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Schmorl's hernia: types, treatment and drugs, prognosis

There are such categories of people who are completely unaware of medical terminology. So, in the clinic, a randomly heard phrase prompted the writing of this article. The phrase sounded like this: “they found Schmorlu in my spine on X-ray”.

The unfortunate patient did not know that this education - a special hernia is named after Hans Christian Schmorl. In the interval between the First and Second World War, this German pathologist wrote the book Healthy and Sick Spine, in which he first described these formations.

Content

Schmorl's hernia - what is it?

Schmorl's hernia

Schmorl's hernia - photo and scheme

Of course, since Schmorl was a pathologist, he could see from his own experience, looking through the medical records of deceased patients, that these interesting formations of intervertebral discs were an accidental finding: patients did not complain of pain or any symptoms, but died of completely different diseases.

In Germany, X-ray examination was already widespread, and subsequently these hernias were diagnosed in vivo, as a curious X-ray phenomenon. They are also called cartilaginous nodules.

In the first decades it was believed that these hernias are completely harmless, but then it was discovered that this is not quite so: under certain conditions they can bring substantial harm. But first things first.

The modern definition is: "Schmorl's hernia is a vertical defect of the intervertebral disc, consisting in the penetration of its part into the spongy substance of the body's bone above - or the underlying vertebra."

What is their difference from ordinary hernia?

Types of Schmorl's hernias

The difference between Schmorl's hernia and ordinary intervertebral hernia is as follows: ordinary hernia and protrusion, whatever clinical picture would accompany their appearance, are located in a horizontal plane.

They can be located "at different hours", when viewed from above, and squeeze various structures, from the nerve roots to the central canal, to cause spinal cord compression with the onset of symptoms of myelitis, in rare cases. But more often, ordinary hernia is a source of pain in various parts of the back.

Schmorl's hernias are embedded in a bone substance that is devoid of nerves. Therefore, they do not cause any symptoms for a very long time, and perhaps for a lifetime. However, they may be “time-mines”.

Types of Schmorl's hernias - small, multiple, complicated, etc.

Like any hernia and protrusion, Schmorl's hernia can be localized in different parts of the spine. Of course, the greatest factor of penetration into the adjacent spongy substance is the pressure force of the disks on each other. Therefore, the largest hernias occur where there is a strong pressure, large intervertebral discs and vertebral bodies.

Schmorl's small hernias occur more frequently in the thoracic, and especially in the cervical region. Since the load on the cervical region is small, Schmorl's hernia of the cervical region is much less lumbar. But since the vertebrae are smaller, the relative size of the defects in the bone tissue is quite comparable with each other.

These hernias can be both single and multiple. Moreover, they can be multiple, both within the spinal cord, one anatomical part (for example, multiple Schmorl's hernias of the thoracic spine).

Also, these hernias can be located in adjacent vertebrae, which significantly weakens the strength. The most unfavorable hernia option is when these cartilaginous nodules are located in one vertebra and above, and below.

This suggests that the vertebral body is almost destroyed, and the question of its turning point is only a matter of time.

Finally, there are multiple hernias in one vertebra, but on the one hand. This is much less common than the presence of single protrusions.

In addition, hernias can be complicated and uncomplicated. In complicated hernias, there are already further intervertebral disc disorders, which will be described below.

Symptoms of Schmorl's hernia

Symptoms of Schmorl's hernia

These cartilaginous nodules are rather “treacherous” elements: they tend to be completely asymptomatic until the lesion of the disc becomes significant. Only then does a slight, aching pain in the back occur.

The fact is that with this type of hernia an unintentional "stabilization" of the disk occurs. After all, its penetration into the adjacent vertebral body contributes to its tight "attachment" to it.

Such a functional block arises, and until this cartilaginous nodule disintegrates from the existing loads, then, as a rule, normal hernia and protrusion do not occur at this level, due to the small mobility of this disc.

As you can see, Schmorl's hernia symptoms are very scarce, and it can only be determined by instrumental types of research, or due to complications. How dangerous are these formations?

Treatment of Schmorl's hernia - drugs and techniques

It is possible to treat Schmorl's hernia, but to cure it conservatively - the task is almost impossible. Imagine a dense cartilaginous node that is securely hidden in the depth of the bone tissue of the adjacent vertebra. All vertebrae are interconnected by an abundance of dense ligaments, muscles.

Therefore, the only way to get rid of a hernia is a planned surgical intervention. Schmorl's hernia of the lumbar spine, the treatment of which with conservative methods lasts for many years without result, is quickly treated by surgery.

Given the fact that “until the thunder clap”, the patient has no complaints, he is not in a hurry for a planned operation. Of course, in Western European countries, where patients have developed a self-awareness of preventive treatment, it is possible to replace the intervertebral disk in a planned manner by placing a full-fledged artificial prosthesis - implant.

