Modern approach to the treatment of sequestered intervertebral hernia

The most dangerous type of intervertebral hernia is a sequestered vertebral hernia. This form of vertebral pathology is characterized by a violation of the integrity of the intervertebral disc, in which the nucleus pulposus falls into the spinal canal and compresses the spinal cord and nerves passing through the canal.

Such a disease develops mainly due to neglected or improperly treated osteochondrosis, vertebral injuries, etc. Sequestr provokes the most complex pain symptoms and can cause paralysis, leading to disability. Due to its criticality, this pathological condition is eliminated in an operative way.

What is a sequestered disc herniation

Sometimes a vertebral hernia is complicated by the prolapse of the nucleus pulposus into the spinal column, where the spinal nerves are located. In other words, the intervertebral hernia undergoes sequestration.

A similar complication develops most often in patients suffering from osteochondrosis spinal hernia, disc bulging or protrusion (protrusion) for a long period of time.

Sequestration is characterized by rupture of the longitudinal ligaments in the disc. As a result of such a rupture, the nucleus pulposus is separated from the intervertebral disc and subsequently prolapsed into the spinal canal.

Causes of occurrence

This pathological condition can have many reasons:

  1. Osteochondrosis;
  2. Excessive vertebral overload caused by heavy sports training or physical labor;
  3. Sedentary life;
  4. Poor nutrition;
  5. Obesity;
  6. Long and regular uncomfortable posture;
  7. Addictions like alcohol abuse or tobacco addiction.

Often, sequestration develops as a result of regular overload of the spine, although isolated cases such as lifting heavy objects can also provoke the appearance of sequestration. There is a high likelihood of such a complication in persons who incorrectly perform the elements of strength training.

But more characteristic of a sequestered hernia is long-term formation under the influence of regular overloading effects on the spine.

In addition, osteochondrosis, excessive weakness of the corset muscles, impaired posture, etc., can provoke such a condition.


Sequestration is classified according to the location of the precipitated nucleus.


With this type of sequestration, the nucleus pulposus falls out between the 6th and 7th vertebrae (C6-C7), located in the cervical region. Gradually, the contents of the affected vertebra begin to be released, under pressure the nerve roots are pinched, blood and nutrients cannot fully pass through the pinched area, which leads to the development of ischemia.


Since the lumbar vertebrae are subjected to more stress than the rest of the vertebral elements, a lumbar hernia located between the 4th and 5th vertebrae (L4-L5) is a very common diagnosis. Such sequestration is treated mainly by an operative method, after which the patient will have to overcome a very long rehabilitation and restorative therapy.


A sequestered vertebral hernia can also form between the lumbar and sacral spine (L5-S1). It accounts for almost 75% of vertebral hernias. For a similar pathological variety, sensitivity disorders caused by nerve-root compression are characteristic. This complication is also called the “horse tail” syndrome.

Symptoms of nucleus pulposus sequestration

The prolapse of the disc nucleus does not always have vivid clinical manifestations, sometimes such a pathology develops imperceptibly.

For example, in patients, a hernia may develop, periodically manifesting itself as painful attacks, to which the patient gradually gets used.

And when he develops a sequestration, the characteristic soreness is taken for another attack due to a hernia.

In the cervical

The sequestration formed between the cervical vertebrae is characterized by such manifestations as:

  • Frequent attacks of headaches;
  • Pain syndrome in the cervical-collar zone, which is characterized by constancy, intensity and increase after a number of different loads;
  • Gradual depletion of muscle tissue in the arms;
  • Feelings of numbness in the upper limbs and neck;
  • Muscle weakness in the neck, shoulders and arms;
  • Changes in gait, gradually turning into paralysis of the limbs.

In the chest

The symptomatic picture of sequestration between the thoracic vertebrae consists of the following symptoms:

  1. Severe pains in the chest, radiating between the shoulder blades, in the ribs, abdomen and chest. For such signs, an increase is characteristic even with small loads;
  2. Gradually develops paralysis of the lower extremities;
  3. Feeling of numbness is noted in the area of ​​the abdomen, chest and lesions on the back;
  4. There is a gradual weakening of the muscle tissues of the press and back, up to atrophy.


