Lumbar spondylotic changes. Lumbar Spondylolisthesis: Causes, Symptoms, and Treatment Options
What is lumbar spondylolisthesis. How does it affect the spine. What are the main types of spondylolisthesis. What symptoms can spondylolisthesis cause. How is spondylolisthesis diagnosed and treated.
Understanding Lumbar Spondylolisthesis: A Comprehensive Overview
Lumbar spondylolisthesis is a spinal condition characterized by the forward slippage of one vertebra over another in the lower back region. This misalignment can lead to various symptoms and complications, affecting an individual’s quality of life. To fully grasp the nature of this condition, it’s essential to explore its causes, types, symptoms, and potential treatment options.
What is Spondylolisthesis?
Spondylolisthesis occurs when a vertebra in the spine slips forward and out of its proper position. While this can happen anywhere along the spine, it is most commonly observed in the lumbar (lower back) region. The severity of the condition can vary, with some individuals experiencing no symptoms at all, while others may suffer from mild to severe back and leg pain.
The Anatomy of the Spine
To better understand spondylolisthesis, it’s crucial to have a basic knowledge of spine anatomy. The spine consists of small bones called vertebrae, stacked on top of one another to create the natural curves of the back. These vertebrae connect to form a canal that protects the spinal cord. Between each vertebra are flexible intervertebral disks, which act as shock absorbers during movement.
Types of Spondylolisthesis: Degenerative and Spondylolytic
There are several types of spondylolisthesis, but the two most common forms in adults are degenerative and spondylolytic (also known as isthmic) spondylolisthesis.
Degenerative Spondylolisthesis
Degenerative spondylolisthesis is primarily associated with the natural aging process. As we grow older, the spine undergoes various changes due to wear and tear. The intervertebral disks lose height, become stiffer, and begin to dry out, weaken, and bulge. This process can lead to instability in the spine, potentially resulting in a vertebra slipping forward.
- More common in women than men
- Typically affects individuals over the age of 50
- Higher incidence noted in the African American population
As the condition progresses, the ligaments along the back of the spine may begin to buckle, leading to nerve compression. In severe cases, the slippage can cause narrowing of the spinal canal, a condition known as spinal stenosis.
Spondylolytic Spondylolisthesis (Isthmic Spondylolisthesis)
Spondylolytic spondylolisthesis is characterized by a stress fracture in the vertebra, typically occurring in an area of the lower spine called the pars interarticularis. This type of spondylolisthesis is also referred to as isthmic spondylolisthesis.
- Often develops during adolescence but may go unnoticed until adulthood
- Affects approximately 4% to 6% of the U.S. population
- Symptoms often arise in middle age
In isthmic spondylolisthesis, only the front part of the vertebra slips forward due to the fracture. While this type of spondylolisthesis is less likely to cause spinal canal narrowing initially, spinal stenosis can develop as patients age, similar to degenerative spondylolisthesis.
Symptoms of Spondylolisthesis: Recognizing the Signs
The symptoms of spondylolisthesis can vary depending on the type and severity of the condition. Understanding these symptoms is crucial for early detection and appropriate treatment.
Degenerative Spondylolisthesis Symptoms
Patients with degenerative spondylolisthesis often experience:
- Leg pain and/or lower back pain
- A feeling of diffuse weakness, particularly when standing or walking for prolonged periods
- Numbness, tingling, and/or pain that is affected by posture
- Relief of symptoms when sitting or bending forward
- Worsening of symptoms when standing or walking
Isthmic Spondylolisthesis Symptoms
Individuals with isthmic spondylolisthesis may experience:
- Low back pain, often perceived as activity-related
- Leg pain, which may accompany the back pain
- In elderly patients, symptoms of spinal stenosis may also be present
Diagnosis and Imaging Techniques for Spondylolisthesis
Accurate diagnosis of spondylolisthesis is essential for developing an effective treatment plan. Healthcare providers typically use a combination of physical examinations and imaging techniques to diagnose the condition.
Physical Examination
During a physical examination, a doctor may assess the patient’s range of motion, check for areas of tenderness, and perform neurological tests to evaluate muscle strength and reflexes.
