Diagnostics

Do protrusion and epidural anesthesia affect each other? Epidural anesthesia: principle of action and application. Epidural anesthesia. Stages of anesthesia, mechanism of action of anesthesia, prescription criteria, epidural anesthesia during childbirth, complications and after

All surgical interventions, procedures, causing pain, in modern medicine, are performed under anesthesia. The type of anesthesia depends on the type, duration of the operation, and the general condition of the patient. There are two types of anesthesia: general anesthesia and spinal anesthesia, in which a specific area of the body loses sensation.

What is spinal anesthesia

If it is necessary to deprive the lower part of a person’s body of sensation during the operation, spinal anesthesia is given. The essence of this method is to inject an anesthetic into a specific place near spinal cord(in the back - that’s why this method came to be called that). This is the subarachnoid space, located between the meninges and the spinal cord, filled with cerebrospinal fluid (CSF).

Passes through the cerebrospinal fluid great amount large nerves, their transmission pain signals into the brain and needs to be blocked. Spinal anesthesia done in the area lumbar region, the area below the lower back is numbed. The anesthesiologist must pass the needle to the spine, intervertebral ligaments, epidural and meninges and inject the selected anesthetic.

Spinal anesthesia - technique

To carry out this method of anesthesia, a special (spinal) very thin needle, a syringe and a selected anesthetic are used. Very important point is correct position patient. This is emphasized during epidural and spinal anesthesia in order to avoid unsuccessful punctures. Spinal anesthesia technique:

anesthesia into the spine is done in the following position: the patient is in a sitting position (you need to bend your back, press your chin to your chest, bend your elbows) or lie on your side. A sitting position is preferable; the spinal area is better visible. Complete immobility is necessary to avoid complications during spinal anesthesia;
Before administering anesthesia to the back, the doctor uses palpation to determine the optimal location for the injection (the area between 5.4 and 3 vertebrae);
to avoid infection or blood poisoning, by special means the place where subdural anesthesia will be performed is processed, everything must be completely sterile;
local anesthesia is performed in the area where the spinal needle is inserted;
the needle for this procedure is long (about 13 cm) and small in diameter (about 1 mm), so in some cases local anesthesia is not performed;
the needle is inserted very slowly, passes through all layers of the skin, the epidural layer, and the hard membrane of the spinal cord membrane. Upon entering the subarachnoid cavity, the movement of the needle is stopped and the mandrin (a conductor that closes the lumen of the needle) is removed from it. If the action is carried out correctly, cerebrospinal fluid flows out of the needle cannula;
the anesthetic is injected, the needle is removed, and the injection site is covered with a sterile bandage.

Immediately after administration of the drug, the patient may experience a side effect: tingling in the lower limbs, spreading warmth, it lasts for a short time - this is a natural effect of anesthesia. Unlike epidural (half an hour), absolute pain relief with spinal anesthesia occurs within 10 minutes. The type of drug determines the duration of the anesthesia and depends on how long the operation will last.

Preparations for spinal anesthesia

Neuraxial anesthesia is performed various drugs: local anesthetics and adjuvants (additives to them). Common drugs for spinal anesthesia:

lidocaine. Suitable for short operations. Used in combination with fentanyl, for 30 to 45 minutes. provides the tenth block level;
procaine Short-acting drug. A 5% solution is used. To enhance the blockade, combine with fentanyl;
Bupivacaine. The difference is the relative performance indicators. The duration of the blockade level is up to an hour, it is possible to use more high doses(from 5 mg and above);
naropin. Used for long operations. Spinal anesthesia can be done with a 0.75% solution (3-5 hours of action) and 1% (4-6 hours);
adjuvants: adrenaline (extends block time), fentanyl (increases the anesthetic effect);
in some cases, morphine or clonidine is used as an additive.

Spinal anesthesia for caesarean section

Caesarean section is the surgical removal of the fetus from manual release placenta. Anesthesia is mandatory. Spinal anesthesia for caesarean section– the risk of drug exposure to the infant is eliminated. First spinal anesthesia for caesarean section was used in 1900 by Kreis. Spinal and epidural anesthesia is used almost everywhere, unless there are contraindications to use. The injection is given once during neuraxial anesthesia (which is the main difference with the epidural technique, where a catheter is inserted to administer the drug).

Contraindications for use this method the following: low platelet levels in the blood, decreased blood clotting, impaired heart rate, infectious processes in the area of drug administration. Recovery occurs quickly. The difference and main advantage compared to general anesthesia is extremely low risk dangerous complications for baby and mother, relatively low blood loss.

