How painful are hernias: The request could not be satisfied
Common Types of Hernias That May Cause You Pain: Surgical Associates of North Texas: Advanced Laparoscopic Surgeons
When you think of muscles, you probably think of movement, one of their most important functions. Many people are unaware of a secondary role that muscles play in keeping your organs in place.
The strength and density of muscle tissue is ideal for holding things where they belong. The dense connective tissue that holds muscles in place and helps to accomplish this task is called the fascia. When a weak spot develops in this fascia then a hole may develop. This will allow the organs or tissues that would normally be contained to bulge through. This fascial defect is called a hernia.
Hernias can range from being relatively benign to life threatening, and determining which is which can be very difficult sometimes. This is why all hernias should be evaluated by a medical professional to determine which category they will fall into. Once a hernia is present, it will require surgical intervention in order to be fixed, so just waiting and hoping that it will go away on its own is never going to work. Not all hernias need surgery right away, however, so just because you get it evaluated early doesn’t necessarily mean you’ll need to have surgery, so don’t let that fear keep you from having it checked out.
There are several different types of hernias, with their location in the body being the differentiating factor. Where the hernia occurs will have an effect on the typical symptoms that are associated with it as well as on the urgency with which it might need dealt with. These are some of the more common types of hernias that you might have.
Inguinal hernias are far and away the most common type of hernia in both men and women, accounting for about 75% of all hernias. Fortunately, their frequent occurrence has provided us with ample opportunity to learn about all the different symptoms they can cause and the best treatment options. Traditionally, the biggest concern with an inguinal hernia was the fear that the bowel protruding through the defect might get trapped, or incarcerated. This can lead to the bowel becoming ischemic and eventually rupturing, which would then lead to sepsis and eventually death. Luckily, the chances of any inguinal hernia having this happen are small, only around 15%. For most people, the biggest issue with their hernia is that they start to hurt.
The pain associated with an inguinal hernia is usually a dull ache in the lower abdomen or groin region, often made worse when you bend over, lift anything heavy or cough. You may not always notice the pain during activity, but instead might notice an increased level of soreness in the area of the hernia at the end of the day. This may persist for years before it ever becomes incarcerated, so just because a hernia is painful doesn’t mean it is any more concerning. In reality, the main reason most people get their hernias repaired is because the pain increases to a point that it becomes too much to bear. Looking at all people with an inguinal hernia, around 85% of them will eventually decide to have surgery to fix it because of this pain.
The other type of groin hernia, femoral hernias are more commonly found in women, and are more common as you get older. The big concerns, ie incarceration/strangulation are similar to what occurs with inguinal hernias. One of the biggest differences, however, is that unlike inguinal hernias where a bulge is often seen before symptoms occur, femoral hernias commonly aren’t know about until they have started to cause symptoms. They will usually require surgery more urgently than inguinal hernias once they are discovered because of this.
The second most common type of hernia after inguinal hernias, umbilical hernias develop in the umbilicus or belly button. All of us have a potential weakness there that results from having our umbilical cords protrude from that spot as newborns. Once the cord is cut and the hole closes, then some of us will eventually develop a hernia at that spot as we get older. Some of the most common risk factors for these types of hernias are anything that causes an increase in abdominal girth. Pregnancy in women is a common cause, while the gradual expansion of the waist line that often accompanies getting older and enjoying eating is another.
These will typically present with a small bulge either in or just to the side of the belly button that will usually become tender if pressed on. When they first appear, they are usually reducible, meaning you can push the bulge back down into the abdomen. This is a good thing. Should the hernia get to a point that you cannot push it back in, then it is at risk for becoming incarcerated. Just like with inguinal hernias, if this happens then the risk of the hernia becoming strangulated and the associated intestines that are pushing through becoming ischemic goes way up. At this point, repair of the hernia is a necessity and should not be delayed any longer.
Surgical solutions for hernia
Since a hernia won’t go away once it has occurred, most of them will eventually require surgical intervention. The location and severity of the hernia will affect the timing and urgency of that repair however, and is something that should be discussed with a hernia specialist. The concerns that many have about these surgeries requiring big incisions and causing you to miss a lot of work are fortunately unfounded these days. If you have a hernia and would like more information, contact the hernia specialists at Surgical Associates of North Texas to set up an appointment to see what the best options are for you.
Hernia FAQ: How to Relieve Hernia Pain
What kind of pain does an inguinal hernia cause?
An inguinal hernia is a protrusion of abdominal contents into and sometimes through the inguinal canal. The inguinal canal contains blood vessels, spermatic vessel and nerves that travel to the testicle. When a hernia occurs, the contents of the hernia compresses these structures, often leading to a feeling of heaviness, pressure or even pain. The pain may be localized to the bulge, or the pain may radiate (shoot down) to the scrotum (the sac where the testicles are) or inner thigh. Some people describe intense pressure or even burning. Most people feel pain at the end of the day, after prolonged standing or sitting. Most people get relief of pain when they lay down flat. It is rare to feel sharp stabbing pain with a hernia, as this kind of pain is often due to a musculoskeletal injury.
How do I relieve pain from an inguinal hernia?
Many people who suffer from discomfort or pain from an inguinal hernia find that laying down flat on their backs can relieve most of their symptoms. Some find it necessary to massage the hernia back into their abdomen. While we advise most patients we have evaluated that it is safe to to this in the short term, there is no substitute for surgery. Surgery will alleviate the pain of most people within a few days. Anyone that has pain that restricts their activity level should be evaluated by an experienced hernia surgeon to understand their options. Over-the-counter pain medication use is not typically advised, as pain severe enough to warrant medication is often an indication for surgical intervention. Recent data suggest that prescribing opioids before surgery increases a patients risk of becoming opioid dependent after surgery – a practice we don’t condone.
Relieving hernia pain with a hernia belt or truss
Some patients are unable to schedule their surgery right away, usually because of a work commitment, planned vacation, or current medical situation. A hernia belt or hernia truss can be a great bridge to surgery in these scenarios. Most local hospital supply pharmacies carry a hernia truss that can easily fit over undergarments. The truss should be put on while the patient is lying flat, with the hernia fully reduced. By tightening the truss in this position, the hernia contents will be kept inside the abdominal cavity. This option helps most patients with pain management for the short term until they can schedule surgery.
