home Audience 6 Rehabilitation after spinal surgery: timing, methods and prospects. Spinal neurosurgery is a last resort

Rehabilitation after spinal surgery: timing, methods and prospects. Spinal neurosurgery is a last resort

The risk of blood clots increases during operations on the lower extremities and pelvic area. To reduce the risk of developing this type of complications after operations, it is mandatory to wear compression stockings and it is possible to prescribe medications that slow down the process of blood clotting (for example, aspirin).

Injury to the spinal dural membrane (the outer dense waterproof membrane spinal cord), which may not always be noticed by the surgeon during surgery. If the damage does not heal on its own and as a result, cerebrospinal fluid enters the surrounding tissues, causing a variety of pain syndromes, and also increases the risk of infection entering the tissue itself. cerebrospinal fluid(meningitis).

IN similar cases required additional operation to eliminate the defect of the dural membrane.

Complications from the lungs due to their improper functioning during and after surgery - stagnation of fluid, turning into inflammation (pneumonia). Occur due to the use of anesthetic drugs that reduce lung function, as well as due to their insufficiently deep work as a result long stay in a supine state or persistent pain. The second most common complication of the lungs is injury to their membrane (pleura).
A variety of infections, the risk of which exists during any operation. To prevent this complication, the patient is prescribed antibiotics, especially when metal structures or bone grafts are introduced into the body.

Based on the level of appearance, infections are distinguished between superficial (in the skin and subcutaneous layer) and deep (in the spine or spinal canal). If the source of inflammation is located on the surface, it is stopped with antiseptic solutions, powders and other external agents. If the infection is deep-seated, you may need long-term use antibiotics, drainage of the pathological focus or repeated surgical intervention up to the removal of previously introduced structures.

Redness, swelling, fever, and poor healing may indicate the development of an infection. postoperative wound, leakage of liquid discharge of a brownish, yellowish or greenish tint, increased pain in the operating area, a general increase in temperature, weakness and toxicosis.

Pain after spinal surgery usually persists for several days, and then gradually subsides. If this does not happen, they speak of an unsuccessful surgical procedure.

Neurological complications

With any surgical intervention on the spine, there is a possibility of damage to the nervous structures, which in one way or another affect the further functioning of the spinal cord, limbs, the entire nervous system, etc. Common complications include:

Injury to a nerve that performs functions related to the sensitivity of certain areas of the body or the movements of certain muscles. As a result of damage, the function of the affected nerve “falls out” general scheme and is not always recoverable.
Injury to the spinal cord or its processes (nerve roots) caused by careless actions of the surgeon, swelling of adjacent tissues and postoperative scars, which disrupt the blood supply and normal functioning of the brain and roots. Depending on the level of damage, a spinal cord injury can cause paralysis of certain parts of the body, and damage to the root can cause pain, numbness, and weakness in the innervation zone.

Complications associated with the use of implants and spinal fusion

Afterwards, there are a number of special complications on the spine that are characteristic of this type of operation:

Delayed fusion or complete non-fusion of bone structures, which requires repeated surgical intervention.
Fractures of implants installed, which are used to hold the vertebrae in the desired position (for example, to treat instability of the cervical spine). This may occur before the surgical area has completely healed and requires repeated intervention to replace the implant.
Migration (displacement) of implants (cage) may occur as before postoperative complication, occurring before the fusion of bone structures or the formation of scar tissue. As a result, major damage is likely blood vessels or spinal cord, loss of ability to stabilize the operated segment. In case of displacement, repeated surgical intervention is required.
Development false joint, which in practice means an unhealed bone or an ineffective fusion, that is, there is movement between the two bones that should be fixed. This complication also requires repeat surgery.
Transitional (transit) syndrome – increased wear and tear of adjacent spinal segments. Occurs due to redistribution of the load on the spinal segments after blocking the pathological area with implants or performing spinal fusion.

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Marina

I live in the city of Istra near Moscow, so it’s difficult to get to the clinic on ordinary days. I made an appointment in advance for the holidays 01/06/2016-01/08/2016, because... I know that only here, as always, will I be returned to working capacity and the ability to work 10 hours a day...

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Tamara:

Please tell me if I can get rid of the pain. 11/19/2016 An operation was performed to remove herniated discs l4-l5-s1. The roots were surrounded by many varicose veins. Bleeding from injured veins. Hemostasis. Discharged on December 10, 2016. The pain did not go away. On December 25, 2016, more pain of a different nature appeared. Severe pain in the sacrum on the left, radiating to the thigh. Burning pain along the front outer part of the thigh under the knee of the shin. The pain appears after walking for no more than 15 minutes. When lying down, the pain goes away, but it is difficult to turn on one side, I help myself to turn with my hands. Life was divided into intervals of 15 minutes lying and standing. Repeated MRI on January 19, 2016: dorsal diffuse protrusion of the l4-l5 disc by 4.5 mm. with narrowing of the intervertebral foramina on both sides with lateralization to the left and compression of the spinal root. At level l4-s1, the dural sac is deformed and displaced dorsally and to the left into the area of the arch defect. At the level of L5-S1 against the background of dorsal diffuse protrusion of the disc by 4 mm. with narrowing of the intervertebral foramina on both sides, a medial disc herniation of up to 6.5 mm persists. with compression of the dural sac. Spondylosis, spondyloarthrosis. 01/25/2016 repeat surgery to remove disc herniation l5-s1. The pain that appeared after the first operation persisted. X-ray of the spine - the height of the intervertebral discs l3-4 l4-5 l5=s1 is reduced, the formation of subchondral sclerosis and marginal bone growths can be traced. Left-sided scoliosis, osteoporosis of the vertebral bodies. X-ray of the hip joints, the joint space is not changed, no bone changes were detected. I am still undergoing treatment to this day, propila-detrolex, tibantin, fluoxetine, neuromidin, mydocalm. Intravenous magnesium, analgin, diphenhydramine - analgin, novocaine, baralgin, diphenhydramine - euphilin, analgin, diphenhydramine for 10 days. Into the muscle chondrolone nicotine b-12, arthrozan, milgamma, meloxiam. The pain persists, only the interval between walking and lying down has increased to 20-30 minutes. The pain is very strong, it makes you feel hot. If I lie down or get on my knees, it goes away. Please give me some advice, I’m very tired of the pain.