Spinal anesthesia during childbirth

The most common method of pain relief during childbirth is the main goal of its implementation is to eliminate pain during labor activity, ensuring comfort and safety for the mother and child. The drug is injected into the lumbar region and blocks pain. The time is calculated so that the effect of the drug decreases by the time of pushing, with the exception of heart defects or high degree myopia in a woman in labor. Lumbar anesthesia is recommended if:

a woman’s psychological unpreparedness for childbirth;
birth of first child;
if the fruit is large;
the onset of premature birth;
stimulation: after the rupture of amniotic fluid and the absence of labor.

Spinal anesthesia - contraindications

Indications for spinal anesthesia are varied; they are divided into two types: relative and absolute. TO relative contraindications relate:

emergency cases when there is no time to carry out all preparatory procedures with the patient;
unstable mood (lability) of the patient;
abnormal abnormalities spine structure;
birth defects or fetal death;
increased intracranial pressure;
the risk of bleeding and the uncertainty of the timing of the operation;
hypoxia, diseases of the central nervous system.

TO absolute contraindications This type of anesthesia can include:

patient's categorical refusal;
lack of conditions for resuscitation and poor lighting;
allergy to anesthetics;
skin infections: sepsis, herpes, meningitis;
intracranial hypertension.

Consequences of spinal anesthesia

As with any anesthesia, SA has natural consequences. The largest study on the consequences was conducted over 5 months. in France. The results and complications of spinal anesthesia in more than 40 thousand patients were analyzed. The number of serious complications is as follows:

death – 0.01% (6 people of the total);
convulsions – 0;
asystole – 0.06 (26);
root or spinal cord injury – 0.06% (24);
cauda equina syndrome – 0.01 (5);
radiculopathy – 0.05% (19).

Common negative consequences include:

bradycardia, a slowing of heart rate, which, if left untreated, can lead to cardiac arrest;
urinary retention (men suffer more often);
increased intracranial pressure;
spinal hematoma;
nausea, dehydration;
PDPH – post-puncture headache, common complication, causing patient complaints.

Spinal anesthesia price

Most Moscow clinics actively use the technique of spinal anesthesia. Many people are interested in how much spinal anesthesia costs. The price of this service varies, depending on the type of drugs used and other factors. If the need for this method of pain relief is justified medical indicators- it is carried out free of charge. Below are prices for spinal anesthesia in popular Moscow clinics.

Clinic name

Price for spinal anesthesia

SM-Clinic (Yartsevskaya St.)

8,000 rub. ( average price)

MC ON CLINIC (Zubovsky Ave.)

Spinal anesthesia reviews

Karina, 32 years old

The first time I had a caesarean section under spinal anesthesia was in America, since I was there. The second baby was “acquired” in Moscow. I want to say – there is no difference, except perhaps in price! Regarding complications, there were no complications, although I read reviews that many people subsequently suffer from headaches. I was completely satisfied - no pain!

Nina Alekseevna 56 years old

The operation was performed for varicose veins. The sensations from anesthesia are as follows: a slight tingling sensation, a feeling of diffuse warmth on the left, then right leg. Numbness started from the tips of my fingers, I also felt like my leg was being treated with an antiseptic, and then nothing at all. I was allowed to get up the next day, but at first I was a little worried about the puncture site.

Mikhail 43 years old

Stones were removed from the ureter under spinal anesthesia. The operation went without problems, no negative feelings. In the postoperative period I had to suffer - I had a severe headache for five days. On the advice of the doctor, I strictly observed bed rest (I almost lay in bed all the time) and drank a lot of fluids. It helped, after a week I was like a cucumber!

Epidural (epidural) anesthesia or epidural anesthesia is a type of anesthetic regional administration of synthetic dosage forms into the epidural space of the back, which is a plexus venous vessels and connective tissues located between the periosteum of the vertebral sections and the dura mater of the spinal cord. Spinal injections (shots) lead to a decrease or complete absence pain sensitivity and relaxation of musculoskeletal tissues. Let's consider all the pros and cons of epidural anesthesia, its technique, and also determine how epidural anesthesia acts on the human body and what are the main differences between this medical procedure and general anesthesia.

Anesthesiology is a section clinical medicine, studying methods of protecting the human body from surgical and/or postoperative effects. The main anesthetic task is anesthesia of vital organs by administering various types of medicinal anesthetics. Exist various ways achieving the task:

general anesthesia;
regional anesthesia.