The methods used in the treatment of herniated intervertebral discs can be roughly divided into two parts:
• 1- Conservative treatment
• 2 – Surgical intervention
Pain caused by lumbar herniated discs in the lumbar spine resolves naturally in most patients within a few months.This indicates the need for conservative treatment methods at the first stage of the course of treatment. The duration of conservative treatment should be at least 6 weeks, while the continuation of such treatment should not exceed more than 6 months. During this course of treatment, the patient is prescribed bed rest, analgesics and muscle relaxants are prescribed, then passive physical exercises are carried out, which, gradually becoming more complex, go into the implementation of a special program of exercises and physical activity.
One of the other methods used by patients with a hernia of the lumbar spine is to use a special brace by patients. Due to the fact that corsets cause muscle weakness, their use is not currently recommended.
If patients develop progressive weakness, or if the effect of conservative treatment is not effective, as well as with the manifestation of periodic pain, with recurrent neurological failure, if there is a hernia on the inside of narrow canals, or if the hernia negatively affects the patient’s social life, in this case it is necessary to resort to surgical methods of treatment.In the event that the patient suffers from urinary or fecal incontinence, or has symptoms such as difficulty moving the ankle or showing similar symptoms, surgery should be performed within 24 hours.
• Standard lumbar discectomy
• Lumbar microdiscectomy.
• Arthroscopic micro discectomy.
Publications of the Association of Neurosurgeons of Turkey, Book “Fundamentals of Neurosurgery”.
Surgery to remove a hernia of the lumbar spine in Omsk
Removal of a hernia of the spine using microdiscectomy. Modern microsurgical technique allows minimally invasive removal of disc herniation of any size and location. Fast recovery after surgery – the day after surgery to remove a herniated disc, the patient is allowed to start walking.
Microdiscectomy (surgery to remove a hernia of the spine)
The operation is aimed at stopping the compression of the nerve root by herniated disc and is rightfully considered the “gold standard” in world practice.
Herniated disc often causes not only extremely painful sensations and various disorders of the innervation of the extremities, but also causes temporary loss of working capacity. If it progresses, it can lead to disability. This is due to the fact that with a hernia, squeezing of the adjacent nerve roots and blood vessels occurs. In the absence of the effect of conservative treatment, surgery to remove a herniated disc is the only possible solution for many patients.
Modern microsurgical technique allows minimally invasive removal of disc herniation of any size and location.Surgical intervention is performed using a microscope and special microsurgical instruments. In the area of the projection of the damaged disc, a 2–3 cm skin incision is made. Thanks to the perfect microsurgical technique, vast experience of neurosurgeons and expert-class equipment, the risk of damage to the nerve structures is minimized when removing a herniated disc. Microdiscectomy is performed under general anesthesia. The duration of the operation is 45-60 minutes.
Among the advantages of microdiscectomy there are:
- the possibility of simultaneous removal of several hernias;
- fast recovery after surgery;
- short hospitalization period.
- The patient is allowed to walk the next day after the disc herniation surgery. The process of walking makes the spine more mobile and reduces the possibility of tissue scar formation at the incision site;
- If the work is not associated with heavy physical labor, then you can start the usual routine 2-4 weeks after the operation or even earlier;
- If the work involves physical labor, you should wait at least 6-8 weeks.
Microdiscectomy of the lumbar spine is most commonly performed. For a hernia of the cervical spine, microdiscectomy is often combined with stabilizing surgeries.
Return to the page:
Return to the page:
Still have questions?
Treatment of a hernia of the spine in St. Petersburg (St. Petersburg)
The word “hernia” is a general medical term that denotes an abnormal protrusion of an organ or a separate part of it relative to its usual position.The presence of a hernia entails painful phenomena that can cause other, more serious, pathologies. In the case of a hernia of the spine, such protruding elements are elastic discs that are placed between the vertebrae. They play the role of a shock absorber under vertical loads, therefore, in case of problems with them, a person’s mobility is significantly limited. Treatment of hernia of the spine in St. Petersburg is carried out in the clinic “Poem of Health” in Ozerki.
+7 (812) 30-888-03
+7 (812) 242-53-50
Clinic address: St. Petersburg, Vyborgsky district, metro Parnas, st.Asafieva, 9, to 2, lit. A
To understand how dangerous an intervertebral hernia is, you need to understand the structure of the spine. It consists of individual vertebrae, within which the spinal cord runs. The vertebrae are separated from each other by discs: elastic formations, which, in turn, consist of a strong shell and an inner jelly-like part. The membrane is called the annulus fibrosus, and it is very strong in a healthy person. With an intervertebral hernia, the ring collapses, and the internal contents of the disc flows out through the gap formed.Typically, the rupture is near the spinal cord, so a person experiences severe pain when the disc ruptures.
There are many factors causing a hernia of the spine. In some cases, a hereditary predisposition becomes the cause of the hernia, but usually this disease is acquired with age. Viral diseases and curvature of the spine are one of the main causes of hernia development. In addition, the disease develops against the background of malnutrition (obesity), osteochondrosis and back injuries.Bad habits, a sedentary lifestyle or hard physical work also negatively affect the condition of the intervertebral discs.
Most often, an intervertebral hernia occurs in the cervical, thoracic and lumbar regions. The first time after the rupture of the disc, severe pain appears, which subsequently decreases. This is explained by the fact that the tissues around the focus of the disease harden and connect with each other. This phenomenon also has a negative side: along with the pain, the mobility of the spine also disappears.This can lead to paralysis of the limbs and loss of mobility of the hip joint. Worst of all, the disease can pass from the spine to other organs, causing a number of serious diseases:
- Chronic bronchitis;
- Gastritis and stomach ulcers;
- Stroke and other cardiovascular diseases.
The first sign of a hernia of the spine, in which you should consult a doctor, is severe pain with sudden movements, stationary position of the body and with strong physical exertion.In severe cases, pain is felt even when sneezing or deeply inhaling and exhaling. As the pathology develops, its symptoms become more and more palpable. Other signs of a herniated disc include chills in the fingers, numbness in the extremities, head and heart pain, and dizziness.
