra, and in the back by the articular processes of the sacrum. Often, when degeneration of the fifth lumbar intervertebral disc occurs, due to inclination of the articular processes, the body of the fifth lumbar vertebra not only descends downward, but also moves posteriorly. This inevitably leads to a narrowing of the lateral recesses of the spinal canal. That is why “disco-radicular conflict” so often arises in this area. Therefore, the most common phenomena of lumboischialgia occur with involvement of the 5th lumbar and 1st sacral roots.

Conservative treatment of lumbar intervertebral disc injuries

In the vast majority of cases, damage to the lumbar intervertebral discs is cured using conservative methods. Conservative treatment of lumbar disc damage should be carried out comprehensively. This complex includes orthopedic, medicinal and physiotherapeutic treatment. Orthopedic methods include creating rest and unloading the spine.

A victim with damage to the lumbar intervertebral disc is put to bed. It is a mistaken idea that the victim should be placed on a hard bed in a supine position. For many victims, this forced position causes increased pain. On the contrary, in some cases there is a decrease or disappearance of pain when the victims are placed in a soft bed that allows significant flexion of the spine. Often the pain goes away or decreases in a position on the side with the hips brought to the stomach. Consequently, in bed the victim must take the position in which the pain disappears or decreases.

Unloading of the spine is achieved by placing the victim in a horizontal position. After some time, after the acute effects of the former injury have passed, this unloading can be supplemented by constant stretching of the spine along an inclined plane using soft rings for the armpits. To increase the tensile force, additional weights can be used, suspended from the victim’s pelvis using a special belt. The size of the load, time and degree of stretching are dictated by the sensations of the victim. Rest and unloading of the damaged spine last for 4-6 weeks. Usually during this period the pain disappears, the tear in the area of the fibrous ring heals with a durable scar. In later periods after a previous injury, with more persistent pain, and sometimes in fresh cases, intermittent stretching of the spine, rather than constant traction, is more effective.

There are several different intermittent spinal stretch techniques. Their essence boils down to the fact that over a relatively short period of 15-20 minutes, using weights or dosed screw traction, the tension is increased to 30-40 kg. The magnitude of the stretching force in each individual case is dictated by the patient’s physique, the degree of development of his muscles, as well as his sensations during the stretching process. The maximum stretch lasts for 30-40 minutes, and then over the next 15-20 minutes it is gradually reduced to pet.

Stretching the spine using a dosed screw rod is carried out on a special table, the platforms of which are spread along the length of the table by a screw rod with a wide thread pitch. The victim is secured at the head end of the table with a special bra put on the chest, and at the foot end with a belt around the pelvis. When the foot and head platforms diverge, the lumbar spine is stretched. In the absence of a special table, intermittent stretching can be performed on a regular table by hanging weights from the pelvic girdle and a bra on the chest.

Underwater spinal stretching in the pool is very useful and effective. This method requires special equipment and equipment.

Drug treatment for lumbar disc damage involves taking medications orally or applying them topically. In the first hours and days after injury, with severe pain, drug treatment should be aimed at relieving pain. Analgin, promedol, etc. can be used. Large doses (up to 2 g per day) of salicylates have a good therapeutic effect. Salicylates can be administered intravenously. Novocaine blockades in various modifications are also useful. Injections of hydrocortisone in an amount of 25-50 mg into paravertebral painful points have a good analgesic effect. Even more effective is the injection of the same amount of hydrocortisone into the damaged intervertebral disc.

Intradiscal administration of hydrocortisone (a solution of novocaine 0.5% with 25-50 mg of hydrocortisone) is carried out in the same way as discography is performed using the method proposed by de Seze. This manipulation requires a certain skill and ability. But even paravertebral administration of hydrocortisone gives a good therapeutic effect.

Of the physiotherapeutic procedures, diadynamic currents are the most effective. Popophoresis with novocaine and thermal procedures can be used. It should be borne in mind that thermal procedures often cause an exacerbation of pain, which apparently occurs due to an increase in local tissue swelling. If the victim's health worsens, they should be discontinued. After 10-12 days, in the absence of pronounced phenomena of irritation of the spinal roots, massage is very useful.

At a later date, such victims can be recommended balneotherapy (Pyatigorsk, Saki, Tskhaltubo, Belokurikha, Matsesta, Karachi). In some cases, wearing soft semi-corsets, corsets or “graces” can be useful.

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Surgical treatment of lumbar intervertebral disc injuries

Indications for surgical treatment of lumbar intervertebral disc injuries arise in cases where conservative treatment is ineffective. Typically, these indications occur in the long term after a previous injury and, in fact, the intervention is carried out regarding the consequences of the previous injury. Such indications are persistent lumbalgia, phenomena of functional failure of the spine, syndrome of chronic compression of the spinal roots, which is not inferior to conservative treatment. In case of fresh injuries to the intervertebral lumbar discs, indications for surgical treatment arise in the case of acutely developed cauda equina compression syndrome with paraparesis or paraplegia, and dysfunction of the pelvic organs.

The history of the emergence and development of surgical methods for treating damage to the lumbar intervertebral discs is essentially the history of surgical treatment of lumbar intervertebral osteochondrosis.