Imaging Studies
Various imaging techniques can be used to confirm the diagnosis of spondylolisthesis and assess its severity:
- X-rays: Provide a clear view of the bone structures and can show the extent of vertebral slippage
- MRI (Magnetic Resonance Imaging): Offers detailed images of soft tissues, including nerves and intervertebral disks
- CT (Computed Tomography) scans: Provide cross-sectional images of the spine, helpful in identifying fractures
Treatment Options for Spondylolisthesis: From Conservative to Surgical Approaches
The treatment of spondylolisthesis depends on the severity of the condition, the presence of neurological symptoms, and the patient’s overall health. Treatment options range from conservative measures to surgical interventions.
Conservative Treatment
For many patients, especially those with mild to moderate spondylolisthesis, conservative treatments can effectively manage symptoms:
- Physical therapy: Strengthening exercises for the core and back muscles
- Pain management: Over-the-counter or prescription pain medications
- Activity modification: Avoiding activities that exacerbate symptoms
- Bracing: In some cases, a back brace may be recommended to provide support
Surgical Intervention
Surgery may be considered for patients with severe symptoms or when conservative treatments fail to provide relief. Surgical options include:
- Decompression: Removal of bone or soft tissue to relieve pressure on nerves
- Spinal fusion: Joining two or more vertebrae to stabilize the spine
- Minimally invasive techniques: Less invasive procedures that may offer faster recovery times
Living with Spondylolisthesis: Lifestyle Modifications and Long-term Management
Managing spondylolisthesis often requires a multifaceted approach that extends beyond medical treatments. Implementing lifestyle modifications and adopting strategies for long-term management can significantly improve quality of life for individuals with this condition.
Exercise and Physical Activity
Regular exercise can play a crucial role in managing spondylolisthesis symptoms and maintaining overall spine health. However, it’s essential to engage in appropriate activities that don’t exacerbate the condition.
- Low-impact exercises: Swimming, cycling, and walking can help maintain fitness without putting excessive strain on the spine
- Core strengthening: Exercises that target the abdominal and back muscles can provide better support for the spine
- Flexibility training: Gentle stretching can help improve range of motion and reduce stiffness
Ergonomics and Posture
Maintaining good posture and ergonomics can help reduce stress on the spine and alleviate symptoms:
- Workplace modifications: Ergonomic chairs, standing desks, and proper computer setup can reduce strain during work hours
- Sleeping position: Using supportive pillows and mattresses can help maintain proper spinal alignment during sleep
- Lifting techniques: Learning and practicing proper lifting techniques can prevent further injury
Preventive Measures and Risk Factors for Spondylolisthesis
While some forms of spondylolisthesis, such as those caused by congenital factors, cannot be prevented, there are steps individuals can take to reduce their risk or slow the progression of the condition.
Maintaining a Healthy Weight
Excess body weight can put additional stress on the spine, potentially exacerbating spondylolisthesis symptoms. Maintaining a healthy weight through proper diet and exercise can help reduce this stress and improve overall spine health.
Avoiding High-Impact Activities
Certain high-impact activities or sports may increase the risk of developing or worsening spondylolisthesis, particularly in individuals with a predisposition to the condition. These may include:
- Gymnastics
- Football
- Weightlifting (especially with improper form)
Regular Check-ups and Early Intervention
Regular medical check-ups can help identify early signs of spondylolisthesis or related spinal conditions. Early intervention can often lead to more effective management and better long-term outcomes.
Future Directions in Spondylolisthesis Research and Treatment
As medical science continues to advance, new approaches to diagnosing, treating, and managing spondylolisthesis are emerging. These developments offer hope for improved outcomes and quality of life for individuals affected by this condition.
Advanced Imaging Techniques
Researchers are exploring new imaging technologies that could provide more detailed and accurate visualizations of the spine, potentially leading to earlier diagnosis and more precise treatment planning.
Regenerative Medicine
Stem cell therapy and other regenerative medicine approaches are being investigated for their potential to repair damaged spinal tissues and promote healing in cases of spondylolisthesis.