In the Poem of Health clinic, diagnostics and treatment of intervertebral hernia in St. Petersburg is carried out using complex methods. The primary diagnostic method is an examination by a doctor at the time of the first appointment. The specialist listens to the patient’s complaints and checks the mobility of the spine.It is highly advisable to show your medical record so that the doctor can understand the prerequisites for the development of the disease.
More detailed diagnostics include tomography. Conventional X-ray only determines the position of the vertebrae relative to each other, but does not show the state of the intervertebral discs due to the low density of the jelly-like material. Tomography provides a complete picture of the patient’s health. The monitor screen will clearly show where the disc ruptured, and how much the liquid leaked out.Based on this, the doctor decides on how to treat an intervertebral hernia.
The choice of the method of therapy depends on the stage of the disease. Treatment of a hernia of the spine in St. Petersburg at the Poem of Health clinic is carried out at any stage of the disease. At an early stage, there are enough conservative methods of treatment, which include:
- Taking medications;
- Physiotherapy exercises and spinal traction;
- Manual therapy and therapeutic massage;
- Hirudotherapy (leech therapy), etc.e.
Surgical intervention is suggested only in severe cases, when there is a threat of disability. An effective method of dealing with intervertebral hernia is laser treatment. Medicines for the treatment of intervertebral hernia in St. Petersburg in our clinic are safe and do not harm other organs.
To make an appointment for a consultation, call us at the indicated phone numbers or leave a request on our website. We offer a high level of medical care and an individual approach to each client.Reception and treatment of intervertebral hernia in St. Petersburg in our clinic are doctors of the highest category.
Spinal hernia: causes, symptoms, treatment
How does the disease develop
A young healthy spine is mobile and elastic. Each vertebral disc has a shell – an annulus fibrosus. Inside it is the nucleus pulposus – a gelatinous cartilaginous filler.
With injuries, excessive loads, diseases, metabolic disorders, cracks or ruptures appear in the annulus fibrosus.For some time, the nucleus pulposus is held by the longitudinal ligament, but then it comes out – in whole or in part.
There are four stages in the development of the disease:
- Prolapse. At this stage, a small fragment of the nucleus pulposus (up to 3 mm) extends beyond the disc without disturbing its membrane. The reason is the first degenerative changes, impaired blood supply, dehydration, cracking of the shell.
The symptoms of protrusion are similar to the manifestations of osteochondrosis: after physical exertion, the patient is worried about aching pain, he quickly gets tired.At this stage, patients rarely seek medical attention, attributing what is happening to fatigue or age.
- Protrusion. From 4 to 16 mm of the nucleus pulposus extends beyond the anatomical dimensions of the annulus fibrosus. This disrupts the blood supply to the disc, the nucleus presses on the fibrous membrane and causes pain. But if the blood vessels and nerves are not pinched, it is not too intense.
At this stage, the disc lining is not yet damaged, but it is dangerous to ignore the symptoms.After all, if the patient is less fortunate and the protruding nucleus still squeezed the nerve, he will suffer from impaired sensitivity of the hands and feet, numbness and coldness in the fingers. If protrusion has occurred in the cervical spine, blood pressure may rise, migraines, dizziness and vision may begin. If in the lumbar spine – there is lumbodynia and disorders in the work of the pelvic organs.
- Extrusion. The nucleus is “squeezed out” from its place by 6-15 mm, that is, almost completely, but its shape is preserved.A person feels a sharp pain, restriction of mobility, muscles become stiff, there is swelling of soft tissues. “Backache” occurs when some kind of external influence: when lifting weights, sudden movement, injury, cold or stress.
No surgery is required at this stage. It is enough to take medication to relieve pain, swelling and muscle spasm. When the spasm of nerve endings weakens, the doctor will draw up an individual rehabilitation program. This will avoid relapses.
- Sequestration. The nucleus falls out, the intervertebral disc pinches the nerve endings, the pain becomes constant. The protrusion is restrained, tissue nutrition is impossible and it dies off, causing inflammation. In the most difficult case, the hernia is squeezed into the spinal canal and provokes purulent processes there.
In addition to severe pain and stiffness, a sequestered hernia can cause neurological diseases, failure of internal organs, and deprive the ability to move independently.In this case, delay is dangerous, its consequences may be irreversible. If non-surgical therapy is ineffective, your doctor will suggest surgery.
What are the intervertebral hernias
The disease has a gradation according to several signs.
- in the lumbar region. The most common type of pathology, up to 65% of hernias occur in the lower back;
- in the thoracic region, up to 31% of cases;
- in the neck, 4%.
By the time of occurrence:
- Secondary, resulting from disc degeneration.
By anatomical features:
- free. The longitudinal ligament maintains the vertical position of the spine, the contents of the nucleus pulposus pass through it.
- wandering. The nucleus flows out, breaks off the disc and moves along the spinal canal;
- Moving.Occurs with injury or extreme stress, accompanied by a displacement of the disc. When the load is removed, the core may return to its place or fix in the wrong position.
In the direction of the nucleus falling out:
- Anterolateral, located in front of the vertebra. It is embedded in the longitudinal ligament and causes severe pain.
- Posterior-lateral, penetrates the posterior wall of the annulus
By the type of fabrics that protrude beyond the boundaries of the ring:
- pulpous, occurs when the nucleus is squeezed out through the fissures of the annulus fibrosus;
- cartilaginous, in this case the cartilage that has lost its elasticity is squeezed out;
- bone, on the nerve endings are pressed by bone growths and osteophytes.More common in elderly patients with spondylosis.
Important! a patient may have several different types of intervertebral herpes at the same time intervertebral herpes It is necessary to carefully examine each painful area and differentiate treatment.
Causes and risk factors
It is not easy to determine the etiology of the disease in each specific case, because several causes or chronic diseases can become a trigger mechanism.The most common are:
- spinal injuries;
- hereditary predisposition;
- benign or malignant neoplasms;
- diseases of the spine – lordosis, scoliosis, osteochondrosis;
- infectious and viral diseases;
- heavy physical activity;
- sedentary lifestyle;
- age-related changes.