Surgical treatment of lumbar intervertebral osteochondrosis (“lumbosacral radiculitis”) was first carried out by Elsberg in 1916. Taking the prolapsed disc substance when it was damaged as interspinal tumors - “chondromas”, Elsberg, Petit, Qutailles, Alajuanine (1928) removed them. Mixter, Barr (1934), having proved that “chondromas” are nothing more than a prolapsed part of the nucleus pulposus of the intervertebral disc, performed a laminectomy and removed the prolapsed part of the intervertebral disc using trans- or extradural access.

Since then, especially abroad, methods of surgical treatment of lumbar intervertebral osteochondrosis have become widespread. Suffice it to say that individual authors have published hundreds and thousands of observations of patients operated on for lumbar intervertebral osteochondrosis.

Existing surgical methods for treating disc prolapse in intervertebral osteochondrosis can be divided into palliative, conditionally radical and radical.

Palliative surgeries for lumbar disc injuries

Such operations include the operation proposed by Love in 1939. Having undergone some changes and additions, it is widely used in the treatment of herniated lumbar intervertebral discs.

The purpose of this surgical intervention is only to remove the prolapsed part of the disc and eliminate compression of the nerve root.

The victim is placed on the operating table in the supine position. To eliminate lumbar lordosis, different authors use different techniques. B. Boychev suggests placing a pillow under the lower abdomen. A.I. Osna gives the patient the “pose of a praying Buddhist monk.” Both of these methods lead to a significant increase in intra-abdominal pressure, and consequently to venous stagnation, causing increased bleeding from the surgical wound. Friberg has designed a special “cradle” in which the victim is placed in the desired position without difficulty breathing or increasing intra-abdominal pressure.

Local anesthesia, spinal anesthesia and general anesthesia are recommended. Proponents of local anesthesia consider the advantage of this type of anesthesia to be the ability to control the progress of the operation by compressing the spinal root and the patient’s reaction to this compression.

Technique of surgery on the lower lumbar discs

A paravertebral semi-oval incision is used to dissect the skin, subcutaneous tissue, and superficial fascia layer by layer. The affected disc should be in the middle of the incision. On the affected side, the lumbar fascia is incised longitudinally at the edge of the supraspinatus ligament. The lateral surface of the spinous processes, semi-arches and articular processes is carefully skeletonized. All soft tissue must be carefully removed from them. A wide powerful hook is used to pull the soft tissues laterally. The semi-arches, the yellow ligaments and articular processes located between them, are exposed. A section of the ligamentum flavum is excised at the desired level. The dura mater is exposed. If this turns out to be insufficient, part of the adjacent sections of the semi-arches is bitten off or the adjacent semi-arches are removed completely. Hemilaminectomy is quite acceptable and justified to expand surgical access, but it is difficult to agree to a wide laminectomy with the removal of 3-5 arches. In addition to the fact that laminectomy significantly weakens the posterior spine, it is believed that it leads to limited movement and pain. Restriction of movement and pain are directly proportional to the size of the lamiectomy. Careful hemostasis is performed throughout the entire intervention. The dural sac is displaced medially. The spinal root is retracted to the side. The posterolateral surface of the affected intervertebral disc is examined. If the disc herniation is located posterior to the posterior longitudinal ligament, it is grasped with a spoon and removed. Otherwise, the posterior longitudinal ligament or the posteriorly protruding portion of the posterior portion of the annulus fibrosus is incised. After this, part of the fallen disc is removed. Produce hemostasis. Layer-by-layer sutures are applied to the wounds.

Some surgeons dissect the dura mater and use a transdural approach. The disadvantage of transdural access is the need for wider removal of the posterior parts of the vertebrae, opening of the posterior and anterior layers of the dura mater, and the possibility of subsequent intradural cicatricial processes.

If necessary, one or two articular processes can be bitten off, which makes surgical access wider. However, this violates the reliability of spinal stability at this level.

During the day the patient is in the prone position. Symptomatic drug treatment is carried out. From the 2nd day the patient is allowed to change position. On the 8-10th day he is discharged for outpatient treatment.

The described surgical intervention is purely palliative and eliminates only the compression of the spinal root by the prolapsed disc. This intervention is not aimed at curing the underlying disease, but only at eliminating the complications caused by it. Removing only part of the prolapsed affected disc does not exclude the possibility of relapse of the disease.

Conditionally radical surgery for damage to the lumbar discs

These operations are based on the proposal of Dandy (1942) not to limit oneself to removing only the prolapsed part of the disc, but to remove the entire affected disc using a sharp bone spoon. By doing this, the author tried to solve the problem of preventing relapses and creating conditions for the occurrence of fibrous ankylosis between adjacent bodies. However, this technique did not lead to the desired results. Relapse rates and adverse outcomes remained high. This depended on the failure of the proposed surgical intervention. The possibility of complete removal of the disc through a small hole in its fibrous ring is too difficult and problematic; fibrous ankylosis in this extremely mobile part of the spine is too unlikely. The main disadvantage of this intervention, in our opinion, is the impossibility of restoring the lost height of the intervertebral disc and normalizing the anatomical relationships in the posterior elements of the vertebrae, and the inability to achieve bone fusion between the vertebral bodies.