General anesthesia provides the body with complete numbness caused by reversible processes of inhibition of the central nervous system.

Regional anesthesia allows you to limit pain relief only to certain areas of the body, using locally administered drugs, so-called local anesthetics. One of the varieties of this method local anesthesia- epidural block. The mechanism of action of this procedure is ensured by penetration pharmacological drugs into the epidural space of the vertebral system through the dural coupling (radicular pocket). The spinal vertebrae and nerve roots are surrounded by a special protective meningeal membrane, which is surrounded by the epidural space. The spinal epidural block begins to work after the insertion of a catheter with an anesthetic medicine into its spinal part. The mediator between the catheter and the meninges is the epidural needle. The lack of sensitivity in a certain systemic organ is explained by the blocking of pain impulses along the nerve branches of the spinal cord.

Epidural blockade (anesthesia) does not lead to a decrease in skeletal muscle tone and loss of general sensitivity, so it is sometimes used during childbirth. An indication for epidural anesthesia during obstetrics may be the need for surgical intervention.

To enhance the effect of local anesthetics, such as Bupivacaine, Lidocaine or Ropivacaine, in injection solution add a certain amount of narcotic alkaloids - Morphine, Promedol, Fentanyl and others. Such combination drugs for epidural anesthesia avoid side effects, For example:

nausea;
vomiting reflex;
respiratory depression;
headaches after epidural anesthesia;
dizziness, etc.

How long a particular opiate acts depends on the dosage of the narcotic alkaloid. For example, entered in venous artery Morphine can maintain an analgesic effect for postoperative pain for 3-5 hours, and 1 mg of a narcotic drug when administered into the epidural space will provide persistent pain relief for 15-20 hours.

Attention! Epidural blockades using Morphine are regulated by the legislation of the Russian Federation.

Execution method

The procedure or technique for epidural anesthesia is as follows. Before administering a drug combination, it is necessary to identify the needle entering the epidural cavity. After the needle tip penetrates through the yellow interspinous ligament, negative pressure should arise, that is, resistance from the dura mater. If the needle comes off, a syringe is attached to it and advancement continues. Control of instrument insertion is carried out as follows:

Loss of resistance method. Advancing the epidural needle when entering the space of the same name reduces resistance, and the syringe plunger moves forward easily.
Hanging drop method. When a medical needle is inserted, a drop of saline solution is suspended from its cannula (head, pavilion). If the needle passes through dense ligaments, the drop disappears into the needle lumen.

The second method can only be used by an experienced anesthesiologist.

Spinal block is performed at any level. Epidural anesthesia is available for the cervical, thoracic, lumbar and sacral spine. Most often intervertebral anesthesia performed for back or lower back pain. As a rule, an epidural sacral spinal block in the lumbar region is performed in the interspinous space between the L4 and L5 vertebrae.

Is epidural anesthesia during childbirth harmful to newborn babies, and why is it dangerous for women?

Pros and cons of epidural anesthesia during childbirth: any intervention, including treatment, in the spinal region spinal system requires certain medical reasoning. In usual practice, surgical treatment of the spine initially involves general anesthesia. Because of high probability possible side effects, epidural anesthesia is used only for special medical indications when general anesthesia is unacceptable. Each specific case is considered individually, and depends on the type and severity of diseases of the spinal system. A special case, this is epidural anesthesia in obstetrics. The task of the anesthesiologist is to minimize possible Negative consequences.

Epidural block during childbirth: indications and contraindications

Childbirth in women is perhaps the only case when, as a anesthetic General anesthesia is not used. The use of epidural anesthesia in obstetrics is possible for the following medical indications:

High pain threshold during childbirth.
Sudden change in fetal heart rate.
Manifestation of hypoxia (oxygen deficiency).
Emergency obstetrics.
Planned caesarean section, if there is a possible threat to the health of the child.
Deviation in labor.
Chronic diseases – bronchopulmonary clinic, arterial hypertension, diabetes etc.

Contraindications for epidural anesthesia during obstetrics are:

Pathological disturbance of the rhythm of heart contractions in a woman in labor.
Low blood pressure (110/60 mmHg and below) as a causal factor possible complication after epidural anesthesia.
Purulent infectious diseases in the puncture area due to a possible complication of epidural anesthesia - the spread of infection.
Chronic diseases of the spinal system of a neurological nature - osteochondrosis, spinal hernia, etc.
Risk of possible internal bleeding due to poor clotting.
Unsatisfactory tests - high white blood cells in the blood or low platelets.
The presence of various neoplasms.