Doctor's answer:

I sincerely sympathize with your misfortune. To answer your question, I need to know what kind of surgical interventions you performed. Submit on the website in the same message your extracts from the hospitals where you were operated on; there should be a description of what operations were performed on you and whether a metal structure was installed during these operations or not. You should also do ENMG of the lower extremities for accurate understanding condition of nerve trunks in the area of surgical intervention

Tamara:

Extract dated November 19, 2016. The patient is positioned on the right side. After image intensifier marking and processing surgical field incision of the skin and soft tissues in the projection of the axial processes L4-S1. The arms are skeletonized. A translaminar approach into the lumen of the spinal canal was performed. The L-5 root is visualized as swollen, tense, surrounded by many varicose veins along with the dural sac, and displaced downward. A small disc herniation was identified and removed in the area of the orifice; the root is free and not tense. Upon further inspection, the mouth of the S-1 root was visualized, ischimized and surrounded by a network of varicose veins. The dural sac was displaced medially from under the root; a disc herniation was identified and removed in several fragments. There is bleeding from injured veins. Hemostasis. Layer-by-layer stitches on the wound. The course of the postoperative period was complicated by the development of seroma. The wound healed a second time. Extract dated January 25, 2016. Position on the right side. After treatment, a skin and soft tissue incision is made along the existing scar in the L4-S1 projection image intensifier control. Access to the lumen of the spinal canal was achieved with technical difficulties. The dural sac and S1 root were visualized. The root is swollen, enlarged, and tense. On the S1 root lies a varicose vein. The root and dural sac are displaced medially. The posterior longitudinal ligament was opened. A sequestered hernia was identified and removed in several large and small fragments. Additional decompression was performed along the root until it exited the bone canal. The spine is located freely. Hemostasis. Stitches were placed on the wound. The wound healed by primary intention.

Intervertebral disc surgery does not end the treatment of intervertebral hernias. For a person to return to normal life, a recovery period and intensive rehabilitation are required. In some cases, complications develop after surgery, although due to the development medical equipment their number is minimal.

Possible complications after removal of intervertebral hernia

Complications can be divided into intraoperative and postoperative.

Intraoperative symptoms develop during the operation and largely depend on the skills of the operating surgeon, the method of surgical intervention, and the instruments used for manipulation. The consequences of surgery on a vertebral hernia vary.

There are two main complications:

Nerve damage. In close proximity to intervertebral hernia As a rule, the spinal nerve root is located, compression of which causes the clinical picture of the hernia. Discectomy may inadvertently damage this root. In the postoperative period, this fact will be manifested by impaired sensitivity or muscle weakness in the corresponding leg (paresis and paralysis).
Damage to hard meninges. The noticed rupture is immediately sutured by a neurosurgeon, but if the rupture is not noticed, then in the postoperative period intense headaches may develop due to the constant leakage of cerebrospinal fluid from the spinal canal, which is accompanied by a decrease intracranial pressure. These effects can last up to several weeks until the hard shell heals on its own.

Postoperative complications:

Early:
- purulent-septic complications (local - epiduritis, osteomyelitis and general - pneumonia, sepsis);
- thromboembolic complications (thromboembolism pulmonary artery, thrombosis of the veins of the lower extremities).
Late:
- recurrence of a vertebral hernia is the most common complication. According to various sources, it ranges from 5 to 30% of all operated hernias;
- scar-adhesive process in the lumen of the spinal canal - accompanied by pain as a result of pinching of nerves by scar tissue.

Reduce the likelihood of developing late complications After disc surgery, following the doctor’s recommendations during the recovery period and high-quality rehabilitation will help you achieve a good quality of life.

Immediately after the operation, the person feels significant relief - decreases pain syndrome, the functions of the pelvic organs and lower extremities are restored. However, it is worth remembering that there is no way to do without restorative treatment. During the recovery period after removal of the hernia, measures are taken to consolidate the achieved result, adapt the spine to new conditions, and form new spinal biomechanics.

Conventionally, the recovery period can be divided into three stages:

in the first stage, a person follows recommendations aimed at preventing and combating pain;
on the second - human adaptation to everyday life;
in the third stage, a set of measures is carried out, the main purpose of which is the complete restoration of the biomechanics of the spine, the prevention of recurrence of intervertebral hernia, strengthening the musculoskeletal system and returning to a full life.

Depending on the severity of the operation and the volume, the recovery period lasts from 4 to 12 months, on average taking about six months.

Do not sit for 1-1.5 months after surgery to avoid early recurrence of the hernia and compression of the nerve roots;
Avoid sudden and strong movements involving the spine - bending forward and sideways, turns with twisting of the spine;
Ride in a car or other type of transport only as a passenger on unfolded seats, in a reclining position;
Avoid lifting heavy objects– maximum weight 3-4 kg in each hand;
Give your spine a rest every 1.5-2 hours - lie down for 15-25 minutes;
Wear a semi-rigid corset. To train the spine, wearing time should be limited to three hours a day.