Attempts by some authors to “improve” this operation by introducing separate bone grafts into the defect between the vertebral bodies also did not lead to the desired result. Our experience in the surgical treatment of lumbar intervertebral osteochondrosis allows us to state with certain confidence that it is impossible to remove the endplates of the adjacent vertebral bodies with a bone spoon or curette so as to expose the spongy bone, without which we cannot count on the occurrence of bone fusion between the vertebral bodies. Naturally, placing individual bone grafts in an unprepared bed cannot lead to bone ankylosis. Inserting these grafts through a small hole is difficult and unsafe. This method does not solve the problems of restoring the height of the intervertebral space and restoring normal relationships in the posterior elements of the vertebrae.

Conditionally radical operations include attempts to combine disc removal with posterior spinal fusion (Ghormley, Love, Joung, Sicard, etc.). According to the intention of these authors, the number of unsatisfactory results in the surgical treatment of intervertebral osteochondrosis can be reduced by supplementing surgical intervention with posterior spinal fusion. In addition to the fact that in conditions of violation of the integrity of the posterior parts of the spine it is extremely difficult to obtain arthrodesis of the posterior parts of the spine, this combined surgical method of treatment is not able to resolve the issue of restoring the normal height of the intervertebral space and normalizing the anatomical relationships in the posterior parts of the vertebrae. However, this method was a significant step forward in the surgical treatment of lumbar intervertebral osteochondrosis. Despite the fact that it did not lead to a significant improvement in the results of surgical treatment of intervertebral osteochondrosis, it still made it possible to clearly understand that it is impossible to solve the issue of treating degenerative lesions of intervertebral discs with one “neurosurgical” approach.

Radical surgery for damaged lumbar discs

Radical intervention should be understood as a surgical procedure that solves all the main aspects of the pathology generated by damage to the intervertebral disc. These main points are the removal of the entire affected disc, the creation of conditions for the onset of bone fusion of the bodies of adjacent vertebrae, the restoration of the normal height of the intervertebral space and the normalization of the anatomical relationships in the posterior parts of the vertebrae.

Radical surgical interventions used in the treatment of injuries to the lumbar intervertebral discs are based on the operation of V.D. Chaklin, proposed by him in 1931 for the treatment of spondylolisthesis. The main points of this operation are exposure of the anterior parts of the spine from the anterior-external extraperitoneal approach, resection of 2/3 of the intervertebral articulation and placement of a bone graft into the resulting defect. Subsequent flexion of the spine helps to reduce lumbar lordosis and the onset of bone fusion between the bodies of adjacent vertebrae.

When applied to the treatment of intervertebral osteochondrosis, this intervention did not resolve the issue of removing the entire affected disc and normalizing the anatomical relationships of the posterior elements of the vertebrae. Wedge-shaped excision of the anterior sections of the intervertebral joint and placement of a bone graft of appropriate size and shape into the resulting wedge-shaped defect did not create conditions for restoring the normal height of the intervertebral space and the divergence along the length of the articular processes.

In 1958, Hensell reported on 23 patients with intervertebral lumbar osteochondrosis who were subjected to surgical treatment using the following technique. Position the patient on his back. A paramedial incision is used to dissect the skin, subcutaneous tissue, and superficial fascia layer by layer. The sheath of the rectus abdominis muscle is opened. The rectus abdominis muscle is pulled outward. The peritoneum is peeled away until the lower lumbar vertebrae and the intervertebral discs lying between them become accessible. The affected disc is removed through the area of the aortic bifurcation. A bone wedge measuring about 3 cm is taken from the crest of the iliac wing and inserted into the defect between the vertebral bodies. Care must be taken to ensure that the bone graft does not cause pressure on the roots and the dural sac. The author warns about the need to protect the vessels well at the time of insertion of the wedge. After the operation, a plaster corset is applied for 4 weeks.

The disadvantages of this method include the possibility of intervention only on the two lower lumbar vertebrae, the presence of large blood vessels limiting the surgical field on all sides, and the use of a wedge-shaped bone graft to fill the defect between the bodies of adjacent vertebrae.

Total discectomy and wedging corporodesis

This name refers to surgical intervention undertaken in case of damage to the lumbar intervertebral discs, during which the entire damaged intervertebral disc is removed, with the exception of the postero-outer sections of the fibrous ring, conditions are created for the onset of bone fusion between the bodies of adjacent vertebrae, the normal height of the intervertebral space is restored, and wedging occurs - reclination - of the inclinated articular processes.

It is known that with a loss of height of the intervertebral disc, a decrease in the vertical diameter of the intervertebral foramen occurs due to the inclination of the articular processes that inevitably follows. delimiting over a considerable distance the intervertebral foramina, in which the spinal roots and radicular vessels pass, and also the spinal ganglia lie. Therefore, during the surgical intervention, it is extremely important to restore the normal vertical diameter of the intervertebral spaces. Normalization of the anatomical relationships in the posterior sections of the two vertebrae is achieved by wedging.

Studies have shown that during the process of wedging corporodesis, the vertical diameter of the intervertebral foramina increases to 1 mm.

Preoperative preparation consists of the usual manipulations performed before intervention in the retroperitoneal space. In addition to general hygiene procedures, the intestines are thoroughly cleaned and the bladder is emptied. On the morning of the operation, the pubis and anterior abdominal wall are shaved. The night before surgery, the patient receives sleeping pills and sedatives. For patients with an unstable nervous system, drug preparation is carried out for several days before surgery.

Anesthesia - endotracheal anesthesia with controlled breathing. Muscle relaxation greatly facilitates the technical performance of the operation.