Minimally Invasive Surgical Techniques
Continued advancements in minimally invasive surgical procedures may offer patients less invasive treatment options with shorter recovery times and reduced risk of complications.
Understanding lumbar spondylolisthesis, its causes, symptoms, and treatment options is crucial for individuals affected by this condition and healthcare providers alike. By staying informed about the latest developments in diagnosis and treatment, patients can work with their healthcare team to develop comprehensive management strategies tailored to their specific needs. As research progresses, the future holds promise for even more effective approaches to managing this complex spinal condition.
Adult Spondylolisthesis in the Low Back – OrthoInfo
In spondylolisthesis, one of the bones in your spine — called a vertebra — slips forward and out of place. This may occur anywhere along the spine, but is most common in the lower back (lumbar spine). In some people, this causes no symptoms at all. Others may have back and leg pain that ranges from mild to severe.
Understanding how your spine works can help you better understand spondylolisthesis. Learn more about spine anatomy at Spine Basics.
The spine is made up of small bones, called vertebrae, which are stacked on top of one another and create the natural curves of the back. These bones connect to create a canal that protects the spinal cord.
Between your vertebrae are flexible intervertebral disks. They act as shock absorbers when you walk or run.
Spondlylolisthesis occurs when one of the vertebrae in the spine slips forward and out of place. This creates instability in the spine, can cause pain, and can also accelerate the formation of bone spurs (outrowths)/arthritis.
There are several causes/types of spondylolisthesis. The two most common types in adults are degenerative and spondylotic/congenital.
Degenerative Spondylolisthesis
As we age, general wear and tear causes changes in the spine. As we age, the intervertebral disks in the spine lose height, become stiff, and begin to dry out, weaken, and bulge. As these disks lose height, the ligaments and joints that hold our vertebrae in proper position begin to weaken. In some people, this can create instability and ultimately result in degenerative spondylolisthesis.
As the spine continues to degenerate, the ligaments along the back of the spine may begin to buckle, resulting in nerve compression.
As the slippage in the spine worsens, the spinal canal can also become narrowed. Ultimately, this narrowing and buckling lead to compression of the spinal cord (spinal stenosis). Spinal stenosis is a common problem in patients with degenerative spondylolisthesis.
Women are more likely than men to have degenerative spondylolisthesis, and it is more common in patients over the age of 50. A higher incidence has been noted in the African American population.
Degenerative spondylolisthesis
In this X-ray taken from the side, vertebrae in the low back have slipped out of place due to degenerative spondylolisthesis.
Spondylolytic Spondylolisthesis (Isthmic Spondylolisthesis)
Another common cause of spondylolisthesis is a crack (stress fracture) in the vertebra. The fracture typically occurs in an area of the lower (lumbar) spine called the pars interarticularis. This type of spondylolisthesis is called isthmic spondylolisthesis.
In most cases of spondylolytic spondylolisthesis, the pars fracture (also called spondylolysis) occurs during adolescence and goes unnoticed until adulthood. The normal disk degeneration that occurs in adulthood can then stress the pars fracture and cause the vertebra to slip forward.
The stress fracture does not always cause the slip to occur, and very rarely does the slip progress significantly ad get worse over time. Symptoms of isthmic spondylolisthesis often arise in middle age.
Because a pars fracture causes the front (vertebra) and back (lamina) parts of the spinal bone to disconnect, only the front part slips forward. This means that narrowing of the spinal canal is less likely than in other kinds of spondylolisthesis, such as DS in which the entire spinal bone slips forward. However, as patients with isthmic spondylolisthesis age, spinal stenosis can occur just as in degenerative spondlylolisthesis, causing bone spurs to narrow the spinal canal and result in nerve compression.
About 4% to 6% of the U.S. population has spondylolysis and spondylolisthesis.
(Left) In spondylolysis, a fracture often occurs at the pars interarticularis. (Right) Because of the pars fracture, only the front part of the bone slips forward.
This X-ray taken from the side shows a pars fracture (arrow) and the resulting spondylolisthesis.
Degenerative Spondylolisthesis
Patients with degenerative spondylolisthesis will often develop leg and/or lower back pain when slippage of the vertebrae begins to put pressure on the spinal nerves. The most common symptoms in the legs include a feeling of diffuse weakness associated with prolonged standing or walking.
