A lot of patients who come to me are very confused and a large part of them is even terrified after seeing a description of X-ray or MRI (magnetic resonance). That is why I am writing this article to dispel doubts about what that terminology means

Intervertebral disc problems (discopathy) is currently considered one of the civilization diseases that occur most often. Already in some teenagers, by reading the MRI description you can meet with the first symptoms of degenerative disc changes, not to mention hernia in the elderly (after the age of 35). 

Discopathy: What is it?

Term used most often in the case of lumbar spine and it can be found in the majority of patients in middle age, but also in younger people. Speaking of discopathy, this is nothing but the beginning of degenerative disc disease. It is important to say that discopathy is not a speparate disease but is a collection of syphomes that may (but do not have to) give pain. Everybody can be “sick” to it: younger and older people, more or less active people, degenerative changes are inevitable and it depends on us how much we will exploit our spine. The diagnosis, “discopathy”, does not give the therapist too much information, because this is a very general statement and problems should be looked at a little more carefully by performing a series of clinical tests. 

Discopathy: How does it start?

Healthy intervertebral disc is very well hydrated and thanks to this hydration, it is able to absorb all loads while walking, standing or sitting. To illustrate mechanics, the spinal disk can be compared to a sponge, which when pressed, gives water to the surrounding structures, and when the load disappears, f.ex. during sleeping, sucks the water back and returns to its original state. 

This is what happens under ideal conditions, but unfortunately it does not happen. In more realistic settings, especially in older age, the load on the spine is much greater than the possibility of regeneration. Already in adolescence, we underestimate the problem of scoliosis (lateral curvature of the spine), hyperlordosis (excessive concussion of the lumbar spine) or hyperkiphosis (excessive convexity of the thoracic spine). In an older age, we work hard, no matter if it is more seated behind a desk or a physical one, but it leads to incorrect use of the spine. The result of this is that the balance of escaping water is much larger than that taken in water and cause permanent dehydration of the intervertebral disc. The result is a permanent reduction in its height and flexibility, and at the same time resistance to damage decreases. In this mechanism, discopathy, or degenerative disease of the spine, starts. 

It is worth knowing that the intervertebral disc is innervated only in the external layer, that is why it sometimes takes a long time before the jelly-like nucleus pulposus reaches this layer and causes pain. If it comes to this point, the effects are catastrophic and usually the changes are irreversible. This does not mean, however, that we do not have much room to make a difference when it comes to significantly reducing pain by proper physiotherapy.

Disc herniation: the first warning

Having knowledge about the discopathy and degeneration of the intervertebral disc, we go to the disc herniation.
By gradual dehydration of the intervertebral disc, lowering its height and elasticity, as well as constant relieving of the spine, it is clear that its regular shape is deformed. As a consequence, the delicate nucleus pulposum begins to pierce the fibers of the fiber ring surrounding it and, simply speaking, flows out into the outer parts of the intervertebral disc.
This process is called the herniation of the nucleus pulposus. This is the first stage of the entire degenerative process, and as we know, the inner batch of the fibrous ring can, but does not have to give pain symptoms, so we should “listen” carefully to our body and possible first signs. 

Disc herniation: the second warning

It is at this stage that patients begin to visit physiotherapists most often because most people experience pain, sometimes even with radiation to one or both limbs. 

If the first symptoms of the hernia were not a sufficient motor for work, there is no other option than to develop a second stage of intervertebral disc herniation. 

At this stage, the nucleus pulposum approaches the extraneous part of the fibrous ring and begins to “protrude” beyond the normal perimeter of the disc. The last rings keep their continuity but they are very tight. Sometimes it happens that all the rings are already broken but the crushing core is not broken up and this condition is also called a hernia.

There is no more to wait here … you have to act because it’s the last bell to be rescued before surgery !!!

Sequestration: the last stage

Sequestration, or the last stage, where the nucleus pierced all the fibrous rings and, in addition, split up itself. Here, the remains of the gelly-like structure detach from the rest of the disk and move to the spinal canal or nerve root area. It is a rather dangerous situation, because the separated sequestration lives its own life and no one has control over where to place it. You can be lucky when it hits a badly innervated place and the pain will go away as the acute inflammation in the disc area decreases (2-6 weeks). If this luck is missing, the sequesters will be pushed down on the so-called the horse’s tail (very good innervation) and in this case there is nothing else but surgical intervention.

Can the hernia absorb?

In conclusion, I would like to raise one more topic and answer the question that I often meet, that is, can the hernia absorb?
I dare say that sometimes the fact that the disc “breaks” into separate pieces (sequestration) can be beneficial for the patient. 

Why do I think so? When the free body is in a place that does not pose a greater threat and pain, it stimulates many defensive mechanisms in our body. The first of them is acute inflammation, and the second is launching to fight, the so-called macrophages (“vacuum cleaners” in our body), whose task is to clean up “waste” such as, for example, unwanted and dead sequestration of the nucleus pulposis. 

So technically it is not the hernia itself that is absorbed but the sequestered detachment. And so, under favorable conditions, absorbtion has the right to exist. The above situation can not take place in the case where the damaged part of the disk is not separated from the rest of its structure. Therefore, in some cases this “bad” sequestration is sometimes more advantageous than a stable, constantly nourished hernia.

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