If the nucleus falls out between the vertebrae of the lumbosacral spine, then the patient has manifestations like:

  • An intense pain attack in the lumbar zone, and the pain torments the patient constantly, is characterized by a pronounced severity and tends to intensify after the slightest load on the lumbar vertebrae. The pain may radiate to the buttocks or lower extremities;
  • Loss of tendon reflexes;
  • Weakness and weakness in the legs;
  • Exhaustion of the leg muscles;
  • Violations of the processes of emptying the intestines or bladder;
  • Feeling of numbness in the fingers and feet;
  • Lumbar stiffness
  • Paralysis of the legs.

Diagnosis of the disease

Diagnostic examination includes several research techniques such as:

  • Computed tomography;
  • Electromyography;
  • Myelography;
  • Magnetic resonance imaging , etc.

How to treat: surgically or conservatively

The final decision on the type of therapy is made by the orthopedist, since it all depends on the specific clinical case. The specialist relies on the condition of the patient and his spine, on possible threats from sequestration and other parameters.

When is surgical treatment recommended?

The intervention of surgeons is far from always indicated. Experts have identified several special conditions that require surgery:

  • When the clinical picture is characterized by a sudden deterioration of the condition, repeated alternation of periods of deterioration and improvement is possible;
  • With large sequestration (more than 10 mm);
  • Excessive weakening of muscle tissue in the nerve-root region;
  • The lack of effect from therapy within six months or the progression of the pathology, despite the patient’s compliance with all medical recommendations;
  • With numbness of the limbs;
  • The presence of autoimmune inflammation;
  • The sequestration sometimes needs surgical therapy in case of separation of the cartilage from the hernia itself, but in practice, such detachable parts dissolve on their own.

It is no secret that the modern possibilities of neurosurgery have stepped forward and such operations today are characterized by minimal complications and the occurrence of re-formation of a sequestered hernia.

Types of operations applied

To get rid of a hernia, they resort to several methods:

  • Chemonucleolysis – the technique involves the introduction of a special drug into the hernia tissue, which will further lead to its dissolution;
  • Laminectomy – surgery to remove the vertebral arch;
  • Microdiscectomy – an operative procedure in which a disc is removed through a small incision using special microsurgical instruments and a microscope;
  • Endoscopic microdiscectomy – the removal operation is performed using a specialized device – an endoscope.

The best option for conservative care without surgery

A conservative approach to the treatment of sequestration will be justified only if the nucleus pulposus is still held by the gelatinous substance, although in fact it has already protruded beyond the boundaries of the disc.

The essence of such a treatment is to keep the sequestration from permanent loss until its tissues are completely dead. Then, at this place, bone growths will form, which will close the hole formed after the exit.

In the course of treatment, it is necessary to ensure that the formed growths do not injure the endings of the nerve fibers, otherwise it will provoke another, no less dangerous problem.

Conservative therapy lasts more than one year, since the process of calcification differs in duration. But in the end, it will be possible to get rid of the problem forever, and, most importantly, without surgical intervention.

The conservative therapeutic process consists of several successive stages:

  • In the first 7 days after the release of sequestration, it is recommended to stay in bed, take non-steroidal and analgesic drugs that relieve inflammation , muscle relaxants, use novocaine blockade, etc.;
  • For 6 months, regular massage procedures are shown, but only on condition that they are performed by a qualified chiropractor;
  • Within six months after the loss of the nucleus, the mandatory wearing of a bandage is shown, which subsequently gradually begins to be removed;
  • The performance of elements of a static gymnastic complex or isometric exercises is shown;
  • Lifting weights and bending over the entire therapeutic period is unacceptable.

After a six-month period of treatment, it is allowed to include additional massage and gymnastic elements, but only with the approval of a doctor.

Rehabilitation and prevention

If the patient needed surgical treatment, then a rehabilitation period must follow, during which the patient must adhere to certain conditions: not to lift heavy things, avoid physical overload, take medications prescribed by an orthopedist, etc.

At the end of rehabilitation, you can start preventive measures that can prevent the development of complications or recurrence of sequestration: regular gymnastic training, treatment in a sanatorium, adherence to the diet recommended by the doctor, swimming, an active life position, adherence to posture, etc.

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