Leg symptoms may be accompanied by numbness, tingling, and/or pain that is often affected by posture. Forward bending or sitting often relieves the symptoms because it opens up space in the spinal canal. Standing or walking often increases symptoms.
Isthmic Spondylolisthesis
Most patients with isthmic spondylolisthesis have low back pain, which they believe is activity-related. The back pain is sometimes accompanied by leg pain. In elderly patients, isthmic spondylolisthesis can also be accompanied by symptoms of spinal stenosis.
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Doctors use the same tools to diagnose both degenerative spondylolisthesis and isthmic spondylolisthesis.
Medical History and Physical Examination
After discussing your symptoms and medical history, your doctor will examine your back. This will include looking at your back and push on different areas to see if it hurts. Your doctor may have you bend forward, backward, and side-to-side to see if you have limitations of movement or pain.
Imaging Tests
Your doctor may order imaging tests to help confirm your diagnosis. These include:
X-rays. X-rays visualize bones and will show whether a lumbar vertebra has slipped forward. They will also show changes that occur with aging, such as loss of disk height or bone spurs.
Flexion-etension X-rays — taken while you lean forward and backward — can show instability or too much movement in your spine.
Magnetic resonance imaging (MRI).
MRI scans create better images than X-rays of soft tissues, such as muscles, disks, nerves, and the spinal cord. They can show the slippage in more detail and whether any of the nerves are pinched.
Computed tomography (CT). CT scans create cross-section images of your spine. While CT is better than MRI for imaging bony details, MRI is superior at imaging nerves.
If you are unable to have an MRI scan because of an associated medical condition, your doctor may order a CT myelogram. In this test, a radiologist will inject dye into your spinal canal. Then, before taking the CT scan, they may have you lie on a table that moves around so the dye can spread inside the spinal canal.
Nonsurgical Treatment
Although nonsurgical treatments will not repair the vertebral slippage, many patients report that these methods help relieve symptoms.
Physical therapy and exercise. Specific exercises can strengthen and stretch your lower back and abdominal muscles.
Medication. Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen, may relieve pain.
Steroid injections. Cortisone is a powerful anti-inflammatory. Cortisone injected around the nerves or in the outermost part of the spinal canal (epidural space) can decrease swelling, as well as pain. Cortisone injections are likely to decrease pain and numbness, but not weakness of the legs. Patients should not receive cortisone injections more than three times per year.
Surgical Treatment
Degenerative Spondylolisthesis. If you have degenerative spondylolisthesis and your symptoms have not improved after 3 to 6 months of nonsurgical treatment, your doctor may recommend surgery, particularly if you are unable to walk or stand and the pain and weakness negatively affect your quality of life. Your doctor will also take into account tht extent of arthritis in your spine and whether your spine has excessive movement.
Surgery for degenerative spondylolisthesis has two goals: 1) relieve the nerve compression and 2) prevent instability. In most cases, relieving the nerve compression is more important. This is typically achieved with laminectomy — a procedure during which your doctor removes the bone spurs and thickened ligaments causing the compression. Sometimes, your surgeon may be able to indirectly decompress your spine using other surgical methods.
If your doctor believes your spine is stable enough, you may not need to have it stabilized with a spinal fusion.
Isthmic Spondylolisthesis. If you have isthmic spondylolisthesis and your symptoms have not improved after 6 to 12 months of nonsurgical treatment, you may be a candidate for surgery. Other indications for surgery include progressive neurologic symptoms, such as weakness, numbness, or falling, and/or symptoms of damage to the nerves below the end of the spinal cord (cauda equina syndrome).
Stabilization of the spine is the main goal of surgery for isthmic spodylolisthesis.
This is achieved by spinal fusion, a welding process that typically uses screws and rods to fuse togehter two or more vertebrae into a single, solid bone. If you also have nerve compression, your doctor may elect to decompress the spine through a laminectomy.
In spinal fusion, screws and rods are often used to help stabilize the spine.
Recovery from a laminectomy without fusion may take only 1 to 2 months because the bones do not have to fuse.