To accelerate the processes of reparation (recovery) during this period, physiotherapeutic methods of influence can be recommended: laser therapy, diadynamic therapy, sinusoidal modulated currents, electrophoresis in the spinal region.

Non-steroidal anti-inflammatory drugs are used to relieve pain.

In general, early rehabilitation period after removal of a hernia can be characterized by a protective regime - during this time the postoperative scar heals and subsides inflammatory process. Then you can move on to more intensive rehabilitation.

Intensive rehabilitation in the postoperative period

After hernia surgery open method the patient is discharged from the hospital after 3-4 weeks, and with endoscopic discectomy - after 1-2 weeks. From the second month, you can begin intensive rehabilitation, including the prevention of intervertebral hernia.

At this stage, exercise therapy and restorative gymnastics are included in the rehabilitation program. These procedures are best carried out under the guidance of a specialist. The best option is to undergo sanatorium-resort treatment. Experienced people work in the sanatoriums exercise therapy instructors, there are swimming pools - swimming during the recovery period is of great importance.

If it is possible to get to a sanatorium or rehabilitation center no, you can use video lessons - many developers of recovery programs publish video lessons on the Internet.

Here is a small set of exercises – restorative exercises for you to do on your own:

While on your back, slowly bend your legs, trying to bring your knees to your chest. Relax your gluteal muscles and try to hold this pose for 45-60 seconds. Slowly straighten your legs.
Lie on your back, spread your arms. Bend your legs at the knees and, leaning on them, raise your pelvis. Hold for 10-15 seconds first. Gradually increase the time to 60 seconds.
Supine position. Hands are placed behind the head, legs are bent at the knees. Rotate your legs, trying to reach the floor with your knees - left and right. Top part The torso should be held horizontally.
Starting position – leaning on your hands and knees. At the same time, stretch the opposite arm and leg horizontally and hold it for 5-10 seconds - switch legs with arms. Increase the exercise time to 45-60 seconds.
Lying on your stomach, hands under your chin. Slowly raise your extended leg up, without lifting your pelvis from the floor, and lower your leg. Repeat the exercise with the other leg.

In addition to rehabilitation exercises after surgery for intervertebral hernia, it is recommended to undergo acupuncture sessions.

Late recovery period

6-8 months after surgery on the intervertebral disc, under the supervision of a doctor, you can begin to restore the muscle corset. The activity of exercises to strengthen the back muscles increases significantly.

During this period, manual therapy procedures and massage are added to the complex treatment - at least twice a year. These procedures allow you to finally restore blood circulation in the problem area, return the patient to an active lifestyle and prevent recurrence of the hernia. intervertebral disc after its removal.

When going outside, do not allow your back to become hypothermic - you should wear a warming belt on the lumbar area. It is worth refusing to wear a strengthening corset to avoid atrophy of the back muscles.

Recovery in the postoperative period is difficult. Don't be upset or upset if something doesn't work out right away. You need to work on yourself - your health depends on your willpower. And doctors will be happy to help.

Coccyx - lower section spine, which consists of three to five fused vertebrae. It is connected to the sacral bone by a joint that can move physiologically only in women during childbirth. These areas of the spine are innervated by the plexuses of the same name - the sacral and coccygeal, and therefore sometimes react to pathology in the body with pain in the area of the sacrum and coccyx.

Coccydynia is a multi-cause pain syndrome with the following features:

paroxysmal or constant pain;
duration - from 20 minutes to several hours;
aching, dull or stabbing in nature;
place of origin - the area of the perineum, rectum or anus;
accompanied by burning and heaviness in the vagina, anus;
pain spreads (radiates) to the vagina, groin, pubic area of the abdomen, buttocks, thighs;
provoked by movements and pressure on the tailbone, defecation;
pain may appear at night without justified reason and go through on your own.

Injuries – dislocation of the coccyx as a result of a fall or blow. In addition, a lot of time may pass after this, and more often the patient is unable to suspect the cause of the pain.
Prolapse of the internal genital organs, weakening of the tone of the sacro-isciatic ligaments and the muscular frame of the perineum in women in postpartum period In addition to painful sensations, they also cause a burning sensation.
Frequent constipation, diarrhea due to prolonged sitting on the toilet, as well as sitting on upholstered furniture also lead to weakening of the perineal muscles, and, in turn, to pain in the tailbone.
Diseases of the musculoskeletal system due to injury or surgery: inflammation in muscle tissue (myositis), scarring around the coccyx, inflammation in the sacrococcygeal joint.
Tumors, tumor-like formations.
Hemorrhoids - dilated veins anus.
Anal fissure is a violation of the integrity of the anal ring.

Inflammation of fatty tissue in the rectum (paraproctitis) or the rectum itself (proctitis).
Spinal diseases - herniated discs between the lumbar vertebrae, inflammation of the nerve roots of the lumbosacral region.
Inflammation or pathology of non-inflammatory origin sciatic nerve.
Gynecological pathology: for example, adnexitis - inflammation of the uterine appendages (ovaries and fallopian tubes), abnormal curvature of the uterus.

Among women

A burning sensation in the area of the sacrum and coccyx in women is a cyclical sensation with a peak of pain during menstruation associated with external endometriosis - the proliferation of cells of the inner layer of the body and cervix along its back wall. My patients use a proven remedy that allows them to get rid of pain in 2 weeks without much effort.