The victim is placed on his back. Using a cushion placed under the lower back, lumbar lordosis is strengthened. This should only be done when the victim is under anesthesia. With increased lumbar lordosis, the spine seems to approach the surface of the wound - its depth becomes smaller.

Technique of total discectomy and wedging corporodesis

The lumbar spine is exposed using the previously described left anterior paramedian extraperitoneal approach. Depending on the level of the affected disc, access without resection or with resection of one of the lower ribs is used. The approach to the intervertebral discs is carried out after mobilization of the vessels, dissection of the prevertebral fascia and displacement of the vessels to the right. Penetration to the lower lumbar discs through the area of division of the abdominal aorta seems to us more difficult, and most importantly, more dangerous. When using access through the aortic bifurcation, the surgical field is limited on all sides by large arterial and venous trunks. Only the lower valve of the limited space remains free of vessels, in which the surgeon has to manipulate. When manipulating discs, the surgeon must always ensure that the surgical instrument does not accidentally damage nearby vessels. When the vessels are displaced to the right, the entire anterior and left lateral sections of the discs and vertebral bodies are free from them. Only the lumboiliac muscle remains adjacent to the spine on the left. The surgeon can safely manipulate the instruments from right to left without any risk of injury blood vessels. Before proceeding with manipulations on the discs, it is advisable to isolate and shift the left border sympathetic trunk to the left. This significantly increases the space for manipulation on the disk. After dissection of the prevertebral fascia and displacement of the vessels to the right, the anterolateral surface of the lumbar vertebral bodies and discs, covered with the anterior longitudinal ligament, widely opens. Before you begin manipulating the disks, you should expose the required disk. To perform a total discectomy, the entire length of the desired disc and adjacent parts of the adjacent vertebral bodies must be opened. So, for example, to remove the V lumbar disc, you should expose top part the body of the 1st sacral vertebra, the 5th lumbar disc and the lower part of the body of the 5th lumbar vertebra. Displaced vessels must be reliably protected by elevators, protecting them from accidental injury.

The anterior longitudinal ligament is cut either in a U-shape or in the form of the letter H, located in a horizontal position. This is not of fundamental importance and does not affect the subsequent stability of this part of the spine, firstly, because in the area of the removed disc, bone fusion subsequently occurs between the bodies of adjacent vertebrae, and secondly, because in both In subsequent cases, the anterior longitudinal ligament at the site of the section is fused with a scar.

The dissected anterior longitudinal ligament is separated in the form of two lateral or one apron-shaped flaps on the right base and retracted to the sides. The anterior longitudinal ligament is separated so that the marginal limbus and the adjacent area of the vertebral body are exposed. The fibrous ring of the intervertebral disc is exposed. Affected discs have a peculiar appearance and differ from a healthy disc. They do not have their characteristic turgor and will not stand in the form of a characteristic cushion over the vertebral bodies. Instead of the silvery-white color of a normal disc, they become yellowish or ivory in color. To the untrained eye it may seem that the height of the disk is reduced. This false impression is created because the lumbar spine is overextended on the bolster, thereby artificially enhancing the lumbar lordosis. The stretched anterior sections of the annulus fibrosus create the false impression of a wide disc. The fibrous ring is separated from the anterior longitudinal ligament along the entire anterolateral surface. Using a wide chisel and a hammer, make the first section parallel to the end plate of the vertebral body adjacent to the disc. The width of the chisel should be such that the section passes through the entire width of the body, with the exception of the side compact plates. The chisel should penetrate to a depth of 2/3 of the anteroposterior diameter of the vertebral body, which corresponds on average to 2.5 cm. The second section is performed in the same way in the area of the second vertebral body adjacent to the disc. These parallel sections are made in such a way that, together with the removed disc, the end plates are separated and the cancellous bone of the adjacent vertebral bodies is exposed. If the chisel is installed incorrectly and the cutting plane in the vertebral body is not close to the endplate, venous bleeding may occur from the venous sinuses of the vertebral bodies.

Using a narrower chisel, two parallel sections are made along the edges of the first ones in a plane perpendicular to the first two sections. Using an osteotome inserted into one of the sections, the isolated disc is easily dislocated from its bed and removed. Usually, minor venous bleeding from its bed is stopped by tamponade with a gauze pad moistened with warm saline solution. Using bone spoons, the posterior portions of the disc are removed. After removal of the disc, the posterior portion of the annulus fibrosus becomes clearly visible. The “hernial orifice” is clearly visible, through which it is possible to extract the prolapsed part of the nucleus pulposus. Particular care should be taken to remove disc remnants in the area of the intervertebral foramina using a curved small bone spoon. Manipulations must be careful and gentle so as not to damage the roots passing here.

This ends the first stage of the operation - total discectomy. When comparing the disc masses removed using the anterior approach with the amount removed using the posteroexternal approach, it becomes quite obvious how palliative the operation performed through the posterior approach is.

The second, no less important and responsible moment of the operation is the “propping” corporodesis. The graft introduced into the resulting defect should promote the onset of bone fusion between the bodies of adjacent vertebrae, restore the normal height of the intervertebral space and wedge the posterior parts of the vertebrae so that the anatomical relationships in them are normalized. The anterior parts of the vertebral bodies should bend over the anterior edge of the graft placed between them. Then the posterior sections of the vertebrae - the arches and articular processes - will fan out. The disrupted normal anatomical relationships in the posterior-external intervertebral joints will be restored, and thanks to this, the intervertebral foramina, which have narrowed due to a decrease in the height of the affected disc, will somewhat expand.

