Intervertebral disc prolapse, nucleus pulposus prolapse
Definition
A ligament sheath prolapse, which can also be called a prolapse, is understood to be back pain and sensory disturbances up to motor failures caused by nerve root compression in the spinal cord. This means that in severe cases, movement and especially walking can also be restricted. The herniated disc occurs in the vertebral bodies of the cervical, thoracic and especially lumbar spine.
Cause
Along the entire spine, the intervertebral discs are located between the individual bony vertebral bodies. The intervertebral discs consist of an outer fibrous ring (annulus fibrosus) and an inner central gelatinous core (nucleus pulposus). These two structures serve to buffer the load acting on the spinal column and contribute to optimal mobility.
With increasing age, the ability of the gelatinous core to bind water decreases and cracks and fissures begin to form in the outer fibrous ring, causing the buffering effect to be lost. This process is called degenerative change. Now degenerative parts of the central gelatinous core can penetrate into these cracks.
In most cases, the tissue protrudes backwards towards the back or to the back and sides. This often happens in the case of sudden, undefined movements (lifting traumas, rotation) and overstraining of the vertebral bodies. There are different degrees of severity of disc degeneration: When the gelatinous core is pushed forward within the fibrous ring, this is called protrusion.
If the gelatinous core breaks through the fibrous ring, i.e. it protrudes into the central canal, the nerves supplying the regions below this section can be damaged. This results in a narrowing (stenosis) of the central canal (Canalis centralis) and, depending on its extent and direction, leads to the pinching (compression) of individual nerves. In extreme cases, there is no longer any connection between the gelatinous core and the prolapse that has emerged through the tear.
As the intervertebral disc loses volume overall, the distance between the surrounding vertebral bodies is reduced. The pressure on the vertebral joints becomes stronger and this can lead to bony marginal bulges (spondylosis). This can also lead to changes in the vertebral bodies, which can then also constrict the nerves.
Symptoms of a slipped disc of BWS
Patients complain of sudden shooting pains, which manifest themselves in the form of a belt but also localized in the area of the thoracic spine. Often this sudden pain is a dull impact or an unfortunate movement such as lifting a heavy object in a forward inclined position. The radiating symptoms are called intercostal neuralgia in this region and can extend to the middle of the front thorax.
Intercostal neuralgia can cause many other symptoms. The symptoms of a slipped disc of BWS are usually felt unilaterally and can be more pronounced in the back or leg. The surrounding muscles are often hardened and tense.
An increase in pain can be observed when coughing, pressing and depending on the breathing position. Particularly with conscious deep breathing, the pain occurs and a feeling of not being able to breathe properly follows. Depending on the orientation and severity of the incident, the spinal cord is compressed and further symptoms occur.
These include sensory disturbances such as tingling in various areas of the skin such as thighs or legs, bladder and rectum disorders and gait problems. For example, it is difficult to lift the forefoot when the affected person falls. Patients often adopt a pain-relieving, relieving posture and feel an increasing loss of strength in their legs.
Continuous constriction of individual nerves can develop into paraplegia. Dizziness is a versatile symptom. Dizziness develops in the brain and can have many causes.
Blood vessels that supply the brain with oxygen run along the spine to the skull. If a herniated disc is present, it can be affected or squeezed. As a result, dizziness, headaches and unconsciousness can occur.
The herniated disc can also affect the spinal cord and cause dizziness. The dizziness is often also psychogenic. If there is severe pain during the herniated disc, the body is in a stressful situation.
Dizziness can occur as a psychological reaction to the pain and stress. In most cases, chest pain is considered too fast for heart and lung complaints or diseases of the upper abdominal organs. But the spine can also be behind chest pain.
At the level of the 2nd and 3rd thoracic vertebrae, nerves emerge from the spinal cord, which are responsible for the sensitive care of the superficial chest area. In the event of a herniated disc, the tear in the disc and the emergence of the jelly-like core of the disc can cause irritation and pressure on the nerves near the spinal cord. Often patients have already gone through lengthy and numerous diagnostic procedures before the diagnosis of a herniated disc of BWS as the cause of chest pain is made.
Typically, the pain originates at the spinal column and can be transmitted there via the rib cage along the ribs. Pain can increase with movement and breathing, which in some cases can distinguish it from a heart attack. With therapy and the reduction of the swelling in the spine, the nerves recover in most cases, so that the pain subsides.
In addition to sensitive complaints in the chest area, a herniated disc of BWS can also have a direct influence on heart function and especially on the heart rhythm. The irritation of the nerve exits at the level of the second and third thoracic vertebrae can lead to cardiac dysrhythmia and blood flow fluctuations in the heart. Those affected can feel additional heart beats, rhythm fluctuations, palpitations and palpitations.
First, all potential causes caused by an organ must be excluded. Only when these have been excluded should the spine be diagnosed. Sensitive disturbances of the BWS can also replace various diseases of the heart.
Together with cardiac dysrhythmia, chest pain can falsely suggest the diagnosis of a heart attack. Stomach pain is also a typical symptom of a slipped disc of BWS. This is also caused by irritation of the nerve cords exiting the spinal cord, triggered by pressure of the intervertebral disc fluid on the nerve roots.
The pain can be projected along the course of the nerves onto the upper body and be transmitted to the stomach area and have a pulling character. The cause can remain undiscovered for a long time, so that those affected have often already undergone numerous diagnostic procedures. Abdominal pain can be a concomitant symptom of spinal diseases and herniated discs.
Especially in older patients, abdominal pain occurs in the context of back pain. The causes are not always clear. The exact nature of the pain must be determined by the doctor and possibly an ultrasound examination should be performed to exclude possible threatening causes.
The pain can be a result of pressure on the abdominal organs in the case of BWS complaints. A herniated disc can also be accompanied by inflammatory processes in the abdominal cavity. Deep herniated discs may also cause irritation of the sciatic nerve.
This can sometimes be so severe that the pain is felt down to the abdomen, as well as in the legs and toes. Breathlessness is a rare symptom of a herniated disc. Respiratory distress is always an acute emergency situation, the cause of which must be clarified as quickly as possible.
In most cases, the shortness of breath comes from the heart or the lungs themselves, but diseases such as the herniated disc can also be behind it. In case of a herniated disc, surrounding structures can be damaged by the emerging core of the disc. This can affect the spinal cord, surrounding nerves or blood vessels.
In the chest area there are some nerves that are involved in the breathing movement. Many muscles at the ribs support breathing by expanding the rib cage. These muscles start to work especially during increased exertion. If they are affected by a herniated disc, breathing difficulties can occur in these situations.
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