The intra spongy hernia is a little known condition, and very different from the herniated disc typical that we all know.
If you have been diagnosed with an intracancellous hernia (also called Schmorl's hernia or Schmorl's nodule), you're probably wondering what it is. What are the causes? Is that bad ? And above all, how to treat it?
This popular article explains everything you need to know about intra spongy hernia, from the diagnosis to the different treatments to get better.
Definition and anatomy
Before talking about intra spongy hernia, it is worth reviewing certain notions of anatomy that will allow you to better understand this condition.
The spine (or spine) is composed of vertebrae superimposed. The cervical region (the neck) includes 7 vertebrae numbered between C1 and C7. There thoracic region (or dorsal), for its part, comprises 12 vertebrae numbered between T1 and T12 (or even D1 to D12 according to nomenclatures). Then the lumbar region (the lower back) has 5 vertebrae numbered between L1 and L5. Finally, the sacral region (composed of the sacrum) has 5 fused vertebrae (although numbered between S1 and S5).
Between each vertebra, there is a intervertebral disc. For example, we call disc C4-C5 the disc which is located between the cervical vertebrae C4 and C5. At neck level. Or, the T-T12 disc is between the T11 and T12 thoracic vertebrae. Last example: the L5-S1 intervertebral disc is located between the last lumbar vertebra (L5) and the first sacral vertebra (S1).
In summary, intervertebral discs are structures located between 2 consecutive vertebrae. When we study the composition of these discs, we see that they resemble pads. More specifically, they are composed of a gelatinous core (Nucleus pulposus) in the central region, surrounded by a fibrous ring (Annulus fibrosus).
But what are the intervertebral discs for? Their roles include:
Role of intervertebral discs:
- The separation of the vertebrae from the spine
- Shock absorption during movements involving impact (walking, running, jumping, etc.)
- The distribution of pressures thanks to the gelatinous core
- Mobility between the vertebrae
What you have to remember is that the gelatinous nucleus can move inside the disc. This displacement can sometimes be the cause of disc pathologies.
Intracancellous herniation (and difference with typical disc herniation)
Typically, a herniated disc occurs when the fibrous ring surrounding the intervertebral disc is fissured, and allows the gelatinous nucleus to pass through its fibers. Most of the time, this migration of the nuclei is done laterally, and sometimes causes irritation of an adjacent nerve root.
To know everything about conventional disc herniation and its management, see the following article.
On the other hand, in the case of intraspongy hernia, the sliding of the gelatinous nucleus does NOT occur laterally. Rather, the nucleus migrates downward (or sometimes upward) toward the adjacent vertebra. It then penetrates the vertebral body of this vertebra.
Although an intracancellous hernia can develop anywhere in the spine, it mainly affects the thoracic and lumbar vertebrae (near the thoraco-lumbar junction). For example, a D12-L1 cancellous hernia means that it is between the last thoracic vertebra and the first lumbar vertebra.
This is a more common condition than one might imagine. Indeed, intra spongy hernias were found in 75% of the bodies studied during the autopsy, regardless of the age of the subject!
Causes of intracancellous hernia
The exact cause of intracancellous hernias has not yet been identified.
However, certain factors can influence the appearance of intracancellous hernia. We think of vertical forces applied to the spine (e.g. walking or prolonged standing, jumping, etc.). Indeed, excessive and repeated forces could weaken the vertebral bodies and promote the appearance of intracancellous hernias.
In adolescents, the vertebral endplates are not as strong as in adults. This can predispose to the appearance of intra spongy hernias.
Besides the compressive forces on the spine and the fragility of the vertebral endplates, other factors can contribute to disc weakening:
- Any structural disorder of the spine
- Scheuermann's disease
- Ankylosing spondylitis
- Any metabolic disorder of the bones (for example, osteopenia or osteoporosis)
- Disc degeneration et Osteoarthritis
- Trauma (such as vertebra fracture)
- Infections (not to be confused with spondylodiscitis)
- A tumor
Symptoms of the disease
Surprisingly, intracancellous hernia is often asymptomatic, that is, it does not cause any symptoms in the individual with this condition. Moreover, most people are unaware that they have an intra spongy hernia: it is often discovered by chance during a radiological examination carried out for another reason.
If you suffer from lumbar pain or back pain, you should know that the intra spongy hernia is not necessarily the responsible party. Indeed, low back pain is complex and depends on several factors.
On the other hand, it happens that the intra spongy hernia causes symptoms in some cases. Lower back pain can sometimes occur due to inflammation of the vertebral endplate of the affected vertebra. Also, the disc collapse can reduce the intervertebral space and irritate the articular cartilages of the vertebrae, causing pain.