Consequently, a graft placed between the bodies of adjacent vertebrae must meet two main requirements: it must facilitate the rapid advance of a bone block between the bodies of adjacent vertebrae and its anterior section must be so strong. to withstand the great pressure exerted on it by the bodies of the adjacent vertebrae during wedging.

Where to get this transplant from? If there is a well-defined, fairly massive crest of the iliac wing, the graft should be taken from the crest. You can take it from the upper metaphysis of the tibia. In that the latter case the anterior section of the graft will consist of strong cortical bone, the crest of the tibia and the cancellous bone of the metaphysis, which has good osteogenic properties. This is not of fundamental importance. It is important that the graft is taken correctly and is the correct size and shape. True, the structure of the graft from the iliac wing crest is closer to the structure of the vertebral bodies. The graft should have the following dimensions: the height of its anterior section should be 3-4 mm greater than the height of the intervertebral defect, the width of its anterior section should correspond to the width of the defect in the frontal plane, the length of the graft should be equal to 2/3 of the anteroposterior size of the defect. Its anterior section should be somewhat wider than the posterior one - it narrows somewhat posteriorly. In an intervertebral defect, the graft should be positioned so that its anterior edge does not extend beyond the anterior surface of the vertebral bodies. Its posterior edge should not contact the posterior portion of the annulus fibrosus of the disc. There should be some space between the posterior edge of the graft and the annulus fibrosus. This is necessary to prevent accidental compression of the anterior dural sac or spinal roots by the posterior edge of the graft.

Before placing the graft into the intervertebral defect, the height of the cushion under the lumbar spine is slightly increased. This further increases lordosis and the height of the intervertebral defect. The height of the roller should be increased carefully and in doses. The graft is placed into the intervertebral defect so that its anterior edge enters the defect 2-3 mm and a corresponding gap is formed between the anterior edge of the vertebral bodies and the anterior edge of the graft. The operating table roller is lowered to the level of the table plane. Eliminate lordosis. In the wound, you can clearly see how the vertebral bodies come together and the graft placed between them is well wedged. It is firmly and reliably held by the bodies of the closed vertebrae. Already at this moment, partial wedging of the posterior parts of the vertebrae occurs. Subsequently, when the patient postoperative period will be given a position of flexion of the spine, this wedging will further increase. No additional grafts in the form of bone chips should be introduced into the defect because they can move posteriorly and subsequently, during bone formation, cause compression of the anterior part of the dural sac or roots. The graft should be formed like this. so that he fulfills the intervertebral defect within the specified boundaries.

Flaps of the separated anterior longitudinal ligament are placed over the graft. The edges of these flaps are sewn together. It should be borne in mind that more often these flaps fail to completely cover the area of the anterior part of the graft, since due to the restoration of the height of the intervertebral space, the size of these flaps is insufficient.

Careful hemostasis during surgery is absolutely mandatory. The wound of the anterior abdominal wall is sutured in layers. Antibiotics are administered. Apply an aseptic dressing. During the operation, blood loss is replaced; it is usually insignificant.

With proper administration of anesthesia, spontaneous breathing is restored by the end of the operation. Extubation is performed. When blood pressure is stable and blood loss is replaced, blood transfusion is stopped. Typically, neither during surgery nor in the postoperative period are there significant fluctuations in blood pressure.

The patient is placed in bed on a hard board in the supine position. The thighs and legs are bent at the hip and knee joints at an angle of 30° and 45°. To do this, under the area knee joints put a high cushion. This achieves some flexion of the lumbar spine and relaxation of the iliopsoas muscles and muscles of the limbs. The patient remains in this position for the first 6-8 days.

Symptomatic drug treatment is carried out. There may be a short-term urinary retention. To prevent intestinal paresis, a 10% solution of sodium chloride in an amount of 100 ml is administered intravenously, and a solution of proserin is administered subcutaneously. Treated with antibiotics. In the first days, an easily digestible diet is prescribed.

On the 7-8th day, the patient is seated in a bed equipped with special devices. The hammock in which the patient sits is made of dense material. The footrest and back rest are made of plastic. These devices are very convenient for the patient and hygienic. The flexion position of the lumbar spine further wedges the posterior sections of the vertebrae. The patient remains in this position for 4 months. After this period, a plaster corset is applied and the patient is discharged. After 4 months, the corset is removed. By this time, the presence of a bone block between the vertebral bodies is usually radiologically noted, and the treatment is considered complete.

During an examination of the spine, a diagnosis was made: the height of the intervertebral discs is reduced, what does this mean and how dangerous is it? What to do next, continue to live a normal life or is it better to do something? It is better to know the answers to these questions from childhood, since more than 80% of people in the world, albeit to varying degrees, are related to problems with the spine. In order to understand how and why the height of the intervertebral discs decreases, you need to delve a little deeper into the anatomy.

The spine is the main support of the human body, consisting of segments (parts), namely the vertebrae. Performs supporting, shock-absorbing (thanks to intervertebral discs) and protective functions (protects the spinal cord from damage).