Digital examination of the rectum reveals a semicircular cord, massage of which leads to increased back pain. This method also helps to eliminate inflammation, scarring, tumors of the rectum, tissue damage or muscle spasm of the anus, injuries in the coccyx or sacrococcygeal joint, and impaired tone of the muscles and ligaments of the pelvis. X-ray of the lumbar and sacral vertebral sections, pelvic bones and hip joints.
Ultrasound examination of the abdominal organs.
Sigmoidoscopy — instrumental method, used for the purpose of exclusion pathological formations in the area of the mucous membrane of the rectum and the sigmoid region.
Anoscopy is an examination of the anus, which makes it possible to identify polyps and hemorrhoids in this area, difficult to reach for diagnostics using the finger method.
Neurological examination.
Electrophysiological study of the obturator apparatus of the rectum and region pelvic floor used to confirm muscle spasm of the colon, and makes it possible to determine the motility of the final sections of the digestive tract.
Consultations with a gynecologist or urologist.

Treatment

Treatment is aimed at eliminating the underlying disease, which caused pain in the coccyx, and symptomatic therapy, i.e. anesthesia.

Physiotherapeutic methods - treatment with mud, ultrasound, infrared waves and high frequency waves.

Rectal massage and oil microenemas help relieve pain and muscle tension.

Acupuncture helps eliminate burning sensation in the coccyx and sacrum area.

Anesthetic mixture: 300 ml of medical and 10 ml of camphor alcohol, 10 powdered Analgin tablets, 10 ml of iodine, bring to homogeneity, leave for 3 weeks and shake before use.

Sedatives: Sedavit, Corvalol, Corvalment to relieve the nervous system.

Traditional medicine practices the use of herbal teas based on mint and chamomile, as well as pain relief using decoctions of medicinal plants. For example, table 2. pour spoons of geranium leaves into 1 liter of water, cook for 5 minutes and make compresses or baths coccygeal region to relieve pain.

Most radical method- removal of the coccyx - indicated for its injury and pathological mobility. To determine the cause of a burning sensation in the sacrum area, a thorough examination of the patient is necessary to exclude organic diseases. different organs and careful selection of treatment methods.

Symptoms of lumbar hernia

Herniated discs are one of the most serious pathologies of the spine. Indeed, as a result of disc protrusion, compression is possible nerve endings or spinal cord. The most common hernia occurs in the lumbar spine, since this area is subject to the greatest stress. Typically, the pathology develops in people 30-50 years old, but can even occur in teenagers. In some patients, the symptoms of a lumbar disc herniation are constant, severe, and cause serious discomfort. Others hardly notice the disease. But in any case, it is very important to consult a doctor in time and begin treatment for the pathology.

general characteristics

The lumbar spine consists of 5 vertebrae. Between them are intervertebral discs, which act as shock absorbers and provide mobility. The lower back can withstand increased stress throughout the day. This section is the basis of the spine; it bears the entire weight of the body. At the same time, the vertebrae are protected from destruction by the discs, which take on almost the entire load.

Intervertebral discs are flat cartilaginous formations. Inside the shell of fibrous tissue there is a semi-liquid core that acts as a shock absorber. When under stress or injury, the disc compresses and springs, protecting the vertebrae. But sometimes fibrous membrane bursts, the core leaks through it. It may compress the spinal cord or nerve roots. This is how a herniated lumbar disc is formed.

The cause of destruction of the fibrous ring may be degenerative changes in cartilage tissue, arising due to impaired blood supply and tissue nutrition. This has been happening more and more recently due to a sedentary lifestyle, since the lining of the disc receives nutrients only when the spine moves. Therefore, the fibrous ring gradually begins to crack, and the nucleus pulposus gradually leaks out.

But in certain situations, rupture of the annulus fibrosus may occur. This happens when there is an injury, a sharp bend or turn of the body, or lifting heavy objects. In this case, there arises sharp pain, which is associated with compression of the nerve roots.

Features of symptoms

Pathology manifests itself differently in each person. Sometimes symptoms intervertebral hernia lumbar pain increases gradually or no serious discomfort occurs at all. In other cases, severe pain appears immediately. It depends on which direction the nucleus pulposus protrudes, how much it affects the spinal canal or spinal nerves. It is the symptoms and their characteristics that become the diagnostic criterion for the doctor.

All manifestations of a hernia can be divided into three large groups:

pain syndrome;
spinal syndrome;
radicular syndrome.

The severity of these symptoms may vary and depend on the stage of the disease, how much nerve roots are affected, and general condition spine.

On late stages pathology, the characteristic signs of a hernia are the so-called “cauda equina” syndrome. It includes paralysis of one foot, absence of the Achilles reflex, loss of sensation in the legs, and disruption of the pelvic organs.

Signs of the initial stage

At the first stage of disc destruction, when cracks just appear on the fibrous ring, pathology does not cause special problems to the patient. But the effectiveness of treatment depends on how early it is started. Therefore, it is very important to recognize the first symptoms in time lumbar hernia and consult a doctor.

First, the patient feels a dull aching pain in the lower back. They are not strong, not even everyone pays attention to them. Fatigue and some stiffness in movements may appear. Such symptoms are often inconsistent and occur from time to time, so diagnosis of the disease at this stage is rare.

Gradually the symptoms increase. The pain intensifies when bending the body, turning, or lifting heavy objects. It begins to spread along the sciatic nerve to the leg. May increase muscle weakness. But such symptoms usually occur after exercise and go away while lying down. At this stage, it is still easy to get rid of the hernia, but if the patient does not see a doctor, the symptoms will gradually increase.

Pain syndrome

Pain is the main symptom of a herniated disc in the lumbar spine. It can be of varying intensity, appear independently or together with other symptoms. But it occurs in any case.

At the initial stage of a hernia, pain appears in the lumbar region. It is not strong, usually associated with load. But as the pathology progresses, the pain increases and spreads. This is due to the fact that the hernia grows and compresses the membranes of the spinal cord or nerve roots.