Vertebral deformities may appear, and cause dorsal kyphosis. This is particularly true if the intracancellous hernia appears during the growth of an adolescent, and is accompanied by a disease such as Scheuermann's disease.
More rarely, the affected disc can become infected and indirectly cause irritation of the corresponding nerves. This can cause pain that radiates down the leg (like sciatica ou cruralgia), associated with numbness and/or weakness of the lower limbs.
Diagnostic
Intraspongy hernia can be detected by several medical imaging exams. The imaging of choice is MRI (magnetic resonance imaging), but it can sometimes be seen on an x-ray or CT scan.
As mentioned previously, the intracancellous hernia could be asymptomatic, and therefore not responsible for the patient's symptoms. It is also often diagnosed incidentally.
To find out if it is indeed the intra spongy hernia that is the source of the pain, the doctor could carry out a clinical examination associated with tests such as a discogram.
Treatment of intra spongy hernia
If the intra spongy hernia does not cause symptoms, no treatment will be carried out. In cases where symptoms are present and limit function, the following modalities can be attempted:
- Rest and reduction in impact sports (rugby, football, running, etc.)
- Medication anti-inflammatory
- Massages and mobilizations (such as lumbar pull-ups or the use of a spinal decompression table) in physiotherapy or osteopathy
If the intracancellous hernia is accompanied by a dorsal kyphosis, therapeutic exercises and mobilizations will aim to correct the deformity, correct the posture and straighten your back.
In addition to physical therapies, there are several products and accessories available on the market to relieve back pain caused by an intrahernia. It should be remembered that these tools generally offer temporary relief, and should be used sparingly.
Among the best-known accessories are:
acupressure mat
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- 🧘 𝐋𝐈𝐁È𝐑𝐄 𝐃𝐄 𝐋𝐀 𝐓𝐄𝐍𝐒𝐈𝐎𝐍 – Our fakir mat stimulates the muscles, promotes circulation and can thus effectively relieve tension. This is how you fight annoying back and neck pain!
- 🧘 𝐃𝐈𝐒𝐒𝐈𝐏𝐄 𝐋𝐄 𝐒𝐓𝐑𝐄𝐒𝐒 𝐑𝐎𝐔𝐓𝐈𝐍𝐈𝐄𝐑 – Whether after a training session, a match or a hard day work: The Wellax acupuncture mat is the ideal support for releasing daily tension. Pure relaxation for body and soul!
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Lumbar belt heated
- 【Powerful 360° Support】With 4 stainless steel supports and 2 steel springs placed along the waist, the back brace for heavy lifting provides strong 360° vertical support for the lower back and allows for optimal decompression of the spine, thereby preventing back injuries caused by lifting dumbbells, prolonged standing or sitting, household chores and work.
- 【Relieve Pain】The ergonomic back support provides strong support for the lower back and abdominal muscles, increasing pressure around the waist to prevent fatigue, strain and other back-related injuries. Relieve waist muscles, herniated discs, sciatica, scoliosis, etc. when wearing the back support belt.
- 【3 Heating Modes】The back brace for lower back pain contains a heating pillow fixed by Velcro, which you can easily operate via the controller. There are 3 heating settings (low, medium, high) that allow you to adjust the temperature as needed to promote blood circulation and relieve back pain.
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Ergonomic back cushion
- ✨Premium Material: Our lumbar support cushion is filled with new temperature sensitive sponge, the lumbar support can adjust the contour of your back according to the temperature. The outer layer of lumbar cushion is made of high quality breathable fabric. The back support cushion fabric is comfortable and soft, not easy to fade. The parts of the lumbar cushion have been certified and are safe and harmless to human health.
- ✨High-quality design: The back support cushion for chair is ergonomic, and the pillow for back pain has a partitioned design, the memory foam back cushion can support your back curve and promote healthy posture. The lumbar support cushion for chair uses elastic straps to keep the lumbar support cushion for sofa firmly fixed on the seat.
- ✨Protect your health: With our car back support, you can better protect your spine, car back support office chair Helps relieve lower and middle back tension caused by prolonged sitting or driving. If you often experience back pain due to prolonged sitting, you should definitely try an office chair back cushion.
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massage gun
- DEEP TISSUE MASSAGE GUN – ALDOM Muscle Massage Gun for Athletes is ideal for relieving muscle pain, soreness and stiffness, promoting blood circulation and helps speed up warm-up and cool-down. It also helps restore the body faster and can be used as your percussion massager at the gym or sports club, is held with one hand and has a comfortable handle.