Symptoms of a hernia of the spine
Small herniated disc does not press on the nerve endings and the patient is unaware of the disease. The first manifestations are easy to confuse with signs of osteochondrosis. But the more the annulus fibrosus is destroyed, the more intense the pain becomes. In addition, the first signs of a hernia are:
- Swelling and muscle tension;
- kyphosis or scoliosis;
- burning sensation, tingling sensation;
Hernia pains can be dull, aching and sharp, tearing or shooting.The patient seeks a position in which suffering is weakened and takes a forced position, reflexively flexing the spine. The gait is disturbed, not only the muscles of the lower back, buttocks and lower legs are painful, but even the skin. In response to a light prick or pinch, she shows hyperesthesia – a sharp soreness. Reflexes of the knee or Achilles tendons change. There is weakness and slight atrophy of the legs, muscle flabbiness.
With a hernia, the patient feels pain constantly. They intensify with certain movements, walking, coughing, sneezing, sometimes accompanied by fever, numbness of the arms and legs.
Additional symptoms depend on the location of the hernia. If the pathology develops in the cervical spine, it is a headache and stiffness of the neck, nausea, tinnitus, increased intracranial pressure and even epilepsy.
In case of damage to the thoracic region, the pain mimics a heart attack, in the lower back – it shoots in the thigh. Often, a lumbar hernia causes frequent and painful urination, exacerbation of hemorrhoids, unusual sweating or dry legs.
Why the disease is dangerous
If the patient does not find time for full treatment, he seriously risks his own health. The most serious danger is complete paralysis, which occurs as a result of severe prolapse, when deformed cartilage damages the spinal cord.
Hernia of the lumbar spine of the spine leads to a violation of the innervation of the abdominal cavity and small pelvis: dysfunction of the intestines, bladder, reproductive organs, decreased muscle strength, entrapment of the sciatic nerve.A man develops a prostate adenoma. Hemorrhoids and varicose veins are also a consequence of disorders in the work of the musculoskeletal system.
A hernia of the thoracic region causes coxarthrosis, disrupts the correct position of the structures of the knee joint, the position of the feet. The position of the tibia is bent.
An increasing hernia of the cervical spine can provoke an ischemic stroke, accompanied by paralysis, loss of speech, and ataxia.The most important blood vessels are located in the neck area; violation of their patency will entail problems of cerebral circulation. The result will be paresis, pain in the elbow joints, wrists and shoulders, disturbances in the functioning of the lungs, heart and thyroid gland.
Medical care for the disease is provided by a neurologist, therapist and orthopedist. The doctor will notice the first alarms during a visual examination of the patient – a violation of posture and insufficient sensitivity of body parts in the zone of action of the pinched nerve.Feeling the spine, the specialist will determine how spasmodic and painful the muscles are and the location of the pathology. You may be asked to bend and straighten to assess your limited mobility. The doctor will diagnose reflexes in the knee and Achilles tendons.
The size and location of the hernia will help determine the MRI, CT, and lateral and frontal x-rays.
The primary task is to alleviate the patient’s condition, so therapy begins with taking painkillers and complete rest.To eliminate painful neurological manifestations, the doctor will prescribe anti-inflammatory nonsteroidal drugs, muscle relaxants, therapeutic ointments – irritating and to relieve puffiness.
A reliable method of pain relief of the affected area is X-ray-controlled blockade. Under local anesthesia, the doctor will inject the medicine into the pinched nerve endings.
When a stable positive trend appears, the doctor will adjust the medication intake.The main thing at this stage is to follow a set of medical and preventive measures. The dynamics of treatment will be monitored by a neurologist, the patient should be examined at least once a month.
Chondroprotectors are used to restore cartilage tissue. The minimum course of treatment is 3 months. Medicines for improving blood circulation have proven themselves well. It is important to take a course of vitamins of group B, D, A, E. This will improve tissue nutrition and start recovery processes.
When treating a hernia, surgical intervention is resorted to only in extreme cases: with a large hernia and its sequestration, if the most important life processes are disturbed or conservative therapy is ineffective.
Non-surgical methods of treatment
After a complete examination, the doctor may recommend treatment of a hernia of the spine with manual or physical therapy. However, these methods are justified only for small hernias of safe localization.
The most popular non-surgical treatment methods:
- hirudotherapy. The leech saliva enzyme promotes the resorption of the hernia and improves blood circulation;
- cryotherapy. Under the action of liquid nitrogen, blood circulates more actively in the affected area, thereby improving tissue nutrition;
- osteopathy. The specialist activates metabolic processes in the tissues of the body, removing blocks, clamps and stagnant processes using massage and point effects;
- acupuncture.Impact on the patient’s body with the help of painless directed punctures with special needles.
The best physical therapy for a hernia of the spine are:
- physiotherapy exercises;
- electrophoresis and phonophoresis;
Each method has its own characteristics and contraindications, the attending physician will recommend the optimal complex.
Manual therapy does not heal the disease, it only makes the patient feel better for a while. The main thing that the patient must do is to eliminate risk factors and take care of the condition of the spine.
You cannot refuse feasible physical exercise. Reasonable loads gently disperse stagnant processes, the muscle corset ensures the stability of the hernia. The movement restores the correct movement pattern and symmetry of movement.
However, there are exercises that are strictly prohibited for a hernia of the spine:
- movements associated with axial load on the spine – lifting dumbbells, barbells, carrying weights, leg press and twisting;
- Physical activity, accompanied by a long stay in an upright position – running, football, skiing.
- Exercises on straight legs and associated with contraction of the back muscles;
- deep squats.
Golfing, bodybuilding and equestrian sports are prohibited.
Go in for swimming, water aerobics, yoga and Pilates, perform the exercise therapy complex developed by the trainer. Scandinavian walking is useful, because in this case the load is distributed to the sports equipment.
In order to prevent a dangerous disease, you must:
- Improve the mobility of the spine;
- Normalize disk power;
- Form a muscle corset.
This is a holistic approach, it requires persistence and lifestyle changes.