At this time, the pain intensifies when bending over, turning the body, raising the leg from the side of the affected nerve, when long walk or lifting weights. Increased pain can also be caused by coughing or sneezing, or any shaking of the body. Gradually, when the bulging disc affects the nerve roots, the pain becomes sharp, shooting or burning. A lumbago occurs in the lower back, which can last from several hours to several days.

Now the pain is felt not only in the back. It affects the buttock, thigh, lower leg and even foot. Usually such sensations occur only on one side. Often shooting pain in the leg prevents the patient from walking and even standing. It can intensify with prolonged sitting, and only subsides when lying on the healthy side with a bent leg.

IN severe cases intervertebral hernia, the pain becomes so severe that the patient is saved only by painkillers. After all, even in a lying position it does not go away. The patient tries to move less, which leads to the progression of degenerative changes in the disc due to deterioration in its nutrition.

Spinal syndrome

Because of constant pain When a herniated spine occurs, a spasm of the back muscles occurs. As a result of the fact that the patient seeks a body position in which it is easier for him, body distortion often occurs. Stooping or scoliosis develops. Sometimes one leg is shorter than the other. This leads to gait disturbance and loss of stability. In addition to pain and muscle spasms, other symptoms develop. They are related to the direction in which the hernia protrudes.

With lateral protrusion, the roots of the spinal cord are compressed. This may interfere with work internal organs, for which these nerves are responsible. If the hernia protrudes in the posterior direction, the spinal cord trunk is compressed. In the presence of such a vertebral symptom, there may be a disruption in the functioning of the pelvic organs, most often urinary or fecal incontinence. Intestinal upset often develops, regardless of food intake. There may be frequent urge to urination, and urine is released in small quantities. In men, potency gradually decreases, prostatitis appears, and in women they develop gynecological diseases and frigidity.

In addition, the location of the disorders is related to which segments of the spine are damaged. Most often, a hernia occurs between the 4th and 5th lumbar vertebrae or in the area of the lumbosacral joint. Compression of the spinal nerves in front of the 5th vertebra causes pain and numbness in the outer surface hips, in the area tibia, on the back of the foot. A characteristic feature such a lesion is the inability to move thumb, as well as foot drop. If the sacral joint area is affected, symptoms spread throughout the buttock and back surface legs. The pain radiates to the heel, and there is also an absence of the Achilles reflex.

Radicular syndrome

Prolonged compression of the spinal cord roots by a herniated disc can lead to their death. This condition is accompanied by certain symptoms.

On initial stage weakness of the leg muscles occurs. It gradually increases, so that problems arise in squatting, jumping, and raising on toes.
Muscle atrophy gradually develops. The leg becomes thinner and becomes much weaker. Because of this, the asymmetry of the torso is noticeable.
The functioning of the knee and hip joints may be impaired. This is accompanied by difficulties in movement, for example, a phenomenon called intermittent claudication occurs.
Sensory impairment often develops. This manifests itself in numbness of the skin, a feeling of goosebumps, tingling, and coldness of the fingers.
As the damaged nerve progresses, the condition of the skin changes. It could be increased work sebaceous glands or, conversely, dryness, hair stops growing.
In severe cases, death of the nerve roots leads to paralysis of the lower extremities.

When urgent medical attention is required

In some cases, it is necessary to start treatment immediately. For example, with compression of the spinal cord trunk or with a sequestered hernia, when the nucleus pulposus completely comes out of the fibrous ring. These pathologies can threaten the patient's life.

Therefore, you need to urgently call ambulance if the following symptoms appear:

strong unbearable pain, not removable by any means;
complete loss of sensation in the hips, buttocks, and groin area;
problems with bowel or bladder movements;
paralysis of the feet, foot drop, which leads to the inability to stand on tiptoes;
the movement of the spine is severely limited;
cauda equina syndrome occurs.

Ignoring this condition is dangerous, as it can lead to complete paralysis of the lower limbs. But even in mild cases, the patient loses the opportunity to lead a normal life. Therefore, treatment of a hernia should begin as early as possible, when the first symptoms appear.

Exercises after surgery on the lumbar spine for a hernia are a necessary rehabilitation complex of physical exercises. Every person who has suffered this major surgery, you need to understand that without proper rehabilitation and physical exercise it is impossible to get back on your feet and return to active life. What is gymnastics after removal of a hernia of the lumbar spine, what is its benefit and how to perform such exercises so that they do not cause harm to the patient.

What are the goals of gymnastics, what are its benefits?

Performance special exercises within the framework of restorative physical education - the most important task of any rehabilitation program. The goal of exercise therapy during rehabilitation after removal of an intervertebral hernia is to help a person quickly begin to actively move.

Of course, surgery to remove such a hernia is very difficult and requires high skill of a neurosurgeon. And in order to smooth out the negative consequences of such interference in the activity of the spine, the patient needs to begin systematic exercises as early as possible. Moreover, in the late and delayed rehabilitation period, you should not only do all the exercises after removal of the intervertebral hernia, but also move more: swim, walk, participate in sports games, etc.

The need to perform therapeutic exercises after such a serious intervention is determined by the following goals:

relief from pain;
recovery normal functions the area undergoing surgery;
normalization of the activity of the spinal disc and the entire spine as a whole;
strengthening muscles and preventing their atrophy;
recovery motor activity;
elimination of physical restrictions in the postoperative period.

Patient's actions in the first days

During this time, a person is prohibited from any load. Strict shown bed rest. Sometimes, when lying down, you may experience a feeling of heat, weakness and pain. In the future, the person’s activity is limited, and at the same time he is prohibited from sitting.

Such restrictions are necessary to exclude complications on the spine, relapse of the disease and other phenomena. As a result, after such a serious intervention, the path to restoring impaired spinal functions will be very difficult. However, it must be completed in order to quickly begin an active life.