It is important to know that contraindications to epidural anesthesia also include a woman’s refusal to undergo a medical procedure.

Failure to comply with these contraindications may have further negative consequences of epidural anesthesia.

Side effects after surgery and possible complications

After surgery, post-puncture syndrome is always possible, which manifests itself on the first day after the surgical procedure:

A woman experiences aching or nagging pain in her back after epidural anesthesia.
Headache with localized pain in the back of the head or frontal part.
In the injection area, minor inflammatory processes are possible - redness or hardening of the soft tissues.
As a result of the fall blood pressure Nausea or vomiting is observed.
Sometimes a slight allergic reaction occurs.
Some patients complain of mild tingling or numbness in the lower or upper extremities.

What should a person do and how to recover from post-puncture syndrome?

For such postoperative syndromes to subside, no special treatment is required, it just takes time. A good anesthesiologist must constantly monitor the situation. As a rule, after 1-1.5 days the headache will disappear, and back pain after epidural anesthesia can last from 2 to 5 days. Blood pressure and skin inflammation will stabilize as soon as all body functions are restored.

If your back hurts and surgery is necessary for medical reasons, then when choosing which is better, general anesthesia or local anesthesia, preference should be given to anesthesia. The exception is anesthesia during obstetrics. Most expectant mothers are interested in how much local anesthesia costs, and whether there is negative reviews after using it, how the child will feel. Subject to special medical indications is done completely free of charge. If a woman in labor desires absolute pain relief, such a medical procedure costs from 2 to 10 thousand Russian rubles. Cost depends on geographical location and prestige medical institution. The only significant “complication” for a woman after pain relief is a minor headache, which disappears within 1-2 days. The consequences for the child are difficult to predict. The negative is weak activity newborn during childbirth. Clinicians do not note any other pathological abnormalities.

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Advantages of this type of pain relief:

The amount of blood lost during surgery is reduced.
Less risk of developing such complications after surgery, such as thrombus formation, thromboembolism pulmonary artery.
Fewer surgery-related and anesthesia-related adverse effects on the heart and lungs.
No pain upon completion of the operation.
No weakness, feeling of nausea, vomiting.
There are no such strict restrictions on the intake of drinks and food in postoperative period.
With spinal anesthesia, you can communicate with the anesthesiologist and surgeon before, during and after surgery.

At your request, the anesthesiologist can induce a sleep-like state in you by injecting additional medications into a vein. But We do not recommend using this opportunity.

Anesthesia - types of pain relief

In modern medicine, two main types of anesthesia are used:

general - when the body’s pain perception function is turned off in parallel with the patient’s consciousness, that is, the patient is transferred to artificial sleep;
epidural - with the help of special manipulations, sensitivity is “turned off” only in a certain area of the body, and the person himself does not lose consciousness.

Spinal anesthesia is a type of epidural anesthesia. Most often it is used during childbirth.

This method helps keep the woman in labor conscious, and gives the baby the opportunity to be born independently. This painkiller is used during caesarean section and during simple childbirth, when it is difficult for a woman to cope with pain.

Drugs used in regional anesthesia

The doctor selects the anesthetic and its dose individually for each anesthesia, depending on the duration and nature of the surgical intervention. On average, 1-2 (ml) of the drug is used for each segment of the spinal cord where it is necessary to block.

The calculated dose of anesthetic is administered fractionally, in several doses.

Used for spinal anesthesia various kinds anesthetics that have various properties and give different effects in duration.

Alternative options really a lot, and therefore, even if you are allergic to any drug, there is nothing to worry about, the doctor will definitely select a replacement.

Here short list medications used in this method of pain relief:

Naropin
Novocaine
Mezaton
Buvanestin
Ropivacaine
Fraxiparine
Lidocaine
Norepinephrine
Bupivacaine (Bloccos)

Preparation for the procedure and technique

Does spinal anesthesia hurt? The entire procedure lasts about 20 minutes and does not cause any discomfort to the patient. discomfort. The injection in the back is painless.

Distinguish the following contraindications for spinal anesthesia:

Refusal of the patient from this method of pain relief.
Lack of conditions for resuscitation.
The patient has lost a large amount of blood.
The patient is dehydrated.
Decreased clotting blood. Treatment with drugs that reduce blood clotting.
Sespis (blood poisoning).
Infection of the skin at the puncture site.
Allergy to anesthetics.
Increased intracranial pressure.
Bradycardia (slow heart rate), heart rhythm disturbances. Heart defects.
Exacerbation of diseases caused by the herpes virus.
Diseases of the central nervous system.
Hypoxia, malformations and fetal death (with pain relief during labor).
Lack of necessary time for the procedure.