To keep the danger to a minimum:
- Normalize weight. Overweight is a difficult test for the spine and the entire musculoskeletal system. But lose pounds gradually, while strengthening the muscle corset;
- Watch your posture. So the load will be evenly distributed to each section of the spine, this will exclude stagnant processes, edema and spasms;
- quit smoking.Nicotine circulating in the blood makes it difficult to feed the intervertebral disc, the cartilage tissue dries and cracks;
- get massage sessions. This will improve blood circulation in the sedentary areas of the spine, maintain muscle tone and intervertebral discs;
- Eat a balanced diet. Products must fully meet the need for vitamins, minerals, fats. Heavy ballast food should be avoided. For the health of the spine, animal protein, vegetables and fruits without heat treatment are useful.
- do not overload your back, warm up before a set of exercises;
- when jumping, do not land on your heels;
- Practice your running technique, excluding concussions and rigid foot positioning;
- do not sit in one position for more than 30 minutes;
- do not slouch, watch your head position;
- Do not sleep on a soft mattress.
Patient safety issue in spine surgery
For more than fifty years, in the treatment of diseases of the spine (intervertebral disc herniation, trauma, fractures, curvature), in order to limit the mobility of the painful segment, the method of so-called instrumental fusion has been actively used, which consists in turning off the mobility of the vertebrae by installing screw metal implants in them, connected by rigid metal bridges, and between the vertebrae – prismatic wedge-shaped inserts made of metal, hard plastic or bone.In the case of a posterior approach, when screw implants are inserted into the vertebra through its stem, this method is called transpedicular fixation / stabilization (TPF). Depending on the therapeutic objectives of the surgery of the vertebrae, in which the screws are installed, there may be several. For example, with scoliosis, there may be more than eight of them, with degenerative pathology or trauma – from two to four.
1- Vertebral body, 2- Vertebral arch, 3- Spinous process, 4- Transverse process, 5- Facet joint, 6- Nerve root, 7- Vertebral canal, 8- Intervertebral disc
The operation of installing screws into the spine is a rather complex surgical procedure, since it requires the surgeon to know the geometry of each specific spine, developed skills in the operation technique and great care when installing screws.As the famous American surgeon Randall Betz shows in his observations, due to a decrease in the critical attitude to their skills, experienced surgeons make mistakes when installing pedicle screws even more often than novice surgeons.
To reduce the likelihood of such errors, which are extremely costly for patients, clinics are buying expensive equipment. But despite the astronomically expensive auxiliary equipment in the operating room, which the clinic buys for the safety of patients, despite the improvement of their skills by surgeons around the world, the so-called artificial spinal stenosis due to an error in determining the trajectory of the screw is not at all uncommon these days.Cases of gross errors in the placement of pedicle screws, which clearly require reinstallation, reach up to 20%. In 20% of cases, the surgeon is forced to resort to a repeated traumatic operation under general anesthesia due to the patient’s complaints of painful phenomena and gross organ dysfunctions after the operation.
Mistakes in the installation of pedicle screws are very dangerous for the patient. A screw that pierces the thin cortical bone of the vertebral arch towards the spinal cord creates a narrowing of the spinal canal, which entails compression of the spinal cord and its nerve roots.The patient in this case may experience constant severe pain that is not eliminated by pain medications. Impaired limb mobility or organ function may also develop.
Punching the cortical layer of the vertebral arch with a screw laterally, in the direction opposite to the spinal cord, also poses a serious danger to the patient, since then the screw can damage vital organs located close to the spinal column.
In Russia, surgeons very often do not reinstall an incorrect screw if the patient does not complain of pain or discomfort during his stay in the clinic.However, an incorrectly installed screw with access to the spinal canal or outside the vertebral body will certainly manifest itself later, after a while after discharge from the clinic. It will manifest itself with severe pain or dangerous organ dysfunctions.
And, of course, the most terrible mistake of a surgeon when he accidentally punches the dura mater of the spinal cord or even the spinal cord itself with the instrument used to prepare the canal in the vertebra under the screw. The Russian press knows the case of the Novosibirsk dancer Lada Teploukhova, who, having turned to a European-level spine surgeon regarding the treatment of scoliosis by installing a screw system, turned out to be disabled as a result of such an error.
Existing effective solutions to improve patient safety
Modern science has found a solution to these mistakes. There is a special tool that not only reduces the patient’s risk during interbody vertebral stabilization surgery, but also increases the accuracy of the surgeon’s work without complicating his manipulations and without using additional complex equipment. A tool that makes the complex operation of installing screw structures simpler and completely safe for the patient.This tool is called Pediguard.
The Pediguard tool was developed and introduced into practice by the Irish surgeon-vertebrologist Ciaran Bolger. Back in 2002, he seriously became interested in the problem: how to reduce the patient’s risk due to accidental damage to the thin cortical layer of the vertebral bone during a surgical procedure? After all, its damage is very expensive for the patient, the surgeon, and the clinic. After extensive laboratory experiments and discussions on the design of the device with his co-authors, Bolger created the instrument that allows the cortical bone to remain intact when the screws are inserted into the spine. .That is, as a result of using the Pediguard tool, the installed pedicular screw in 99% of cases is located in the spinal bone, without leaving it, without touching the nerve roots, and even more so without getting into the spinal canal.
The recognition of Kiaran Bolger’s merits as a spinal surgeon is evidenced by the fact that in 2011 he was elected President of the European Society of Spinal Surgeons (EuroSpine). Professor Bolger is currently conducting an advanced training course for European surgeons under the auspices of EuroSpine on complex cases of spinal pathology.
A patient treated with Pediguard by the surgeon is more likely to not complain of low back pain after a transpedicular fixation operation than without it. It also has a much lower risk of becoming disabled after an operation with its use in comparison with other surgical techniques, even the most modern ones.
Since the instrument allows the cortical layer of the bone to be kept intact, the surgeon can easily do his job almost perfectly with close to 100% accuracy.
Even if the surgeon used a spinal robot during the operation, the risk of a serious error for the patient is significant. It is a known fact that when pedicle screws are inserted in the thoracic spine, the spinal robot can give an error of up to 18%. There are also cases when the 3D navigation device, due to the accumulation of optical distortions, misled the surgeon, and he used screws of the wrong length, piercing the patient’s vertebrae through and through.