What does intensive rehabilitation include?

Physical education in postoperative period is mandatory. The patient is discharged from the hospital after about a month if the operation was performed using the open method, and after approximately 2 weeks if it was done using endoscopy. However, in both cases, not only charging is necessary, but also comprehensive measures to restore spinal mobility.

Intensive rehabilitation with the help of physical therapy is prescribed to the patient from the second month after surgery. Exercise therapy is performed only under the supervision of a rehabilitation specialist. In parallel, the patient is recommended for sanatorium-resort treatment.

At the early recovery stage, the following rehabilitation exercises are performed:

Gently bend the leg in a supine position. At the same time, you should try to press your knees to your chest. You need to stay in this position for about 45 seconds, then slowly return to your previous position.
In a supine position, spread your arms. The lower limbs bend at the knees. In this position, you must try to raise your pelvis. At first, you should try to maintain this position for about 10 seconds, then gradually increase this time.
Rotate your legs (on your back), while the limbs themselves are bent at the knees.
In a pose with support on your knees and hands, you must simultaneously extend the opposite limbs in a horizontal position. Try to hold them in this position for at least 5 seconds. Then you need to swap arms and legs.
In the position on the stomach, it is necessary to raise the straight lower limb upward, and the pelvis does not come off the floor. In addition, without lifting the pelvis, you need to lower the lower limb.

In the early rehabilitation period, such exercises are intense. And if a person experiences pain while performing gymnastic exercises, he needs to either reduce the intensity of the loads or temporarily stop doing them.

Some simple exercises to restore the spine

Of course, after intensive rehabilitation, gymnastics does not stop. It must be performed regularly and without interruptions in order to prevent deterioration and recurrence of lumbar intervertebral hernia.

List of some exercises that need to be performed while lying on your back:

clench your palms into a fist and pull your feet up, raise your head a little, then return to your previous position;
simultaneously pull your knees to your chest (this should be done so that tension is felt in the buttocks);
arrange the bent ones lower limbs and try to tilt your right knee towards the opposite heel (then you need to do it for the opposite leg);
stretch your arms wide and in this position reach with your left hand right palm(while the hips should be motionless), repeat the same for the right hand;
place your feet together and bend your lower limbs, place a ball between your knees, alternately squeeze and relax your knees;
resting your feet on the floor, carefully lift your pelvis;
press the floor with your feet in a lying position in turn;
place your palms over your chest and squeeze them with force;
rotate the feet, while placing the lower limbs as wide as possible;
perform exercises like “bicycle” while lying down.

Side and stomach exercises

At the same time, it is necessary to perform simple gymnastic exercises lying on your stomach. It must be remembered that if you lie on your left side, then the right limb is located under the head (or vice versa). A few simple side exercises:

pull your knees towards your stomach (while exhaling);
raise both legs, making them straight;
raise your leg as you inhale, and lower it as you exhale (then, turning over, do the same for the left limb);
pull forward upper limbs and try to raise your torso a little;
raise your leg (your hands should be placed under your chin).

Here are simple exercises that are performed on the stomach:

rest your chin on your hands, rest your feet and raise your knees (muscle tension in the buttocks should be felt);
pull the knee to the elbow (do it alternately for the right and left sides);
bend your leg at the knee, while turning your head.

Although these exercises are simple, they do not need to be performed for a long time. It is necessary to monitor your well-being and reduce the load if severe pain occurs.

Features of rehabilitation and physical therapy in the late period

In the late rehabilitation period, the patient, under the supervision of a doctor, begins to work on muscle restoration. At the same time, he can count on a significant increase in the intensity of physical activity. These same factors help strengthen muscles and further enhance a person’s lifestyle.

Gymnastic activity at this time is supplemented manual therapy. It is necessary to take courses of therapeutic and preventive massage at least twice a year. Such a complex effect helps restore blood circulation in the damaged spine, quickly returning a person to an active and varied life. A targeted complex effect on a person helps him prevent a recurrence of the hernia.

And for physical education to bring maximum benefit, such a person needs:

do not lift things heavier than 9 kg;
do not jump or stand for a long time;
try to prevent hypothermia (to do this you need to wear a scarf or a special belt on the lower back);
The corset will no longer be needed at this time (moreover, it can be harmful because it can cause atrophy).

What types of exercise can provide the most benefits?

Efforts spent on physical therapy may be in vain if a person does not adhere to the basic recommendations of the doctor. They are simple, but the treatment of the intervertebral disc will depend on them:

It is strictly forbidden to overcool. After classes, you need to take a shower (warm) to relax your muscles. During the cold season, you should dress warmly. Even in warm weather you need to wrap your lower back.
It is not recommended to sit for a long time. Periodically you need to change your body position to avoid unnecessary strain on the vertebrae.
You can't stand for a long time. If you do this for a long time, then there may be painful sensations. When it is not possible to lie down a little, it is better to walk around or carefully do a few squats.
Lifting heavy objects is strictly prohibited. Even in the first year after surgery, you should not lift anything more than 3 kg. In the future, the load can be increased.
It is recommended to lift all objects only with a straight back.

Physical education after surgery to remove an intervertebral hernia is vital for the patient. It is a mistaken belief that you need to try to move less. Without physical activity it is impossible normal operation any organs human body. In addition, the spine will be able to function normally after such an intervention; it just needs to be loaded correctly. However, this must be done very carefully and only under the supervision of highly qualified specialists.

What is osteophyte: causes and treatment of marginal bone growths

Bone growths on joints are called osteophytes, and a similar phenomenon in general is osteophytosis. Often they do not make themselves felt until they become extensive, causing long-term permanent or short-term, but intense pain and limited mobility. They are usually detected during a comprehensive examination after radiography.