The fusion process takes time. It may be several months before the bone is solid, although your comfort level will often improve quickly.
For more information about spinal fusion and recovery: Spinal Fusion
Nonsurgical treatment is successful in most degenerative spondylolisthesis and isthmic spondylolisthesis patients. When surgery is indicated, successful clinical outcomes have been reported in more thn 85% of patients. In addition, results from the largest clinical trial on spine patient outcomes revealed that patients who were treated surgically maintained substantially greater pain relief and improvement of function than patients who were treated nonsurgically.
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Spondylolisthesis – NHS
Spondylolisthesis is where one of the bones in your spine, called a vertebra, slips forward. It can be painful, but there are treatments that can help.
It may happen anywhere along the spine, but is most common in the lower back.
Check if you have spondylolisthesis
The main symptoms of spondylolisthesis include:
- pain in your lower back, often worse when standing or walking and relieved when sitting or bending forward
- pain spreading to your bottom or thighs
- tight hamstrings (the muscles in the back of your thighs)
- pain, numbness or tingling spreading from your lower back down 1 leg (sciatica)
Spondylolisthesis does not always cause symptoms.
Information:
Spondylolisthesis is not the same as a slipped disc. This is when the tissue between the bones in your spine pushes out.
Non-urgent advice: See a GP if:
- you have lower back pain that does not go away after 3 to 4 weeks
- you have pain in your thighs or bottom that does not go away after 3 to 4 weeks
- you’re finding it difficult to walk or stand up straight
- you’re worried about the pain or you’re struggling to cope
- you have pain, numbness and tingling down 1 leg for more than 3 or 4 weeks
What happens at your GP appointment
If you have symptoms of spondylolisthesis, the GP may examine your back.
They may also ask you to lie down and raise 1 leg straight up in the air. This is painful if you have tight hamstrings or sciatica caused by spondylolisthesis.
The GP may arrange an X-ray to see if a bone in your spine has slipped forward.
You may have other scans, such as an MRI scan, if you have pain, numbness or weakness in your legs.
Treatments for spondylolisthesis
Treatments for spondylolisthesis depend on the symptoms you have and how severe they are.
Common treatments include:
- avoiding activities that make symptoms worse, such as bending, lifting, athletics and gymnastics
- taking anti-inflammatory painkillers such as ibuprofen or stronger painkillers on prescription
- steroid injections in your back to relieve pain, numbness and tingling in your leg
- physiotherapy to strengthen and stretch the muscles in your lower back, tummy and legs
The GP may refer you to a physiotherapist, or you can refer yourself in some areas.
Waiting times for physiotherapy on the NHS can be long. You can also get it privately.
Surgery for spondylolisthesis
The GP may refer you to a specialist for back surgery if other treatments do not work.
Types of surgery include:
- spinal fusion – the slipped bone (vertebra) is joined to the bone below with metal rods, screws and a bone graft
- lumbar decompression – a procedure to relieve pressure on the compressed spinal nerves
The operation is done under general anaesthetic, which means you will not be awake.
Recovery from surgery can take several weeks, but if often improves many of the symptoms of spondylolisthesis.
Talk to your surgeon about the risks and benefits of spinal surgery.
Causes of spondylolisthesis
Spondylolisthesis can:
- happen as you get older – the bones of the spine can weaken with age
- run in families
- be caused by a tiny crack in a bone (stress fracture) – this is more common in athletes and gymnasts
Page last reviewed: 01 June 2022
Next review due: 01 June 2025
Hernia of the cervical spine: symptoms and treatment
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We have been successfully treating intervertebral disc herniations of the cervical spine without surgery since 2013
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Our method of modulated resorption has successfully proven itself and has already helped thousands of patients
The goal of our treatment is to act on the cause of pain
We use a complex of modern physiotherapy procedures and drug treatment
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Neck pain is the fourth leading cause of temporary disability, with an annual incidence of over 30%. One of the causes of this pain syndrome is protrusions or hernias of the cervical discs.
The intervertebral disc is a cartilaginous structure made up of three components: the inner nucleus pulposus, the outer annulus fibrosus, and the endplates that attach the discs to adjacent vertebrae.