Pediguard tool is in great demand in the USA and many European countries – France, Germany, Great Britain.In 2012, Heiko Koller and his colleagues from the Bad Wildungen Clinic in Germany were the first to dare to operate the cervical spine with the Pediguard instrument. It should be said that the operation on the cervical spine is a jeweler’s work due to the thinness of the bone structures of the vertebrae of the neck, as well as the presence in the vertebrae of the canals of the main blood vessels that feed the brain. Perforation of the cortical layer of the cervical vertebrae is fraught for the patient with either severe bleeding with acute cerebral ischemia, or bilateral paralysis of the whole body.Using the Pediguard instrument, Dr. Koller and colleagues operated on 36 patients without significant complications.
It is also known that Dr. Isador Lieberman from the Spine Institute in Texas, USA, performed several dozen operations, including on the cervical spine, without complications in conditions where he did not even have an operating X-ray machine.
Doctors Isador Lieberman (2011 BECKER’S ORTHOPEDIC & SPINE REVIEW ranked among the top 100 surgeons in North America) and Kirill Ilalov, USA, use Pediguard during a humanitarian mission in Uganda, 2013.
Since the beginning of 2015, the Pediguard has been consistently used in the operating room by one of Europe’s leading spinal surgeons, Professor Jean-Charles Le Hueck from the University of Bordeaux. And this is despite the almost absolutely complete equipment of his clinic by modern standards: Professor Le Hueck is provided with an operating tomograph, a 3D navigation system and a spinal surgical robot.
Because of his active teaching career, Jean-Charles Le Hueck intends to use Pediguard to train young European surgeons in difficult cases to achieve repeatable, high-quality results faster and to give them confidence in their abilities.For the surgeon’s confidence that in a difficult clinical case he will do his job without risking the patient is worth a lot.
Recently, many advanced surgeons in Russia have begun to successfully use the Pediguard instrument in their work.
Of course, as a surgical instrument, Pediguard significantly increases the cost of treatment for the patient. However, its price is much, many tens of times lower than the costs incurred by the patient for the rehabilitation of the spinal cord injured as a result of a medical error, as well as for legal costs to obtain compensation from the hospital, whose staff evade admitting their grave mistake.
90,000 Injection blockade for back pain in Moscow at the Dikul clinic: prices, appointment
Blockades (injections) are one of the non-surgical options for the treatment of back pain. They are generally seen as an option to treat back pain after a course of conservative treatment and / or physical therapy, but before surgery. An injection of a blockade for back pain can be used as a method of relieving pain syndrome, and as a diagnostic tool to help identify the source of the patient’s back pain.
For pain relief, injections may be more effective than oral medications because they deliver the medications directly to the anatomical site that is causing the pain. Typically, steroids are injected to deliver a potent anti-inflammatory solution directly to the area that is causing the pain. Depending on the type of injection, pain relief can be both long-term and short-term.
What blockade is treated
Blockages can help with two main back problems:
Inflammation or damage to a nerve, usually in the neck or lower back.Doctors call this condition “radiculopathy.” The problem arises where the nerve root leaves the spine. In radiculopathy, acute lower back pain radiates to the legs or neck pain radiates to the arm. A herniated disc can cause radiculopathy. This condition can develop due to the fact that a herniated disc, osteophyte or tumor puts pressure on the nerve structures of the spine. In spinal stenosis, compression of the nerves in the spinal canal occurs. This usually causes pain in the buttocks or legs.And the patient may have back pain at the same time. Pain with spinal stenosis may increase with physical activity and decrease with forward bending of the trunk.
Doctors also use injections for other types of back pain. Sometimes they also use blockages for diagnostic purposes.
Localization of injection
Injections can be focused on nerve roots, facet joints, discs, or sacroiliac joint. But there is a problem with these injections for the treatment of back pain, which many doctors understand: the analysis of the information of the results of these injections can be erroneous.
Here’s why it is: How can the clinician be sure that the injection for back pain will not affect the facet joint or nerve roots if it was injected into the disc? These structures are so close to each other that it is possible that the drug will act on them as well. Moreover, even diagnostic injections are correct only in 50% of cases!
This inaccuracy becomes part of the next problem: a patient with back pain does not always recover from injections.
Types of injections for the treatment of back pain
There are different types of injections that can be performed:
- Trigger point injections – very easy to perform and precision errors minimized
- Epidural injections are injections into the area between the spinal canal and the nerve roots and bony part of the spine. These injections are primarily relevant for patients with sciatica.
- Injection into intervertebral discs
- Facet joint injection
- Nerve root injection
- Injections for piriformis syndrome
- Sacroiliac joint injection
- Intrathecal pumps
Trigger point injection
A trigger point is a tight band or knot in a muscle that is painful when touched or pressed.The trigger point also indicates pain elsewhere. The trigger point can be in the hip or pelvis and direct the pain to the back. It can also be in the back and be a source of referred pain to other parts of the back.
If the doctor uses trigger point injections, he will inject the drug directly at the trigger point. This is usually done using a local anesthetic such as lidocaine and sometimes a low dose of a steroid. The fluid is injected into the spasmodic muscle.These injections are usually not used to treat sciatica, but they are often used to treat piriformis syndrome.
After injection, the muscles must be massaged or manipulated. The purpose of this is to deliver the drug to the entire muscle.
Trigger point injections may have side effects:
- allergic reaction
- infectious disease
- nerve damage leading to muscle dysfunction
- minor bleeding
Epidural injections are injections into the spine and are often prescribed as an alternative to surgery for severe back pain, herniated discs, spinal stenosis and osteochondrosis.The injection contains steroids. However, the effectiveness of the blockade may not be sustainable and the injections may need to be repeated.
For these injections, a needle delivers the steroid either to the vertebral joints or to the area of the intervertebral foramen where the nerve root is compressed. Steroid injections carry risks of side effects, including:
- Nerve injury
- Infection in 5/1000 cases, which can lead to paraplegia
- Infection in the bone, with the development of osteomyelitis
- Infection in the meninges leading to meningitis
- The needle pierces the dura mater of the spinal cord
- Spinal cord injury or spinal cord infarction
- Cushing’s syndrome after repeated injections
It takes two days to understand if this type of back pain treatment works.