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Epidural anesthesia acts by creating a pharmacological blockade of the spinal roots - one of the basic structural elements spinal cord. Special preparations are used for this local anesthesia(bupivacaine, levobupivacaine, ropivacaine), opiates (fentanyl, sufentanil).

An anesthetic solution is injected into the epidural space between the dura mater of the spinal cord and the periosteum of the vertebrae, which makes it possible to block pain impulses from the spinal roots.

To increase the duration and intensity of pain relief, add to the solution local anesthetic special substances are added - vasoconstrictors, which narrow blood vessels (ephedrine, phenylephrine, adrenaline).

Before administering anesthesia, the doctor examines the patient to rule out problems in lumbar region, skin diseases and other contraindications. Preparation includes a blood test for hemoglobin and hematocrit number.

This will help identify anemia, which can cause complications such as arterial hypotension– lowering blood pressure. According to indications, a study is carried out on the value of prothrombin time to ensure normal blood clotting.

Advice: the patient should know that epidural anesthesia can only be performed in an operating room, which will be equipped with equipment for monitoring his condition, resuscitation measures, general anesthesia.

How is epidural anesthesia given? Preparation includes treating the skin with antiseptics and the patient taking the desired position (lying on his side or sitting).

The doctor then palpates the iliac crests and selects an area to puncture. When he no longer feels resistance as the needle passes, it means the epidural space has been reached.

If the doctor did everything correctly, there will be no pain.

Then a “test dose” of a local anesthetic solution is injected and supplemented with an anesthetic drug, or a thin catheter is passed through the lumen of the needle for fractional (gradual) administration.

At the point where it emerges from the skin, it is fixed with an adhesive plaster. Before the immediate effect of anesthesia, warmth and numbness are felt in the lower extremities.

It begins within a few minutes, and the duration of the effect can be adjusted by adding a new dose of drugs.

Advice: the patient has every right to refuse this particular type of anesthesia, even if there are no contraindications. The argument may be personal desire, unpleasant experience, painful procedure. A local anesthetic solution is used to numb the process.

READ ALSO: Exercises for hernia of the lumbar spine

Other complications

The use of epidural anesthesia carries less harm to the human body, rather than general.

But here the qualifications of the anesthesiologist largely play a role. The fact is that not only the effect of pain relief, but also its consequences depends on how the puncture is performed correctly.

In addition, it is worth noting that the disease itself plays an important role, which will be eliminated surgically. In addition, you need to take into account:

severity of the disease;
patient's age;
general state health and human body;
are there secondary diseases, and at what stage of development they are;
does the patient have bad habits, and what kind of life he led before the operation.

But still, before agreeing to the procedure, it is worth knowing what complications may arise during spinal anesthesia:

After surgical intervention will be over, the patient will feel nausea and headache. To get rid of such symptoms faster, it is best to spend this day in bed and drink more warm liquids.
Also, at first, blood pressure readings will be low. To eliminate this consequence, the patient should again drink a lot of fluids, and the doctor should administer special drugs intravenously that increase blood pressure.
For several days after the operation, the place where the puncture was placed will still hurt; as such, no treatment is required; you just need to try to ensure that this area has less contact with objects, for example, sleep on your stomach, if this is permissible after the operation.
Among men, such a consequence as problems with urination occurs. Usually this problem goes away after a day after the operation is over.

Neurological disorders may also occur, which manifest themselves in the form of tingling in certain areas of the skin, or skin will partially lose their sensitivity.

Weakness of the leg muscles may also occur. Just in time last reason, women who have undergone a spinal puncture during childbirth should not get up for the next 4 hours.

After all, standing with a child in their arms, their legs may simply give way and they will drop the child.

Allergies may also occur.

But it makes itself felt if the doctor has chosen the wrong anesthetic solution for his patient.

Still, it is worth noting that all of the above-mentioned complications are not so severe and, with a timely response, can go away in literally 1-2 days. But for the sake of fairness, it is necessary to stipulate that this method of pain relief can also cause more serious problems - bradycardia, spinal or epidural hematoma.

The most serious problem for the patient when it occurs is acute pain. Appearing with any movement, it often does not subside for a minute.

This complicates treatment, limits the patient’s movement, significantly reducing the quality of life. If the pain does not respond to painkillers in the form of tablets, experts recommend an epidural block.