The spinal cord, located in the spinal canal of the spine, is a fairly elastic structure that can adapt to changes in body position. Depending on the part of the spine, spinal nerves branch off from it and innervate certain parts of the body.

The head, shoulders and arms are innervated by nerves that branch from cervical spine.
The middle part of the body is correspondingly innervated by nerves branching from the thoracic part of the spine.
Lower body and legs - innervated by nerves branching from the lumbosacral segment of the spine.

Consequently, if problems arise with the innervation (impaired sensitivity, severe pain reaction, etc.) of any parts of the body, the development of pathology in the corresponding part of the spine can be suspected.

From the moment a person began to walk upright, the load on the spinal column increased significantly. Accordingly, the role of intervertebral discs has increased.

Intervertebral discs

Fibrous, cartilage-like structures, consisting of a nucleus surrounded by a fibrous (tendon-like tissue) ring and shaped like a round plate, located between the vertebrae are called intervertebral discs. Their main purpose is depreciation (load softening).

How does a decrease in the height of intervertebral discs develop?

There is one important point in the structure of intervertebral discs that is related to the development of pathology - they do not contain blood vessels, so nutrients enter them from tissues located nearby. In particular, the latter include the spinal muscles. Therefore, when dystrophy (malnutrition) of the spinal muscles occurs, a malnutrition of the intervertebral discs occurs.

The jelly-like, but at the same time quite elastic (thanks to the fibrous ring that limits it) core of the disc provides a reliable and at the same time elastic connection of the vertebrae with each other. As a result of a disruption in receipt nutrients the disc begins to dehydrate, lose its height and elasticity, the fibrous ring also loses its flexibility and becomes more fragile. The connection of the vertebrae deteriorates, and instability in the affected motor part of the spine increases.

With further development of the process, degeneration (degeneration) and hardening of the cartilage tissue of the disc occurs, it becomes similar to bone. The disc decreases in size even more, loses height, ceases to perform a shock-absorbing function and begins to put pressure on the nerve endings, causing pain.

Degenerative-dystrophic (degeneration and malnutrition) processes in which a decrease in the height of the intervertebral discs and rapid growth of osteophytes (bone formations) occur are called osteochondrosis (spondylosis). The terms have Greek roots, meaning joint (spine), the ending -oz characterizes dystrophic (malnutrition) changes.

Complicated course of osteochondrosis

According to a similar scenario, pathology occurs not only in diseases that cause disturbances in the trophism of the discs. Most often, with spinal injuries or traumatic loads, compression of the disc occurs, followed by protrusion of the nucleus; if this occurs without violating the integrity of the fibrous ring, it is called protrusion; if prolapse (protrusion) is accompanied by rupture of the ring and the nucleus moving beyond its limits, this is intervertebral disc herniation.

At the same time, as a result of compression, the height of the discs also decreases, and with a further increase in pressure, the size of the hernia will increase.

What are the risks of reducing the height of intervertebral discs?

There are four stages of pathology development. Each of them has its own characteristic features:

I. The initial, still hidden form of the flow. Minor discomfort, usually appearing in the morning and disappearing during the day. Most people do not seek help, although they feel limited mobility. The affected disc has the same height as the healthy (adjacent) one.

II. Painful sensations appear, deformation of the fibrous ring occurs, the stability of the affected part of the spine is disrupted, pathological mobility develops, and nerve endings are pinched (causing pain). Blood and lymph flows are disrupted. The height of the intervertebral disc is reduced, a quarter less than the neighboring one.

III. Further deformation and rupture of the disc ring, the formation of a hernia. Deforming pathology of the affected vertebral sections (scoliosis - deflection of the spine to the side, kyphosis - hump or backward deflection). The affected disc is half the size of a healthy one.

IV. Final. Shift and compaction of the affected vertebrae, accompanied by pain and. Sharp pain when moving, minimal mobility. Possible disability. An even more significant reduction in disc height.

The result of complications of a herniated disc can be: dysfunction of the pelvic organs and loss of sensitivity, paralysis of the leg muscles, movement in a wheelchair.

What to do, how to prevent

Eat right, engage in health-improving physical exercises, drink a sufficient amount of fluid (at least 2 liters per day, maintains normal metabolism), do not overload the spine (heavy lifting), avoid injuries, stress and hypothermia, during sedentary work - take gymnastic breaks, periodically undergo preventive examination of the spine, and if problems are detected, immediately seek help.

How can low intervertebral disc height be treated? and got the best answer

Answer from LIBERTA[guru]
a decrease in the height of the intervertebral discs, this is osteochondrosis... can it lead to some troubles or not? Of course it can, but very moderately. For example, to limited mobility of the back, which is very natural in old age. In addition, osteochondrosis contributes to the appearance of arthrosis of the intervertebral joints. In general, these two diseases usually go hand in hand. And finally, as osteochondrosis develops, it gradually leads to spondylosis.
read more...

Answer from 2 answers[guru]

Hello! Here is a selection of topics with answers to your question: how can low intervertebral disc height be cured?

Answer from Prokopyuchka[guru]
physiotherapy. vitamins, good nutrition. (eat more cartilage, for example bone joints, pig ears, etc.) ointments containing chondroitin and glycosamin

Answer from Baklanova Elena[guru]
There is a special complex home use for regular exercises for people with spinal problems. It provides stabilization of the spine and strengthens the muscle corset. Write in PM if anyone is interested))

Answer from Alexey Alekseev[guru]
It depends how old you are and what condition you are in. and the best thing is to do it three times a day on the horizontal bar, raising your knees to your chest 12 times. It is great!

