The most difficult variant of a spinal disc herniation development is the sequestered disc or just the sequester. In this case an intervertebral disc comes out; to be more precise its nucleus pulposus comes out into the spinal channel, besides into its region, where there is meninx fibrosis and cerebrospinal nerves. This form of herniation leads to the most serious pain syndromes, besides it can lead to paralysis, which occurs in the result of compression of the spinal canal by herniation. As the disease can lead to very serious complications, it is considered that the most preferable way to treat the sequestrated disc of a spine is an operative interference.
Symptoms and manifestations of the disease
By virtue of the fact that the influence is made directly on the spinal nerves, manifestations of the sequestered disc are much more serious and complicated than manifestations of a simple disc herniation. Usually this disease may acquire people who suffer from a disc herniation or bulging for a long period of time. Patients remember very well the beginning of the disease (disc sequestration), because almost always it is very acute and it goes along with a very sharp pain. But sometimes there are cases, when the disease flows without any symptoms for a long period of time and patients complaints’ are very few. Taking into consideration this absence of symptoms, appearance of the sequestered disc is much unexpected event.
More often manifestations of the disease appear after some provoking factor, such as hypothermia, stress situation or loads lifting; and a very strong pain develops in the low back. Very soon this pain spreads to the leg, going along the back or side surface of the hip. It leads to the serious restriction of the leg mobility, or even to the full immobility, when the person cannot walk at all. The pain will be accompanied by neurologic symptoms: the leg becomes weak, numbness appears and the reflexes in the leg disappear. This disease can develop up to the paraplegia.
It is necessary to draw the attention to the fact that manifestations and symptoms of the sequestrated disc are very similar to those of the usual disc herniation in the pelvic part of the spine the difference is only in their symptoms strength and speed of development. Besides, a common disc herniation, which makes influence on the nerve root, hardly ever leads to the leg paralysis; in any case it gives a person an opportunity to move.
The sequestrated disc is dangerous, and its danger is compound. The problem is not only that the herniated disc presses the spinal canal (mechanically and by inflammatory process in the tissues), the problem is that it can lead to paralysis. Parts of the nucleus pulposus create and additional problem when they fell into the spinal canal. The fact is that they contain a high concentration of protein molecules. And it can provoke an autoimmune reaction of inflammatory character, similar to that which is invoked by the well-known to everybody rheumatism.
Problems of treatment
Treatment of such disease as the sequestered disc has its peculiar problems. First of all they are connected with its location.
Inflammatory process which appeared invokes a serious disturbance and restriction of blood circulation in the affected area, and as a result nutrition of the correspondent part of the spine is disturbed considerably. Besides, the herniated disc itself occurs “hidden”, and it is an additional problem. Therefore, very often the traditional conservative methods of treatment are ineffective; analgesics and anti-inflammatory medicines just cannot penetrate to this affected area. In this case results of treatment depend a lot on the competence of the physician caring for patient; incompetent prescriptions will not bring any good results in treatment.
Taking into consideration all the above mentioned it is easy to understand why many people think that the sequestration can be treated only by operative methods, and very often this idea is supported by narrow minded neurosurgeons. You should remember that any even the most sparing operation will not make the spinal column healthy. And in case with the sequestered disc there is a very high risk of recurrences.
In fact, therapeutically correct and competent methods can give an opportunity to avoid the operation. But actually with this diagnosis there are not many chances for conservative treatment to be successful, they are lower that while treatment of usual disc herniation.
Conservative treatment of herniation
At the beginning of the treatment patients are almost always prescribed to take nonsteroidal anti-inflammatory medicines. Their task is to remove inflammation, which appears in the compressed root; if the inflammation is removed pain will be also removed. The disc herniation certainly cannot be removed with the help of these medicines, but they can considerably relieve the patient’s life. As a rule treatment starts from these medicines. But these medicines should not be applied more than two months, because the risk of appearance of side effects grows highly.
One of the well-known solutions is a procaine block of the affected segment of the spine. It will decrease swelling and remove spasm, weaken inflammation of the compressed nerve. Such block gives immediate effect, and it can work during the period from one to three weeks. If it is necessary it can be repeated but not more than once a week.
Manual therapy will be effective only in that case, if the disc herniation is accompanied by displacement of intervertebral joints; by the way it happens very often. But you should take into consideration that rough manipulations are not admitted in this case; they can provoke swelling and increase spasm of muscles. All these will lead to an additional harm and will be able to send the patient to surgical table. With the same care massages should be done.
Other physiotherapeutic procedures will help only to half quantity of patients and in some cases can lead to feeling unwell. That is why you should be very careful with procedures and apply them only after the doctor’s prescription.
Very often it is recommended to patients to use a back belt. It is used only while sharp phase of the disease and during that period of time when a person is in vertical position. While having rest you should put it off.
Movement therapy can be applied only after the pain syndrome has been removed totally. By this you should follow the doctors’ recommendations and to increase load gradually, starting from light and simple exercises, which cannot cause any pain.
When it is necessary to use the operative treatment?
We can distinguish four main surgical indications:
- if during half a year treatment period the state of the patient is not better or is even worse, in spite of all doctor’s prescriptions being used correctly by the patient;
- if the weakness of the patient’s muscles along the travel od the nervous root is increasing very fast;
- practically always the operation is necessary for treatment of the sequestration, especially in that case, if some part of cartilaginous tissue broke off the herniated disc. To set the sequestration is impossible, so in case when neurological disorders appear it is better to make the operation. But if there are not any neurological disorders it is not necessary to hurry up with the operation, very often they can dry out and reabsorb.
- If during treatment there is some improving, but it changes for deterioration in some period of time, and this situation repeats several times in the same part of the spine.
- Modern surgical methods give an opportunity to minimize the risk of after operational recurrences and complications. In particular, operation aimed at sequestration removal is a neurosurgical operation, and it is possible to minimize a risk to do harm to other internal organs while operation.