Intervertebral hernia (herniated disc) is a displacement of the central part of the intervertebral disc – the nucleus pulposus with a rupture of its outer part – the fibrous ring. A hernia can develop at any level of the spine, in the case of a protrusion in the cervical region, it is located at the level of 1-7 cervical vertebrae.
- Neck pain is the fourth leading cause of temporary disability, with an annual incidence of over 30%. One of the causes of this pain syndrome is protrusions or hernias of the cervical discs.
The intervertebral disc is a cartilaginous structure made up of three components: the inner nucleus pulposus, the outer annulus fibrosus, and the endplates that attach the discs to adjacent vertebrae.
Intervertebral hernia (herniated disc) is a displacement of the central part of the intervertebral disc – the nucleus pulposus with a rupture of its outer part – the fibrous ring. A hernia can develop at any level of the spine, in the case of a protrusion in the cervical region, it is located at the level of 1-7 cervical vertebrae.
Fig.1 Herniation of the intervertebral disc
Depending on the direction of the protrusion of the hernia, there are: 37 lateral: anterior and posterolateral. Posterior and posterolateral hernial protrusions are considered the most dangerous, as they can penetrate directly into the spinal canal and affect the spinal cord. According to the degree and nature of disc damage, hernias are divided into:
- Small (1-5 mm) – only the inner fibers of the annulus are damaged.
- Medium (6-8 mm) – with a rupture of the fibrous ring, but preserved longitudinal ligament and partial penetration of the hernia into the canal of the spinal cord.
- Large (9-12 mm) – with a rupture of the longitudinal ligament of the spine.
- Hernias >12 mm are the most severe form, usually with sequestration.
It is possible to develop the pathology of adjacent intervertebral hernias, which is accompanied by the formation of a symptomatic hernia of large sizes at one level and protrusion in the adjacent spinal motion segment – a complex of 2 adjacent vertebrae and their musculo-ligamentous apparatus at this level, and 1 disc between these calls.
Do not delay treatment. Make an appointment with a neurologist at the Temed Clinic by phone: 8 (958) 400-43-25
Causes
The etiology of herniated intervertebral discs of the cervical spine is multifactorial.
Risk factors include:
Male
Current smoking
Heavy lifting
Frequent board diving
Occupation
For example, it has been proven that the incidence of cervical hernia is higher in military pilots, professional drivers and those who work with vibration equipment.
The prevalence of this disease increases with age in both men and women, and is most common in people in their third to fifth decades of life. More often detected in women, accounting for more than 60% of cases. For both sexes, the most commonly diagnosed patients were in the 51 to 60 age group.
The symptoms of a cervical herniated disc develop due to a combination of mechanical compression of the nerve by the hernial bulge and an increase in inflammatory substances at the site of herniation.
This article is advisory in nature. Treatment is prescribed by a specialist after consultation.
Symptoms
Cervical hernias are quite rare (about 4%), but if they form, the manifestations can be quite diverse.
Herniated disc formation can be acute or more chronic. Chronic herniated discs occur when the disc degenerates and dries out during the natural aging process, usually resulting in subtle or gradual symptoms that are usually less severe.
May be present:
1
pain in the neck, sometimes extending to the shoulder and arm
fluctuations in blood pressure
3
dizziness
4
drowsiness and weakness
5
sleep disorders
6
numbness and poop fingering
7
weakness of one of the upper limbs
Acute hernias usually lead to sudden onset of more severe symptoms than chronic hernias . At the same time, acute hernias are more susceptible to resorption if treatment is started on time, choosing the right technique.
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Pain in the presence of a hernia in the cervical region almost always radiates (spreads) to one or both upper limbs.
Since most pathological disc protrusion occurs at the level of the 7th and 6th vertebrae, radicular symptoms usually extend to the middle or first 2 fingers – for example, to the thumb and forefinger, respectively.