Answer from JOSIC[guru]
I have had this problem for 10 years (I earned this bug at a construction site). Sergey, I have been sleeping on the floor for these 10 years (the mattress is my enemy). Tough, but I got used to it. I try to lie with my legs extended. During the night the skeleton stretches. Only at night does it begin to hurt in the spine area. And this is for life. ADVICE - DO NOT DO ANY OPERATIONS (it’s pointless, it won’t help, money is wasted).

Answer from Violetta Solntseva[guru]
And Madame Irka, and Roma Kim, and Agung are all right, partially.
If you have had an MRI and there are no contraindications:
1Hangs on the bar (carefully come down),
2light but intense massage on the sides of the spinal column and immediately -
3 rubbing St. John's wort oil (the preparation is in the net) and the oil is absorbed like into a sponge (without massage it is almost not absorbed).
The result will appear in 7-8 weeks. And you will feel it yourself... You can do an MRI again.
Good luck!

Answer from VERI[guru]
Stretching will help

Answer from Nelly Voloshina[guru]
There is no cure, but regular performance of special exercises will alleviate the condition, as well as swimming and UNDERWATER traction.

Answer from Agung[guru]
..no way
I advise you to do pull-ups on the bar
and don't jump off but get off

Answer from Errare humanum est[guru]
horizontal bar

Answer from little man[guru]
traction + massage + therapeutic exercise
you need to hang for 20-25 minutes, also homeopathic ointments, for example “Sofia with beeswax”

Answer from Croy Baker[newbie]
hang yourself on the horizontal bar every day. your heels hung on you for about twenty seconds. You can’t jump off the horizontal bar; step off it carefully. strengthen your back muscles, lose weight if you are overweight. swimming.

Answer from Dasha Zhu[guru]
Dead number

Answer from Madame Irka[newbie]
massage recommended, physical therapy

Answer from Manual Massage[guru]
chondroprotectors + massage + exercise therapy

Answer from Andrey[guru]
Get treatment from an osteopath. Not to be confused with a chiropractor. An osteopath will eliminate the cause, not the consequences. Just don’t run into an amateur, look for a good one. You can look at the register of osteopaths in Russia. They all passed the special. education. Treatment is not cheap, but you will forget about the diagnosis.

Answer from Galina Makarchenko[guru]
It’s unlikely to be cured, but you can try to stop it. First, find out the reasons for the decrease in height, and then treat it. Most likely, this is due to carrying heavy loads - reduce loads of this kind

Answer from Incognita[guru]
osteochondrosis, these are degenerative changes in the spine... the condition can be stabilized, but not cured... massages, magnets, electricity, stretching in the hospital - all this is complete nonsense... Strengthen the back muscles, that's all... drugs containing chondratin do not help at all... massage relieves pain...

Answer from Yergey Sviridov[guru]
"Dr. Bubnovsky's methods. Improvement of the spine and joints Healthy lifestyle library"

Very often, when visiting a therapist with characteristic complaints of pain in the neck and lower back, the patient receives a standard referral for an x-ray. Based on the results of this examination, a professional opinion from a radiologist is given. And it very often includes such a term as decreased disc height in the lumbar or cervical region. In the thoracic and sacral spine, this pathology is less common. This is due to limited mobility in these departments.

A decrease in the height of the intervertebral discs speaks primarily of severe dehydration (dehydration) of cartilage tissue. Secondly, this characteristic feature for disc protrusion. The condition is a complication of long-term osteochondrosis. In turn, protrusion of the fibrous ring is a risk of developing hernial protrusion of the nucleus pulposus. Moreover, a disc rupture can happen at any time. It is impossible to predict the moment of this neurological catastrophe. Therefore, it is necessary to take timely measures to carry out effective and correct treatment.

A decrease in the height of the intervertebral disc is always accompanied by prolapse and protrusion of its boundaries beyond the vertebral bodies. You should not think that this pathology will go away on its own. No, the condition will only get worse in the future. It is possible to restore the shape of the fibrous ring and its shock-absorbing abilities only by normalizing diffuse nutrition. To do this, you need to activate the muscle frame of the back. And first you need to dock pain syndrome. This is a treatment regimen using manual therapy methods in our clinic.

Moderate decrease in spinal disc height

A decrease in the height of the spinal disc does not always indicate that a stable protrusion has already formed. In the early stages of the pathological process, this phenomenon may be transient in nature. Those. under the influence of negative factors, such as emotional stress or physical overload, dehydration of cartilage tissue occurs. Then, as the general condition improves, hydration is restored through diffuse exchange, and the height of the disc is restored.

But even a moderate decrease in the height of the discs should be considered as a negative signal to begin the process of restoring the spinal column. In the absence of osteochondrosis and degenerative changes in the cartilage fibers, patients cannot show any pathological signs. Even under the influence of extreme factors. Even after very heavy physical activity, if the cartilage tissue is healthy, the intervertebral discs restore their anatomical shape within 2-5 hours.