Osteophytes can be localized on:

Joints of the hands and feet;
Spine;
Large joints of the upper or lower extremities.

Most often, osteophytosis occurs after injuries such as moderate and severe limb fractures, such as side effect at joint pathologies caused by degenerative-dystrophic changes in tissues and their destruction (arthrosis and arthritis of various types).

In some cases, osteophytes occur during a long-term inflammatory process in bone tissue. Metastases from other organs affected cancer diseases, also sometimes contribute to the development of osteophytosis. Diabetes– another factor provoking osteophytosis.

Often osteophytes are also called bone spurs; they can form from almost any bone tissue. Typically, these growths have a cone- or spike-shaped shape; if they are extensive, the mobility of the joints is significantly limited.

In addition, osteophytes can cause severe pain if the nerves are pinched. The range of human movements is sharply limited depending on their location - it becomes difficult to squat, bend, turn or move a limb to the side.

In this case, osteophytosis requires treatment, usually surgery.

What it is

Osteophytes are bone growths, so named because of their appearance. Literally translated from Greek this medical term means "bone spur". Sometimes you can find another name for osteophytes - exophyte. In fact, exophyte and osteophytes are the same thing.

Osteophytes can be single or multiple, resembling spines, cones, hills, tubercles or processes. Their structure is the same as bone tissue.

Highlight the following types osteophytes:

Compact;
Spongy;
Metaplastic;
Osteochondral.

Osteophytes and osteophytosis can be successfully treated, including with folk remedies at home. If treatment is ineffective, they are removed.

The different types of osteophytes are discussed in more detail below.

Compact osteophytes

Bone tissue contains the so-called compact substance. Osteophytes of this type are its derivatives. The compact substance is indispensable in the formation of bones; in fact, it is their main part. This substance performs the following functions:

Protective – compact substance is the outer layer of bones. It is very durable and can withstand heavy loads.
Nutritional – reserves of various minerals, including calcium and phosphorus, are stored here.
Construction – up to 80% of the human bone skeleton consists of compact bone substance.

The compact layer is homogeneous in structure, it is especially dense in the middle sections of long and short tubular bones - fibula, tibia, femur, radius, ulna, humerus, foot bones and phalanges of the fingers.

Compact osteophytes most often form on the metatarsal bones of the foot or on the phalanges of the fingers of the upper and lower extremities.

Because the growths form at the ends of long bones, they are also called marginal osteophytes.

Spongy osteophytes

This type of osteophyte is formed from spongy bone tissue. These tissues have a special cellular structure formed from partitions and plates. The spongy substance is loose and not as dense as the compact one. It is this substance that forms the epiphyses - the marginal sections of the tubular bones.

The ribs, sternum, wrists, and vertebrae are entirely made of spongy tissue. Inside these bones there is red marrow, which is directly involved in the process of hematopoiesis.

If very heavy loads are placed on the spongy tissue, the formation and growth of osteophytes begins.

Osteochondral osteophytes

This type occurs when the structure of the cartilage tissue changes. In a healthy joint, all surfaces are covered with a cartilage layer. She performs very important functions: thanks to cartilage, the sliding of the articular elements relative to each other during movement is ensured, rather than friction, which would otherwise destroy bone tissue. In addition, cartilage serves as a shock absorber.

But if on cartilage tissue A disproportionate load is regularly given, if an inflammatory process occurs in the joints and their degenerative changes occur, the cartilage loses its density and elasticity. It dries out and begins to deform.

Then the bone tissue, the mechanical impact on which increases, begins to grow. The formation of osteophytes in this case is a protective reaction of the body - in this way it tries to increase the area of the joint and distribute the load. In this case, osteophytes of the hip joint often develop.

The location of osteochondral osteophytes is large joints, knee or hip.

Why does osteophytosis occur?

Disruption of metabolic processes in the body is the very first and most common cause of the formation of osteophytes. Often this phenomenon is a consequence of excessive stress on the joints, which causes the destruction of cartilage. Injuries of various origins can also cause the development of osteophytes.

It is obvious that treatment of osteophytes should first of all be aimed at eliminating the root cause.

Their formation can be prevented if you treat the disease, which can become an impetus for this, and treat injuries in a timely and complete manner

Treatment of osteophytes

Identification of osteophytes in itself is not enough to begin treatment. It is imperative to establish the reason for their appearance. It is believed that if the growths do not cause pain and do not reduce mobility, then their treatment is not necessary.

If there is severe pain due to pinched nerves, then it is necessary to remove them surgically. Surgery is never performed just to eliminate osteophytosis. Eliminated first the main problem in joints and bones. What type of surgery will take place and on what scale depends on the degree of joint damage.

For example: osteophytosis of the knee joint is diagnosed, treatment conservative methods, just as treatment with folk remedies did not bring results, surgery is indicated. In this case, it is first necessary to correctly align the elements of the knee joint and, if necessary, remove damaged parts of bones and cartilage. If required, completely worn-out cartilage is removed and replaced with mosaic grafts, and damaged bones are replaced with titanium implants.

Thus, osteophytosis is a consequence of other pathologies or injuries in quite neglected form. His treatment is only a step in complex therapy main disease.

Spinal surgery to install metal structures

Injuries spinal column Nowadays this is far from uncommon. Various kinds Both older people and very young people have problems with the spine. Modern medicine has long been armed with effective methods for treating fractures and injuries of the spine. One of the methods is an operation to install a metal structure directly on the bones of the spine. This is practiced in case of damage to the spinal column.