So-called “red flags” may also appear with neck pain, which may be signs of systemic inflammatory conditions, malignancy, or infection – these include:
- fever and chills
- night sweats
- unexplained weight loss
- inflammatory arthritis
- past tumors, systemic infections, tuberculosis or HIV immunity)
- persistent pain syndrome
- point pain over the body vertebra
- enlargement/pain of cervical lymph nodes
Typical signs of damage to individual nerves due to compression of a herniated disc in the cervical spine:
C2
eye or ear pain, headache
C3 and C4
trapezius muscle soreness and muscle spasms
C5
- neck pain , shoulder and shoulder blade;
- tingling, burning, crawling on the side of the arm;
- impossibility of shoulder abduction and elbow flexion;
- weakness on shoulder flexion, external rotation and supination of the forearm
C6
- pain in the neck, shoulder and shoulder blade; tingling, “crawling” along the lateral surface of the forearm, hand and two fingers;
- inability to flex the elbow and extend the wrist;
- weakness on shoulder abduction, external rotation, supination and pronation of the forearm
C7
- neck and shoulder pain;
- tingling, burning, crawling sensations on the back of the forearm and third finger;
- limited elbow extension and wrist flexion
C8
- neck and shoulder pain;
- tingling, burning, crawling on the inside of the forearm, hand and two fingers;
- weakness in finger flexion, hand grip and thumb extension
Diagnosis
The following information is important in the diagnosis of a herniated disc:
9005 3
g. 90% pain in the neck versus 10% pain in the upper limb)In the course of diagnosis it is important to evaluate:
- the patient’s range of motion as it may indicate the severity of pain and degeneration of the hernia
- neurological status – assessment of sensory disorders, motor weakness and tendon reflex disorders.
- detection of any signs of spinal cord dysfunction.
Make an appointment with a neurologist
Appointment lasts 60 minutes, includes diagnostics, analysis of your MRI and preparation of a treatment plan, takes place both in person and online.
Hernia Imaging Methods:
1
X-ray
This is an affordable test that is usually performed as the first step.
Anterior, lateral, and oblique scans help assess the overall position of the spine and any spondylotic changes.2
Computed tomography (CT)
The method is most sensitive when examining the bone structures of the spine. It may also show a calcified herniated disc or any process of bone destruction.
3
Magnetic resonance imaging (MRI)
P preferred imaging modality and most sensitive investigation of herniated disc because it has the most significant ability to demonstrate soft tissue and nerve structures.
4
Electrodiagnostic testing (electromyography and nerve conduction studies)
May be an option in patients who have ambiguous symptoms or imaging and to rule out nerve injury.
5
Contrast discography
Method of obtaining an image after the introduction of a special contrast agent into the area of the intervertebral disc, which allows assessing the structure of the cartilage layer and adjacent vertebrae
Anterior, lateral, and oblique scans help assess the overall position of the spine and any spondylotic changes. Temed Clinic recognizes MRI examination as the gold standard for diagnosing changes intervertebral discs.
Therefore, patients are admitted only in the presence of a recent MRI (the study was not more than 3 months old).
You can choose for yourself any center where such studies are carried out. It is important for us to see the result – a snapshot on an electronic medium.
MRI recommendation: 1.5 (or 3) Tesla, 3 mm slice. You can also contact the Temed Clinic call center to make an appointment with our recommended MRI center by phone: 8 (958) 405-53-27
Treatment of cervical disc herniation
include:
- decompression of the spine: special exercises and traction
- formation of the muscular corset, especially the back muscles to reduce the compression load on the spinal column
- symptomatic treatment:
- pain relief in the acute period
- massage to improve blood circulation 9004 5
- stretching of spasmodic muscle groups.
At the Temed Clinic, we do not use these common methods of treating herniated discs, but have developed a new approach, the effectiveness of which is confirmed by many years of practice and thousands of successful treatment results recorded on before/after MRI images.
Our approach to non-surgical treatment of intervertebral disc herniation is based on four simple principles:
- rational rest, justified medical treatment,
- completion of the complex with a rehabilitation program.
Methods of conservative treatment
On average, the effectiveness of various methods of non-surgical treatment of intervertebral hernia of the cervical region, according to various estimates, is 70-90%. In most cases, it is possible to achieve significant improvement, especially with the timely initiation of therapy, and even large hernial protrusions can be treated.