The technique is not a treatment for spinal pathology, but has an analgesic therapeutic effect.

Unlike injections of novocaine into the spinal column, epidural blockade for a herniated disc affects tissues that lie quite deep.

Manipulation requires special high-precision equipment and good classification doctor It is performed only for lumbar hernia.

Indications for the procedure

This method involves the introduction of a complex of drugs through a special catheter directly into the epidural area. This allows:

effectively relieve acute pain;
relieve spasms, relax the lower back muscles as much as possible;
deliver the medicine directly to the center of the injury.

Using the added contrast agent the anesthesiologist monitors the degree of distribution of the therapeutic composition.

This allows the specialist to monitor the accuracy of insertion and passage along the vertebra using a fluoroscope.

Sometimes it's the only one possible way pain relief and treatment for intervertebral hernia, .

Use for sequestered hernia

Doctors often diagnose local epidural edema. This is a serious complication that can lead to paresis of the limbs and disruption of the full functioning of internal organs.

Swelling impairs blood circulation in the lumbar region, causing excruciating pain.

A feature of the disease is its concealment under edematous tissue, which is why surgical intervention is often indicated.

Therefore, one option may be an epidural block, which helps:

inject drugs directly into the epidural space;
reduce swelling;
restore blood supply to muscles, nutrition of nerves;
achieve a lasting analgesic effect.

This great way eliminate pathology, achieve stabilization, remission, improve general and physical state patient.

Epidural anesthesia and spinal pathologies

Method of pain relief for a patient surgical intervention using epidural anesthesia is used for caesarean section, urological and gynecological operations.

At the same time, the question arises: is it possible to use epidural anesthesia for hernias or is it contraindicated?

This method of anesthesia is widely used by European specialists. There is sufficient experience working with patients with various pathological changes on disks.

Doctors are unanimous in the opinion that epidural anesthesia for a hernia of the lumbar spine is quite possible if the following contraindications are absent:

placement of the lunge directly at the required injection site;
large swelling of soft tissues, impairing the accuracy of the anesthesiologist’s work;
inflammatory processes on the skin;
spinal cord diseases.

The safety and ability to provide this type of anesthesia to many patients allows it to be used for operations on abdominal organs. For example, epidural anesthesia is increasingly used instead of general anesthesia for ventral hernia.

It is simply irreplaceable during laparoscopic operations, significantly reducing the patient’s recovery period.

Problems after manipulation

The technique of injecting drugs and anesthesia directly into the epidural area is gaining popularity. However, some are concerned about side effects, wondering if a hernia is possible after an epidural.

Patients often complain of back pain after the procedure. It often goes away within six months without a trace and is a reaction to the insertion of a catheter.

But the direct relationship between education as side effect was not recorded.

Spinal block is the fastest and most effective method relieve the patient from pain with painful changes in the vertebrae.

But this is a fairly serious manipulation that requires a highly qualified neurologist, precise work, and careful study of contraindications.

Only in this case can side effects be avoided. And you can prevent the appearance of a hernia only by changing your lifestyle and attitude towards your health.

Denial of responsibility

The information in the articles is for general informational purposes only and should not be used for self-diagnosis of health problems or for therapeutic purposes. This article is not a substitute for medical advice from a doctor (neurologist, therapist). Please consult your doctor first to know the exact cause of your health problem.

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Throughout life, the human spine experiences serious stress. Injuries, static overload (for example, carrying heavy bags), sedentary image Life over the years can cause spinal diseases.

The spine can be compared to a train, in which individual cars (vertebrae) are connected to each other through joints. Between the vertebrae there are elastic pads ( intervertebral discs), acting as shock absorbers that prevent the vertebrae from rubbing against each other. Inside each such disc there is a gel-like center (nucleus pulposus), surrounded by fibrous tissue. outer shell(fibrous ring). When loads are placed on the spinal column, intervertebral discs are displaced and compressed. If the integrity of the disc is maintained and it does not extend beyond the spinal column, then this does not lead to the development of the disease.

Protrusion and hernia: what is the difference?

The intervertebral disc does not have its own blood vessels, and feeds by penetration nutrients from the surrounding tissues of the spine. Malnutrition of the discs is the basis for the development of osteochondrosis. When the metabolism inside the disc is disrupted, it dries out, the height of the disc decreases, and the fibrous capsule delaminates, causing it to lose its strength. Under excessive loads, the bodies of neighboring vertebrae come closer together, they exert great pressure on the damaged disc, which leads to “squeezing” its contents out of the spinal column. If at the same time the fibrous ring retains its integrity, then such a protrusion of the disc is called protrusion. This is the first stage of the formation of an intervertebral hernia. This stage is reversible and with proper treatment and lifestyle changes occurs full recovery health.

