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WHAT IS A HERNIATED DISC AND HOW DOES IT OCCUR?

Intervertebral disc

The intervertebral disc is a cartilaginous tissue that is located between the vertebrae and serves for amortization during movements and loads on the spine itself. 

There are 23 intervertebral discs in the human spine.:

  • 6 in the cervical spine
  • 12 in the thoracic spine
  • 5 in the lumbar spine 
 
The intervertebral disc consists of 3 parts: 
  • Središnje želatinozne jezgre (nucleus pulposus) – sastoji se od vode (66 do 86 %), kolagena i proteoglikana te sjedi u sredini intervertebralnog diska i odgovorna je za većinu fleksibilnosti kralježnice
  • Perifernog tvrdog prstena (annulus fibrosus) – sastoji se od lamela ili koncentričnih slojeva kolagenih vlakana te služi kao zaštita za unutarnju jezgru i pomaže kod apsorpcije šoka na kralježnicu tijekom kretanja
  • Dvije vertebralne završne ploče – gornja i donja završna ploča (debljine 0.6 – 1 mm) prekrivaju gornji i donji dio diska, dopuštaju difuziju i osiguravaju glavni izvor prehrane za sami disk 
 
Herniated disc

Disc protrusion (herniated disc)

There are different types of degenerative disc changes, but one of the most common is intervertebral disc hernia. 

A hernia occurs when the content of the gelatinous nucleus (nucleus pulposus) protrudes through the lamellae of the hard ring (anulus fibrosis) leading to a displacement of the disc outside the intervertebral space. 

Due to the physiological shape of the intervertebral disc, protrusion usually occurs posterior – lateral (back and out of the spine) and thus can protrude into the spinal canal and create problems for the patient. 

The whole process of disc protrusion results in a decrease in stability and an increase in the load on the segment of the spine where the protrusion occurred. 

Stages of disc herniation

There are 4 stages of herniated disc: 

  1. Bulging diska – često ne prikazuje nikakve simptome jer nije dovoljno velika promjena da vrši pritisak na obližnje živce i leđnu moždinu 
  2. Herniated disc – u ovoj fazi možete početi osjećati bol na području gdje se nalazi prolaps diska i gdje je stvorio kompresiju
  3. Ekstruzija diska – jezgra probija stijenku diska i izlazi na površinu
  4. Sekvestracija diska – jezgra počinje curiti van diska
 
The first 2 stages are stages of incomplete disc herniation in which the gelatinous core has not yet leaked through the hard ring. Instead, the core causes the disc to protrude and exerts pressure on the outer tissues.
 

During the 3. and 4. stage the nucleus penetrates the disc wall and more serious symptoms develop in the patient. At this stage, symptoms such as numbness, weakness, pain and tingling in the lower back and along the legs may occur. 

 
Stages of disc herniation
Exercises for disc hernia

Treatment of herniated disc

Treatment of disc herniation can be conservative or non-operative and operative or surgical. 

Conservative treatment of intervertebral disc hernia is similar to tendinopathy and occurs in 3 stages: 

  1. Inicijalna upalna faza – U ovoj fazi potrebno je zaštiti diskove od daljnjeg oštećenja i posjetiti liječnika medicine ili fizioterapeuta što je prije moguće kako bi vas uputio na daljnje pretrage i dao vam upute kako ne bi došlo do većeg oštećenja diska nego što je to bilo do tada. Također se u ovoj fazi mogu koristiti protuupalni lijekovi i kreme te pasivni modaliteti poput dry needling, cupping,massage and similar modalities that will not cause greater damage to the disk but will relieve the pain itself. 
  2. Faza popravka – Nakon što je upalna faza završila u fazi popravka uvodimo prvo statičke a onda dinamičke vježbe i druge potrebne modalitete terapija kako bi potaknuli daljnju regeneraciju diska. 
  3. Faza remodeliranja – U posljednjoj fazi rehabilitacije progrediramo u dinamičke rotacijske pokrete kako bi se pospješila regeneracija nucleusa pulposusa i anulusa fibrosusa. Također u ovoj fazi uvodimo ekscentrične vježbe i progresivno opterećenje same kralježnice. 
 
Surgery is performed exclusively in cases where the patient does not control urine and stool and cannot move freely. More precisely when the magnetic resonance imaging shows that the disk is pressing the vital structures and there is no other solution than surgery. 
 
Detaljno o nastanku protruzije diska, opcijama liječenja te kada ga je potrebno operirati pogledajte u našem Youtube videu
Bsc. PT. Toni Marić

Bsc. PT. Toni Marić

Toni is bacc. physical therapist and the owner of the Ad Sacrum clinic who has been treating top athletes for years and also teaches at the Dry needling courses for physiotherapists.

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