Fig.2 Resorption of intervertebral disc herniation in the cervical region. It took 1 course to achieve the result.
In general practice, the following methods are used to treat cervical hernia:
Collar immobilization
Traction
Pharmacotherapy disk.
In clinical practice, such groups of drugs are used as:- non-steroidal anti-inflammatory drugs (NSAIDs)
- glucocorticosteroid hormones (for severe acute pain for a short period of time)
- muscle relaxants – for severe muscle spasms in a short course
- antidepressants and anticonvulsants – to relieve neuropathic pain.
Physiotherapy
It is prescribed after a short period of complete rest and immobilization, provided that the spinal cord is not involved.
Physical rehabilitation
Methods include:
- motor exercises and therapeutic exercises;
- cervicothoracic stabilization programs combined with aerobic training;
- application of ice, heat, ultrasound and electrostimulation therapy.
Cervical spine stabilization reduces pain, maximizes joint and muscle function and prevents further injury.
Stabilization exercises are aimed at:
- improving the flexibility of the cervical spine
- training the correct posture
- strengthening the pectoral muscles.
Spinal corticosteroid injections
A common alternative to surgery.
Spinal manipulation therapy (chiropractic)
May also be used to restore normal range of motion and reduce pain.
In clinical practice, such groups of drugs are used as:
At the Temed Clinic we do not support many of these methods. Our herniated disc treatment is based on the body’s natural physiological ability to heal and reduce disc herniation.
For more information about the method used in our clinic, read the section
Treatment of the spine
Surgical treatment of hernia
Hernia thorax of the cervical spine, the symptoms of which are not amenable to conservative treatment, as a rule, are subject to surgical correction . The main goal of surgery is to relieve pain by relieving nerve root compression.
Indications for surgery are severe or progressive neurological symptoms and significant pain.
Depending on the characteristics of a particular hernia, different surgical techniques are used:
- Anterior cervical discectomy is the gold standard of surgical treatment, as it removes the protrusion and prevents recurrent compression of the nerve roots and spinal cord.
- Posterior laminophoraminotomy – may be considered in patients with anterolateral hernias.
- Total disc replacement is a new treatment that remains controversial.
Out of 100 patients who were previously recommended surgery and who came to us for treatment, only 6 surgery was actually required
6%
Find out more about the treatment from the patients themselves!
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Rehabilitation
Rehabilitation measures are required after both surgical and conservative treatment.
In addition to the attending physician, a physical therapist, physiotherapist, neurologist and other specialists are involved in the recovery of the patient. The central place in rehabilitation is the restoration of lost functions and getting rid of the pain syndrome.
Read more about the course of physical therapy at the Temed Clinic in section
Herniated disc prevention includes: cervicothoracic spine
- severe axial (at the level of the 2nd cervical vertebra) or radicular pain
- myelopathy (spinal cord injury) with concomitant weakness, increased reflexes and neurogenic bowel/bladder dysfunction
- radiculopathy with weakness and numbness of the upper extremities.
List of sources:
- A.A. Spontaneous resorption of herniated intervertebral discs. Bulletin of Traumatology and Orthopedics. N.N. Priorov. 2016;3:81–89. [Kuleshov A.A., Krupatkin A.I., Murav’yova N.V. Spontaneous Resorption of Intervertebral Disc Herniations. Vestnik travmatologii i orthopedii im. N.N. Priorova. 2016; 3:81–89(in Russ.)].
- Tkachev A.M., Akarachkova E.S., Smirnova A.V. Spontaneous regression of herniated intervertebral discs in the lumbar spine during gabapentin therapy. Pharmateka. 2017;19:20–24. [Tkachev A.M., Akarachkova E.S., Smirnova A.V. et al. Spontaneous regression of lumbar disc herniations against the background of therapy with gabapentin. Farmateka. 2017; 19:20–24 (in Russ.)].
- Parfenov V.A., Isaikin A.I. Pain in the lower back: myths and reality. – M.: IMA-Press, 2016. – 104 p.
- European guidelines for the management of acute nonspecific low back pain in primary care Eur Spine J (2006) 15 (Suppl.