Using imaging and neurophysiology methods for back pain blockade
When injections are used, it is important to inject at the correct site. Medical science has two ways to do this:
- Using an EMG needle placed in a muscle. After being placed in the muscle, the patient contracts the muscles. The needle moves if the location is not correct. This can be painful, but if the orthopedist has sufficient experience with the procedure, there is a chance that he will select the correct location the first time.
- Use of fluoroscopy and radiopaque dyes. With this method, the injection is performed before the fluoroscope visualizes the area where the contrast has entered. But for most patients, other methods of controlling the injection are preferable, since the contrasts can be unpleasant.
- Use of MRI to assist with injection, especially in piriformis syndrome. In this method, MRI was used before and after injection to determine how accurately the injection was performed.
EMG may be more effective because it teaches the patient to isolate the muscle that is causing the problem and then relax it.
Injection for herniated disc
Disc injections should not be given if other injections have not been successful. On the discogram, contrast is injected into the disc so that the disc can be seen on x-rays or other examinations.injections>
Typically, the injection uses a local anesthetic along with a steroid and can be done with EMG or MRI guidance. It is standard practice to try physical therapy and anti-inflammatory drugs first, and use steroid injection only when other treatments have failed.
Facet joint and nerve root injection
All joints have the potential to degenerate with age, including the small joints that connect the vertebrae to each other. If a person has a back injury that causes back pain but the X-rays show nothing, then the person may have facet joint problems. Often, manual therapy relieves pain in facet joint syndrome;
- These injections require visual control using fluoroscopy or computed tomography to quickly and accurately target the desired anatomical areas.
- Injections can also target nerve roots, in which case X-ray monitoring is necessary.
- Injection in the sacroiliac joints
- When injected into these joints, imaging by computed tomography or fluoroscopy is required.
- Intrathecal pumps
These are devices that inject morphine or baclofen directly into the cerebrospinal fluid. This method is only for those who are bedridden and other treatments do not work, such as those with spinal cancer.
Injection can be very effective in relieving back pain. In fact, they are often more effective than oral medications for treating back pain. This is because injected drugs reach the focus of pain faster than drugs taken orally. It is important to note, however, that the cause of pain, its location, and a person’s pain tolerance can also affect the effectiveness of the injections. Thus, the effectiveness of injections for back pain can vary from person to person.
It is important to note that there are different types of injections for the treatment of back pain. In some cases, doctors prescribe long-term injections to treat back pain. In other cases, they may prescribe medication that only works for a short period of time. A person’s perception of the effectiveness of an injection for back pain may depend on the length of time and the level of relief the patient expects.
The type of medication is also a deciding factor in whether the injections are effective in relieving back pain.There are many types of medications, including steroids and anesthetics, that can be used to relieve back pain. Some are more effective than others for treating certain types of back pain. Often, however, medications that help reduce inflammation and relieve pain are among the most effective.
90,000 Correctable body – Ogonyok No. 20 (5326) dated 05/26/2014
Both in Russia and around the world, the number of people turning to the services of osteopaths is growing – specialists who treat exclusively with their own hands
Elena Mekshun, Ada Gorbacheva
Osteopaths take on the treatment of a wide range of diseases.Here and venous insufficiency (varicose veins), and inflammatory and degenerative-dystrophic diseases of the joints (arthritis and arthrosis), and diseases of the spine (osteochondrosis, hernia of the spine, etc.), and osteoporosis, and neurological diseases, and diseases of the urinary and respiratory systems … According to the European Osteopathic Center, 67.1 percent of patients who see osteopathic doctors suffer from diseases of the musculoskeletal system, 11.3 percent – mental disorders, in third place – patients with disorders of the nervous system.Osteopathy is especially important for children, experts say. It allows you to get rid of the consequences of birth trauma, spinal deformity (scoliosis, kyphosis, kyphoscoliosis), muscle hypertonia, sleep disorders and any other pathological and conditionally pathological conditions, from regurgitation to attention deficit hyperactivity disorder. Osteopathic doctors say: violations in the condition of the newborn, which are easy to correct the next day with a single procedure, will require several sessions in a month, and a year later – a long course of treatment, and some of them will not be able to get rid of completely.That is why, for example, in France there is an osteopathic doctor in every maternity hospital.
Experts warn: for the use of osteopathic therapy, just like in traditional medicine, there are contraindications: infectious diseases in the acute period, when the patient’s temperature rises (during the rehabilitation period, when the drug treatment is over, osteopaths can be involved), blood diseases, malignant neoplasms, any acute conditions, including strokes, heart attacks, mechanical damage (trauma).
– In these cases, osteopathy is relevant in rehabilitation. I think these are the strictest contraindications. When an osteopath is unable to provide significant assistance, his manipulations can still be used, since it may not be about treatment, but about improving the quality of life. Example: in the case of deforming arthrosis, we cannot improve the situation with morphological changes in the tissues of the joint, but we can slightly increase the range of motion and reduce pain, – explains the doctor-osteopath Alexei Vyazov.
The main working tool of a doctor in diagnostics and treatment is fingers and palms. “During normal palpation, the doctor rather sensitively presses on the organs to determine whether they are enlarged in comparison with their usual state, how painful the sensations are when palpating. The osteopath’s hands can catch the slightest pulsations of tissues, fluids, energy currents of the body,” said the head physician of the clinic “Center for Rehabilitation Therapy and Osteopathy” Ekaterina Goncharova.
Organs and tissues of a healthy person have a certain shape, density, temperature.When pathological changes begin in them, these characteristics change: organs can shift, increase, become a little denser. The hands of an osteopath are able to pick up changes that do not yet cause pain and are not recognized during a routine medical examination, experts emphasize. Treatment with an osteopath is, as a rule, a cycle of appointments with a frequency of no more than once a week, plus additional rehabilitation procedures: physiotherapy exercises according to the Pilates method, massage, homeopathy. In some cases, the help of a psychologist or body-oriented psychotherapy may be needed.A neurological examination before and after the osteopathic treatment cycle is highly recommended.
The first session is more diagnostic – the doctor talks with the patient, examines him carefully, asks to take certain positions and make certain movements, makes a feeling, puts his hands on a particular area of the body, trying to catch physiological pulsation, said Olga Yashchina, general director of the Ostmed clinic … At the first visit, it is advisable to capture all available images, test results.