At the same time, the affected cartilage is simply removed, and the “hole” in the spongy substance of the vertebral body is filled with the patient's bone autograft (taken, for example, from the ilium). After such a planned treatment, the patient can forget for many years about the vertebra that potentially threatened the person with a fracture, and did not allow him to engage in active life.

In the Russian Federation, a preventive approach to their own health, while, unfortunately, seems absurd: there is so little money, and to pay them “in advance,” until nothing happened, our people are not used to it. . Therefore, Schmorl's hernia is treated symptomatically, and is not cured, since it is impossible to do this with the help of massage, acupuncture, or physical therapy.

At best, secondary symptoms caused by a collapsing disc can be removed: smooth muscle tonic spasm and pain. But Schmorl's hernia itself is inaccessible to no effect other than operational.

About drugs

Nonsteroidal anti-inflammatory drugs that relieve pain also have a certain effect.

Chondroprotectors used in tablets and capsules are ineffective even without these cartilaginous nodules. Therefore, taking drugs such as Artra, Alflutop, Teraflex, Inoltra enriches only the pockets of manufacturers: the use of glucosamine in the United States has long been derived from drugs in nutraceuticals (food additives), and the effectiveness of chondroitin sulfate in a number of randomized studies “ I did not reach the evidence level.

Even the use of artificial substitutes for articular fluids introduced directly into the affected vertebra is meaningless: the movement of the intervertebral disc is limited, since it is “anchored” in the body of the adjacent vertebra by a cartilaginous node.

Complications - what risk does Schmorl's hernia carry?

risk of Schmorl's hernia In any case, an intervertebral disc defect is not good. It does not matter whether a bulging occurred sideways or upwards, one thing is clear - its integrity is broken. In the event that the cartilaginous nodule “dived” into a massive and large vertebra (for example, Schmorl's hernia of the lumbar spine), the integrity of the vertebral body also decreases, since a defect occurs in the spongy substance.

This is fraught with at least two complications that lead to the development of severe symptoms:

Со временем, когда возникает все большее обезвоживание диска вследствие возрастных изменений и остеохондроза, он перестает плотно входить в вещество кости. 1) Over time, when there is an increasing dehydration of the disc due to age-related changes and osteochondrosis, it ceases to enter tightly into the bone substance.

In case the hernia is located above the disc, in the body of the overlying vertebra, it may crumble, become fragmented and begin to occupy a place on the upper surface of the disc. As a result, the formation of ordinary hernias and severe wear of the disc is provoked.

Если грыжа Шморля поясничного отдела позвоночника расположена между диском и нижележащим позвонком, то ситуация может быть несколько хуже: при тех же условиях прогрессирующего остеохондроза позвоночника, наличии избыточной массы тела и резком повышении физической нагрузки (например, при попытке поднять мешок картошки на плечо) этот диск может целиком, или большей своей частью провалиться в это отверстие, поскольку вместо ровной площадки тела позвонка под диском образовалась дырка. 2) If the Schmorl's hernia of the lumbar spine is located between the disc and the underlying vertebra, the situation may be somewhat worse: under the same conditions of progressive spinal osteochondrosis, overweight and a sharp increase in physical activity (for example, when trying to lift a bag of potatoes on the shoulder) this disk can fall entirely, or for the most part, into this hole, because instead of a flat area of ​​the vertebral body, a hole is formed under the disk.

This condition is fraught with the appearance of acute back pain, the development of radicular symptomatology, and the appearance of indications for neurosurgical surgery.

Третий, более редкий вид осложнения состоит в том, что возникает просто перелом позвонка, ослабленного вследствие существования значительного дефекта в его стенке. 3) The third, more rare type of complication is that there is simply a fracture of the vertebra, weakened due to the existence of a significant defect in its wall.

Of course, this mainly occurs when the weakness and fragility of the bone tissue itself occurs: often this condition occurs when signs of osteoporosis appear in the elderly and senile age.

Schmorl's hernia in the lumbar spine may be the indirect “culprit” of a spinal fracture.

In the event that cartilaginous nodules appear in the vertebra from both sides at once, it is “the right candidate” for a fracture, even with a small load.

Therefore, the patient should be warned about this danger: if the displacement of the vertebral body debris causes compression of the central canal and ischemia with compression of the spinal cord, then the result can be complete paralysis, below the site of injury.

All these complications do not allow to treat these entities "carelessly". Therefore, medical science is studying them, and offers ways to prevent complications.

Forecast

Therefore, patients can be recommended moderate therapeutic exercises, swimming to relieve the spinal column, and constant monitoring of their bone tissue for osteoporosis and deepening the lesion of the vertebral bodies.

  • In the case when the bone tissue becomes fragile, and the hernia increases, you need to begin to treat osteoporosis , use a corset and prevent weight lifting.
  • If the hernia has been stable for many years, then the weight should be monitored, not allowing it to increase, and an annual X-ray examination of the spine should be carried out in two projections, which is enough for the primary control of the situation.
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