If the pathological effect on the intervertebral disc persists, then at some point this leads to rupture of the altered fibrous ring and extrusion of part of the nucleus pulposus outside intervertebral disc. This is how a disc herniation forms. Once in spinal canal, the nucleus pulposus compresses the nerves located next to the disc, which leads to pain. First of all, those intervertebral discs that experience heaviest load. As a rule, these are the discs of the cervical and lumbar vertebrae. The thoracic spine is the least affected.

How does disc protrusion and herniation manifest?

The main symptom of a herniated disc is severe pain in the back or neck with any movement. Also, signs of the disease may include loss of sensitivity (numbness) in the skin of the neck, arms, legs, the appearance of “pins and needles” in the toes or hands, and pain in the joints of the extremities.

If the lumbar spine is affected, they also experience pain in the lower abdomen (often women take a long time to treat non-existent “inflammation in the appendages”), urination and defecation disorders.

Hernias in the thoracic region may be accompanied by a feeling of stiffness in the chest, pain in the heart, and shortness of breath.

Hernias in cervical spine manifested by pain in the neck, headaches, dizziness, and fluctuations in blood pressure.

IN severe cases Herniated discs can even lead to swelling, menstrual irregularities and infertility.

But disc protrusion on early stages formations may not manifest themselves in any way. Occasionally a person experiences pain in the spine after intense physical exertion.

An exacerbation of the condition is observed with significant physical exertion, including during pregnancy, when the spine of the expectant mother experiences enormous pressure. By the way, women often do not know before pregnancy that they have intervertebral disc diseases; problems appear already while they are expecting a baby.

Why do protrusions and hernias form?

The causes of the formation of protrusions and herniations of intervertebral discs are:

osteocondritis of the spine;
obesity;
anatomically irregular shape spine (scoliosis, joint dysplasia);
sedentary lifestyle life, sedentary work;
sport “suddenly” – sudden, unusual high loads, incorrect technique of performing movements, leading to spinal injuries;
poor nutrition and non-compliance with drinking regime.

Spine and pregnancy

Back pain is often called “normal” during pregnancy. However, so that developing spinal diseases during pregnancy do not lead to serious problems With health, painful manifestations in the back cannot be ignored.

The constantly growing uterus causes a deviation in the center of gravity, which changes the location of the vertebrae relative to each other, “tightens” the muscular-ligamentous apparatus and increases the load on the spine. Moreover, on average future mom gains 10–15 kg during pregnancy. If a woman is healthy, she has no diseases of the spine, pelvic bones and joints, she has strong muscles, and is not overweight, then the load during childbearing is distributed evenly and no problems arise. Otherwise, starting from the second trimester of pregnancy, existing disc diseases make themselves felt.

Changes dramatically with pregnancy hormonal background. Thus, the level of the main pregnancy-preserving hormone - progesterone - increases more than 100 times. Progesterone relaxes the vascular wall, the permeability of the vascular wall increases, which promotes edema nerve roots in places where they are compressed by a hernia. During pregnancy, the developing fetus actively uses calcium to build its own skeleton. If a woman does not receive enough of this element from food, it is “washed out” from the bones, including the vertebrae. On later pregnancy, active production of the hormone relaxin begins, it relaxes the muscles and ligaments of the pelvis and spine, which leads to increased shock-absorbing load on the spine.

A typical sign of unhealthy intervertebral discs during pregnancy is coccydynia - pain in the pelvic bones and tailbone, which radiates to the rectum, perineum and abdomen.

How to find out if there are hernias and protrusions?

To determine whether you have a protrusion or herniated disc, you will have to do an MRI - magnetic resonance imaging. Without an MRI, one can only guess about the existence of a disc protrusion or herniation based on symptoms, but it is impossible to clarify its size, location, or the presence of a rupture of the fibrous ring. However, this method is contraindicated for the first and second trimester of pregnancy. Therefore, at this time, they are limited to only ultrasound and blood tests (to exclude inflammatory in nature pain). In the third trimester, MRI is prescribed in case of severe pain or manifestations of compression nerve root and mobility limitations. This study provides comprehensive information to determine pregnancy management tactics and method of delivery.

In addition to MRI, they are also used to diagnose the disease. X-ray examinations– computed tomogram (CT) and CT myelography (using contrast agent), but they are also contraindicated during pregnancy.