Reduced height of lumbar intervertebral discs

Most often modern man An X-ray image shows a decrease in the height of the intervertebral disc in the lumbar spine, and this is far from an accident. There are several reasons for the increased risk of destruction of the fibrous ring in this section:

sedentary lifestyle and lack of regular physical activity on the muscle frame;
poor nutrition, when the diet is rich in fast carbohydrates and refined foods and does not contain fresh vegetables and fruits, sea fish and omega fatty acids;
constant injury to cartilage discs during sudden movements, bending, jumping;
wearing shoes with heels (in women) deforms the entire configuration of the lumbar spine, shifting the physiological center of gravity anteriorly;
incorrect positioning of the foot in the form of flat feet and club feet;
curvature of the spine in the associated sections;
inflammatory processes, rheumatism, etc.

It is worth noting that a decrease in the height of the lumbar discs quite quickly leads to the formation of a hernial protrusion of the nucleus pulposus. Therefore, if there are radiographic signs of decreased intervertebral disc height, effective treatment should be started immediately.

At our manual therapy clinic, patients are offered a free consultation with a leading specialist. During the appointment, the doctor will talk about how the treatment can be carried out and what potential results can be obtained.

Reduced height of intervertebral discs of the cervical spine

Very often, the images reveal a decrease in the height of the cervical discs C4-C5 and C5-C6, since they bear the main static load when performing certain actions during monotonous work. Accordingly, people engaged in sedentary work in offices are susceptible to pathology.

A decrease in the height of the cervical discs is accompanied by serious pain in the collar area. At the end of the working day, the patient experiences severe tension in the neck muscles and an attack of headache localized in the back of the head. There may be sensations of muscle weakness and numbness in the upper extremities.

If the decrease in the height of the intervertebral discs of the cervical spine is not treated, this can lead to the development of vertebral artery syndrome. It will be expressed in impaired blood supply to the posterior cerebral structures. May provoke increased blood pressure, severe headaches, dizziness, decreased mental performance, and depression.

To treat cervical protrusion, it is better to use manual therapy methods. This will allow you to effectively and safely restore the height of the intervertebral disc and eliminate the risk of developing concomitant pathologies.

An intervertebral disc is a formation consisting of fibrous and cartilaginous tissue, which contains a nucleus in the center and is located between two adjacent vertebrae. Moreover, it is important to understand that intervertebral discs do not contain blood vessels, which means that nutrition comes to them from the tissues with which they are surrounded. For this reason, if the nutrition of the back muscles is disrupted, namely due to the vessels that pass here and feed the spinal discs, the blood supply to these important structures is disrupted.

The disc itself is quite elastic, but in the absence of a sufficient amount of nutrients, it begins to lose water, which greatly affects its height and elasticity, and the fibrous ring itself becomes more fragile. All this has a negative impact on general condition spine, its instability increases, and one of the most common manifestations of this pathology can be considered a decrease in the height of the intervertebral discs.

As the pathology progresses, the cartilage tissue of the spine becomes more similar to bone, which is called degeneration or degeneration. In this case, the disc suffers even more, it shrinks, loses its height, and ceases to perform one of the most important functions - shock absorption. In addition, it begins to put pressure on the nerve endings located nearby. All this causes severe pain. This condition is called osteochondrosis or spondylosis, and is very common among both the female and male population.

A decrease in the height of the L5-S1 intervertebral disc can also be observed with a traumatic injury to the back. If injury occurs without compromising the integrity of the annulus fibrosus, this is called protrusion. But if the ring is torn and the nucleus extends beyond its limits, then this is called a disc herniation.

What does this threaten?

In total, there are four stages of pathology. And each of them has its own special characteristics. At the initial stage, the course of the disease is hidden. The only symptom is back discomfort in the morning, which disappears after a few hours. The height of the discs remains unchanged.

In the second stage, pain becomes more severe, deformation of the fibrous ring begins, and the stability of the affected area of the spine is greatly impaired. Nerve roots may be pinched, blood and lymph flow may be impaired, and a moderate decrease in the height of the intervertebral discs may be detected.

At the third stage, further deformation of the disc ring occurs and it ruptures. Pathologies such as or lordosis are well expressed. And finally, the final stage is a shift and hardening of the vertebrae, which is accompanied by severe pain. A person's ability to move is severely limited. The height of the disc is reduced to its minimum.

As a result, disturbances in the functioning of the pelvic organs, complete loss of sensitivity, and even paralysis of the muscles of the lower extremities may occur. As a result, the person becomes disabled and can only move in a wheelchair.

Conservative therapy

In the early stages of development, a moderate decrease in the height of the intervertebral discs, which can be seen on photographs, can be treated. However, it is important to understand that treatment must be comprehensive and medications alone cannot be used.

When making this diagnosis, you should definitely create a gentle regime for your back for a while, engage in physical therapy, swimming, and get a referral from a doctor for physiotherapeutic procedures and massage.

As for the procedure for stretching the spine, it can only be carried out after a complete examination and doctor’s prescription. Otherwise, such treatment can lead to serious consequences. If spinal traction is still prescribed, then it is better to choose its underwater version, that is, using a pool. Medications should be used only as prescribed by a doctor and in individually selected dosages.

If conservative treatment does not bring visible relief for several months, then surgery may be prescribed. There are certain indications here, for example, persistent lumbago, functional failure of the vertebrae, chronic compression of the roots. The doctor decides which operation will be most effective, and here everything depends not only on the degree of development of the pathology, but also on the patient’s age, his general health and his weight.