Often, patients are alarmed by the fact that when visiting an osteopath with pain in one part of the body, they see that the specialist pays more attention to manipulating another part of the body during a session. “It happens that a patient treats with the consequences of a five-year-old injury – pain in the leg. You need to understand: during the injury, disturbances occurred in the body, for example, the vertebrae were displaced, neck pain appeared, but over time the body compensated for this situation by changing the position of the muscles. now your leg hurts.When treating with an osteopath, the pain goes to the place that hurt five years ago, but now does not bother you, that is, you may again have discomfort in the neck area. There is no need to be afraid of these moments – the doctor looks for the root cause of disturbances in the body and acts on it. Gradually, the pain will disappear from all parts of the body that suffered five years ago during the trauma, “explains Mrs. Yashchina.
On average, an appointment with an osteopath takes about 45-60 minutes. However, the treatment itself can take 10 minutes – depending on the specific case and the patient’s condition, the time can be adjusted by the doctor.
Within three days after osteopathic treatment, experts recommend avoiding heavy physical exertion, therapeutic massage sessions and other therapeutic effects on the body, as well as taking new medications.
“The placebo effect is great”
Leading physician of the TAO Chinese Medicine Clinic Zhang Ziqiang – about what Chinese massage is and in what cases it is most effective
– Osteopathy and Chinese massage are treatments using the hands that involve the body’s self-regulation mechanism.With regard to the choice between these two methods, a small comparative description can be made.
Osteopathy is a higher quality and multifaceted stage in the development of manual medicine. Osteopathy quite successfully copes with various problems of the musculoskeletal system.
As for the Chinese massage, it is fundamentally different in its approach. Chinese massage consists of a mechanical effect on biologically active points located on the surface of the skin, it eliminates muscle tension, harmonizing all processes.And the thousand-year experience of studying the human body and ways of influencing the processes occurring in it, makes Chinese massage effective not only for the treatment of diseases of the musculoskeletal system, but also for the treatment of most existing diseases.
However, each of the medical systems has its own strengths and weaknesses. For example, Western medicine is indispensable in the provision of emergency medical care or complex surgical operations, and traditional Chinese medicine is famous for having no side effects and giving excellent results in the rehabilitation and restoration of impaired body functions.The combination of different medical systems makes it possible to more accurately determine the etiology of the disease, the cause and nature of local pathological changes, to timely track the changes occurring in the body during treatment. In China, for example, the integration into a single system of two practices – Western and traditional Chinese medicine – has made it possible to achieve great success in the treatment of many diseases that they could not cope with before. The development of this area is supported by the Chinese state health care system.
Moreover, the results are always higher if the patient believes in the success of the treatment. The placebo effect is certainly great, because psychosomatics is the cause of many diseases. Long-term depression, anger, fear, resentment lead to a variety of diseases. That is, in addition to the course of treatment, it is important for the doctor to assess the mental state of the patient and try to minimize the negative impact of the depressed psyche on the course of treatment, to bring the person to spiritual harmony. Indeed, just as negative emotions can cause a disease, positive emotions and spiritual harmony can heal it.
Recorded Oleg Trubetskoy
Hand to hand
– Osteopathy differs from other methods of medicine in that in this case the experience of a specialist is passed from hand to hand, it is accumulated over the years. For example, a doctor is considered to have mastered a certain technique only if he has repeated it a thousand times! Since Russian osteopathy is young – it is about 20 years old, and abroad this direction has existed and developed for about 150 years, it can be argued that foreign colleagues have experience, and therefore the level of professionalism is higher, – explained the general director of the clinic.
Compared with classical medicine, the effect of treatment with osteopathy depends more on the doctor. “Despite the difference in the qualifications and experience of medical workers, all traditional hospitals use the same medicines, the same medical instruments. In an osteopathic clinic, the doctor’s hands are the“ pill ”. and the doctor’s skills. Accordingly, the outcome of the treatment depends only on the professionalism of the specialist, “says Mr. Vyazov.
The problem is that there is no evidence base and reliable statistics on the results of osteopathic treatment. No randomized, double-blind studies have been conducted. Isolated cases of healing and rave reviews on the Internet cannot serve as evidence. And yet, all over the world, osteopaths are seen as regularly as they are to a dentist.
Annually about 300 thousand Russians resort to osteopathic care. Moreover, as noted by a number of experts, more and more often doctors themselves refer their patients to osteopaths.For prevention.
When visiting an osteopath for the first time, it is recommended to find your doctors according to the registries of osteopathic doctors. “Unfortunately, charlatans, dropouts, self-proclaimed professors and similar“ osteopracts ”felt the fashionable trend in the development of effective medicine and also proclaimed themselves“ osteopaths. ”But a good osteopath will never accept cheaply on the road, in basement offices and in beauty salons. Look at the clinic, check the licenses and diplomas of doctors “, – recommends Ekaterina Goncharova.
An osteopath must necessarily have a higher medical education and complete 4-5 years of training (not one or two seminars!) As an osteopath. “It is desirable to have an international diploma of the level of D.O. E. Diplome d’Osteopathe Europe,” says the Center for Rehabilitation Therapy and Osteopathy.
For specialists trained in osteopathy before 2014, the Ministry of Health of the Russian Federation approved a professional retraining program for obtaining a diploma of an osteopathic doctor, which will be in effect until 2016.In the future, the training of osteopathic doctors with the possibility of obtaining a diploma will take place within the framework of the residency program. And only doctors who have received a diploma in educational institutions licensed to teach osteopathy will be able to provide osteopathic care to patients in Russia. The Russian Ministry of Health also said that a professional standard of care in the direction of “Osteopathy” is being developed.
“It is important to hear the person”
Lina Ledikhova, leading orthodontist at the Scientific and Clinical Center for Maxillofacial Surgery and Dentistry Sanabilis, on honesty in relations with the patient
– I am sure that you cannot persuade patients to align their teeth, since orthodontic treatment is a long and laborious process.A person must want it himself, otherwise, treatment fatigue quickly sets in. Such patients always ask me only one question: “Doctor, when will you remove the braces?” A beautiful smile does not bother them so much. It is also very important to rationally approach treatment planning – to find a compromise between what the doctor wants and what the patient wants to get in the end.