Why can the spinal column become damaged?
In what cases is an operation to install a metal structure necessary?
Classification of metal structures
- Rehabilitation Tips
- Contraindications to removal of the structure

Today we will tell you how such a device can shorten the period of rehabilitation after injuries and how wearing it affects a person’s everyday life.

Why can the spinal column become damaged?

Eat a large number of reasons that can cause back injury. As a rule, this happens when there is excessive impact on one or another part of the spine. Among the common reasons:

falling from a great height;
impacts during collapse;
car accident.

The most fragile parts of the spine are most susceptible to injury:

lumbar;
cervical.

This can lead to death or lifelong immobilization. But to understand the nature of spinal injuries, you need to know their classification.

The nature of this damage is as follows:

mild bruises that do not require surgery because they do not leave behind severe clinical manifestations;
injuries that occur as a result of degenerative processes of intervertebral discs or ligamentous apparatus. Requires surgery - the damaged structure is restored or changed;
fractures of vertebral bodies, arches or processes;
fractures or dislocations;
dislocations and subluxations.

In what cases is an operation to install a metal structure necessary?

Cervical and lumbar region The spine is exposed to the following pathological processes during injuries:

reduction in the diameter of the spinal canal;
changes in the ligamentous apparatus and intervertebral disc of a degenerative-dystrophic nature;
intervertebral hernia.

In these cases, prosthetic surgery is prescribed. The patient is fitted with special plates that stabilize the specified part of the spine and immobilize the part or segment.

This treatment method is widely used for various injuries spines. Such an operation minimizes the rehabilitation period; the patient can soon return to his usual lifestyle.

Classification of metal structures

Thanks to modern technologies, metal structures used for operations of this kind can have different sizes and shapes. They are classified as follows:

when installing structures inside the bone canal (intramedullary osteosynthesis), solid or hollow rods are used, as well as intramedullary rods, both with and without locking;
with extramedullary osteosynthesis (installation of structures on the bone), staples, screws and plates are used.

Compared to previous years, rehabilitation after such operations is quite fast.

Rehabilitation after surgery and its features

With any injury, the body needs to recover and this time greatly depends on many different factors.

Surgeries on the spine are among the most complex and traumatic, because it protects another important organ – the spinal cord. The rehabilitation period after spinal injuries can range from 2-3 days (hernia surgery) to several years (paresis, organ paralysis or spinal cord injuries).

And the wider the area of fixation of the vertebral bodies, the longer the rehabilitation period will be, including bed rest. During these operations, the dynamics of the body's recovery are monitored using x-rays, pictures are taken every week. During the same period, the specialist engages in physical therapy with the patient, speeding up the recovery period. In addition to physical education, the patient is prescribed physiotherapeutic procedures and massage of the limbs. Soon the person will be able to get out of bed and start walking. If your back hurts after surgery, you should tell your doctor. There is probably a need to change the method of pain relief.

To ease the patient’s condition after the operation and learn to walk with metal structures (fusion time is on average 3-4 months), he needs to wear a special medical corset. You will need to wear it for about a year, and the process of adaptation to a foreign design can last up to 2 years.

The measures already listed for the rehabilitation of the spine improve blood circulation and develop ligaments and joints:

Do physical therapy exercises every day. They help not only to restore the former functions of the back, but also to strengthen the muscles, and this, in turn, helps to significantly ease the load on the vertebrae by wearing a muscle corset;
Massage your back regularly. This procedure will increase blood flow to the area of injury, and the more blood circulates in this area, the faster the spine will recover;
A fairly popular and relatively old method of rehabilitation is physiotherapy. This method works through natural factors such as laser, ultrasound, cold, heat and magnets. This treatment helps improve blood microcirculation, develops the body's regenerative abilities and has a beneficial effect in every possible way;
Reflexology is a controversial method of spinal rehabilitation after surgery. It involves influencing certain points on the body and allows you to tone the muscles and increase blood flow.

It is very important to remember to take care of your sutures after surgery. If hygiene is not observed, the suture material will become an entry point for infection. This can provoke inflammatory changes and rejection of the installed material will begin. In such cases, it is not excluded deaths. If the suture material becomes infected, the patient is prescribed a minor operation; in this case, the old material should be removed, the wound should be re-treated and sutured.

Why are metal structures sometimes removed?

The reasons why metal structures must be removed can be absolute or relative.

TO absolute reasons include the following:

There are fewer relative reasons for implant removal:

psychological factor or desire of the patient. Not everyone can calmly relate to the presence of a foreign body in the body;
physical discomfort when the structure prevents you from doing certain actions or wearing clothes.

Contraindications to removal of the structure

If the patient asks the doctor to remove the structure, he must weigh the pros and cons of repeated surgery. The contraindications in this case are:

After a period of rehabilitation, the restoration of lost functions begins, and in severe cases they can be restored at least partially. But remember that if repeated trauma occurs in the affected area, it may cause more serious complications, which will take a longer time to treat.

Moderately traumatic surgical interventions can cause significant pain after surgery. At the same time, traditional opioids (morphine, promedol, etc.) are not suitable for patients after such operations, since their use, especially in early period after general anesthesia, is dangerous for the development of central respiratory depression and requires monitoring the patient in an intensive care unit. Meanwhile, due to their condition, patients after such operations do not require hospitalization in the intensive care unit, but they require good and safe pain relief.

Almost everyone experiences some pain after surgery. In the world of medicine, this is considered more of a norm than a pathology. After all, any operation is an intervention in the entire system of the human body, so it takes some time to recover and heal wounds for further full functioning. Painful sensations are purely individual and depend both on the postoperative condition of the person and on the general criteria of his health. Pain after surgery can be constant, or it can be intermittent, intensifying with body tension - walking, laughing, sneezing or coughing, or even deep breathing.