Discopathies

Discopathy refers to a generic suffering and alteration of the intervertebral disc, the cushion placed between one vertebra and the other which aims to cushion loads and facilitate movement.

The vertebral column, on the sagittal plane, is made up of 4 curves, the sacral curve: it is rigid as the sacral vertebrae are fused together; it is a curve with anterior concavity. Lumbar lordosis with posterior concavity, dorsal kyphosis with posterior convexity and finally cervical lordosis with posterior concavity. These curves are used to cushion the loads, this system of curves, in fact, exponentially increases the dynamic resistance of the column to axial compressions. This resistance is also related to the harmony of these curves, the radius of curvature must be neither too much nor too little. If there is an alteration of these curves (verticalization, inversion) this cushioning system fails and the intervertebral disc will be found to bear a greater load, going into suffering over time (discopathies), which may evolve into disc degeneration, protrusions, up to herniation.

Structure of the intervertebral disc:

the disc is made up of two distinct parts. A central part of the nucleus pulposus is a gelatinous substance made up of 88% water and chemically made up of a fundamental substance based on mucopolysaccharides. There are no vessels or nerves within the nucleus.

A peripheral part is the fibrous annulus formed by the succession of concentric fibrous layers.

The nucleus pulposus during the upright position, when subjected to pressure, tends to release water which is absorbed by the vertebral bodies. When this static pressure is maintained all day in the evening the core will be significantly less hydrated than in the morning, it follows that the disc has significantly reduced its thickness. On the contrary, during the night, in a lying position, the vertebral bodies are no longer burdened by the axial pressure due to the weight of the body, but subjected only to muscle tone. In this period the core attracts the water that passes from the vertebral bodies to the core which thus regains its initial thickness.

The diagnostic test useful for assessing the state of the intervertebral discs is the magnetic resonance with which the hydration status of the discs, any compressions or herniations, can be seen. The term ‘discopathy’ is often written on the reports, this indicates a non-specific suffering of the intervertebral disc which is often the basis of a pain in the spine; this term, however, should not cause alarm as this diagnosis is quite vague and imprecise. The situation is different when it comes to protrusion, herniation, etc.

Over the years the discs dehydrate and their function as shock absorbers diminishes. The consequences of a disc disease are linked precisely to the reduction of the cushioning capacity of the disc and the simultaneous loss of normal relationships between one vertebra and the other, the set of these processes can favor disc herniation and over time lead to the appearance of vertebral arthrosis. These abnormalities can irritate adjacent muscle and nerve structures, triggering pain. Although back pain is the most common symptom associated with discopathy, in most cases the pathology progresses completely asymptomatically.

The therapy of a generic disc disease is based on physiotherapy: mobilization, kinesitherapy, postural re-education etc.

Herniated discs deserve a separate discussion: one of the solutions often proposed is surgical intervention which would have the advantage of resolving the symptoms in a short time.

The study of Henrik Weber in 1983 over 280 patients exanimated respectively 1, 4 and 10 years from the diagnosis of hernia showed however that the long-term results were more satisfactory and the patients for whom a conservative treatment was chosen. Moreover, other studies show that the clinical picture of patients diagnosed with a hernia improve in most cases spontaneously in 4-6 weeks from the onset of symptoms and, other studies confirm that 20-30% of asymptomatic patients of age less than 60 years shows a lumbar hernia on magnetic resonance imaging.

Most operators in the sector therefore agree that in the case of a herniated disc there is a surgical indication only where:

• the conservative treatment has failed;
• despite this the patient is subject to recurrent sciatica;
• the motor deficit is really significant;
• there are symptoms of cauda equina syndrome (urinary retention / incontinence, fecal incontinence, erectile dysfunction …)

Therefore, by choosing a conservative approach to herniated discs, physiotherapy can be used to overcome the painful episode. Starting from the first days when alongside any analgesics and rest instinctively sought and, at times “self-prescribed” by the patient, you can make use of the help of decontracting / reflexogenic massage therapy, of exercises and antalgic postures (McKenzie), of lumbar supports and then move on to postural re-education (Souchard, Mézieres, Wellback…) and back-school. Our staff makes use of professionals specialized in the various methods and able to recommend the most suitable path after an initial evaluation.