- 6 MASSAGE HEADS + 30 SPEED - The deep tissue massage gun comes with 6 different massage heads to help relieve sore muscles, 30 adjustable speed modes, Choose the speed and massage heads that best suits your needs. your needs (1 to 800 pulses per minute) to target different body parts and muscle groups, Integrate a percussive massage experience. Reduce muscle recovery time.
- SUPER QUIET AND POWERFUL MASSAGE GUN - Professional handheld percussion massager. Featuring a powerful, high-penetration motor, the deep tissue massager is designed to send waves of relaxation and relief throughout the body, and increase everyday mobility and flexibility with percussive therapy for pain relief joints and muscle pain and prolongs the duration of muscle massage
- Relieve Muscle Pain - Our massage gun can help relieve tight muscles, aches and stiff backs, relaxes tender tissues. The deep muscle massager quickly removes lactic acid produced after exercise, significantly reducing muscle recovery time
- 8 Massage Head + 99 Speeds – The powerful massage gun contains multiple easy-to-replace massage heads that can care for different body parts and muscle groups. 99 speed adjustment settings allow you to better choose the vibration speed to achieve the most comfortable state for you
- LED Touch Screen – The muscle massage gun is equipped with an LED screen, which can display the speed and battery percentage. You can increase or decrease the speed of the electric massager by simply pressing the + or - button, and it can be adjusted quickly with a long press, which is easy and convenient to use
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If conservative treatment is not effective, surgery can be performed as a last resort to remove the damaged disc (discectomy ou microdiscectomy), thereby relieving pain.
arthrodesis is also indicated in certain cases to fuse the vertebrae concerned. The operation is also indicated in case of symptomatic and disabling dorsal kyphosis, once the period of growth is over.
What about natural remedies?
Like accessories and anti-back pain products, natural products and grandmother's remedies are very popular with people suffering from back pain.
Often, these remedies include anti-inflammatory properties to relieve various body pains.
On the other hand, it should be noted that most of these natural products are not scientifically proven. It is therefore important to speak to your doctor before using them, particularly to avoid any interaction with your medications.
Natural remedies that could relieve symptoms include:
Turmeric
Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.
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Ginger
In addition to the particular flavor it brings to cooking and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. THE gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).
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Omega-3
Omega-3s are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove to be very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Since sciatica is most often linked to inflammation secondary to a herniated disc, it can also respond to omega-3s if you consume them regularly.
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- ✔ WHY OMEGA 3? Each recommended daily dose of our premium Omega 3 fish oil supplement provides high-potency essential fatty acids – Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA) which both help support various functions bodily, especially in the normal functioning of the heart. DHA supports the maintenance of normal brain function and normal vision. All these claims are supported by EFSA
- ✔ WHAT INGREDIENTS ARE USED AT NUTRAVITA? – We have a dedicated team of pharmacologists, chemists and researchers who work to find the finest and most beneficial ingredients, allowing us to provide advanced, high strength vitamins and supplements that do not contain dyes or flavorings artificial. From *fish* which may NOT be suitable for people with allergies. The soft capsule is made from (bovine) gelatin.
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Lemon eucalyptus
Eucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.
- Eucalyptus Citriodora Essential Oil.
- 100% pure.
- Botanical name: eucalyptus citriodo.
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wintergreen
Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the essential oils most used in aromatherapy. This oil, extracted from the shrub of the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.
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The intra spongy hernia, recognized as an occupational disease?
A disease is said to be occupational if it results from direct exposure to a physical, chemical or biological risk. It must also result from the conditions in which a worker exercises his professional activity, and must appear in one of the tables of the general or agricultural Social Security system.
The tables of occupational diseases 97 and 98 relate to back pain, and define a number of criteria which must all be met to allow recognition of the disease.
Here are the conditions that must be met for back pain to be recognized as an occupational disease:
- It must be a chronic condition (defined by a duration of at least 3 months)
- If the pain radiates into the leg: sciatica or radiculalgia femoral crural must be caused by a herniated disc with a topography consistent with the root involvement. For sciatica, the herniated disc must be level L4-L5 or L5-S1. For the radiculalgia crural, the herniated disc must be level L2-L3, or L3-L4, or L4-L5.
- The herniated disc must be explicitly qualified in the report of the radiological examination via a scanner ou IRM.
- The duration of exposure to the risk is 5 years, and the period of coverage must be a maximum of 6 months.
As mentioned previously, the intra spongy hernia is often asymptomatic. And even though it causes back pain, it does not meet the above criteria. This condition cannot therefore be recognized as an occupational disease.
If the pain is so intense that it prevents you from doing your job, the doctor may prescribe a sick leave. The duration will be determined based on the condition, symptoms, physical nature of the work, etc. The return to work will be gradual and will begin when the symptoms have improved.
In extreme cases, a professional redeployment could be considered.