Comprehensive preparation

If the existence of problems is known already before pregnancy, you need to prepare yourself in advance for the upcoming stress. Visit a neurologist or neurosurgeon and get an MRI to get information about the severity of the disease. At least six months in advance, start strengthening the muscular corset of the spine. There are many different techniques and programs: yoga, Pilates, kinesiotherapy, swimming pool, massage. All this will significantly delay the occurrence of complications during pregnancy and after childbirth and will allow you to maintain health.

Rules of conduct for diseases of the spine

Treatment of protrusion and herniated discs is the specialization of neurologists and neurosurgeons. But in the case of pregnancy, when everything medications, which enter the mother’s body, directly affect her unborn child, treatment should be coordinated with an obstetrician-gynecologist. It should be remembered that pregnant women should not use almost all painkillers in tablets and most painkillers ointments. Many physiotherapeutic procedures are also contraindicated.

Therefore, if a woman has already encountered spinal problems before pregnancy, it is necessary to begin preventing exacerbations of the disease as early as possible.

The main place in the prevention of exacerbations of the disease is occupied by physical therapy with a physical therapy instructor. It is important to remember that regular fitness activities can often cause an increase in symptoms. The physical therapy instructor will select for you individual complex daily exercises that will help restore muscle elasticity, strengthen them, relieve spasms and pain, restore blood supply and lymphatic drainage, and improve spinal mobility. In order for classes to be given positive effect, they should be regular, preferably daily, and in strict accordance with the doctor’s recommendations.

If you have a sedentary job, take short breaks every hour, stand up, stretch, do a couple of exercises or walk.

Walk outdoors more often.

Wear only comfortable shoes with heels no more than 3 cm.

Avoid sharp turns and do not carry heavy objects. Do not bend over too much when cleaning the house, wash the floors with a mop, use a long attachment for a vacuum cleaner.

You need to sit and sleep on hard surfaces; purchase orthopedic pillows (this will allow you to evenly distribute the load).

Starting from the second trimester of pregnancy, the doctor may prescribe wearing a bandage or a special corset that fixes the spine in the place where there is a problem. Relief from pain is provided by light dry traction with your own weight on a plane at an angle of 30°. It is performed on a special inclined board with holders for the shoulder section. You need to lie down on the board, put your hands in the straps up to your armpits, relax and lie down for 10–15 minutes. Such devices are usually available in special orthopedic offices; it is better to use them under the supervision of a doctor. Water traction in the pool will also help. It is performed only under the supervision of a specialist. The patient is immersed in a pool with warm water, fixing shoulder girdle. A load weighing from one to several kilograms is secured to the legs. The duration of the procedure is set individually for each patient and can range from a couple of minutes to an hour.

Eat right, don't gain weight. Among the mandatory products are dairy, fish, vegetables, herbs and nuts. They contain the necessary skeletal system calcium, magnesium, manganese and vitamins. Coffee, on the contrary, removes calcium from the body and can also interfere with its absorption. If you can’t give up coffee, drink it with milk: this will help maintain calcium balance. You should drink enough fluids to maintain electrolyte balance and remove from the body toxic substances. Salt in the diet must be limited.

In case of exacerbation of the disease, rest and moderate dry heat(heating to body temperature, maximum 40 °C). Herbal distracting ointments can be used as pain relief. In some cases, specialized massage and acupuncture are prescribed.

How will childbirth proceed with spinal diseases?

Childbirth requires significant physical effort from a woman. Unfortunately, like any other serious exercise stress, they can provoke an exacerbation of spinal diseases. During the pushing period of labor, the load on the intervertebral discs increases so much that nerves may be pinched by a herniated disc. Nerve compression appears severe pain, numbness of the legs, crawling sensation, lameness, disruption of the pelvic organs.

at large sizes hernias;
unfortunate location of the hernia when there is high risk her infringement;
with pronounced pain syndrome during pregnancy;
when spinal problems are combined with obstetric complications ( incorrect location fetus, placenta, narrow pelvis, large fetus) and other diseases (hypertension, gestosis).

In milder cases, you can give birth on your own. The question of the method of pain relief for labor and caesarean section is decided individually. Intervertebral hernia upper sections spine, with rare exceptions, are not a contraindication to spinal (epidural) anesthesia during childbirth and caesarean section. If there are hernias in the lumbar and sacral regions, then performing epidural anesthesia may have technical difficulties. The question of the possibility of using this type of anesthesia is decided individually by an anesthesiologist.