Computed tomography in the visualization of intervertebral discs. The intervertebral disc and its changes What is the vacuum phenomenon of the PCS

The intervertebral disc is a structure containing a liquid component of a gel-like consistency (nucleus pulposus), enclosed in a shell of a dense substance (annulus fibrosus). The intervertebral disc is not visualized on X-ray of the spine, only (in most cases when the disc is not compacted) the space that it occupies is visible. And only by reducing the height of this space can we indirectly judge the decrease in the height of the disk itself. Computed tomography of the spine clearly visualizes discs that have a large (7 mm or more) thickness (in lumbar). In the soft tissue mode, the intervertebral disc looks like a structure with a density of +70…+80 units of the Hounsfield scale, with smooth edges, without bulging in one direction or another.

View of the intervertebral discs on CT scan of the lumbar spine. In the left image, arrows mark the edges of the disk (number 1 is the anterior, 2 is the posterior, 3 and 4 are the lateral). The height of the discs is not reduced, their shape is normal, lenticular, no protrusion of the edges of the disc is visible anteriorly, posteriorly, or laterally. This CT picture corresponds to the norm with a few exceptions - pay attention to the sloping of the anterior upper edge of the body of the 3rd lumbar vertebra and the presence of small osteophytes with signs of sclerosis - these are manifestations of spinal osteochondrosis on CT scan in the L2-L3 segment at the stage of moderately pronounced changes.

Degenerative changes in the intervertebral discs on CT

The main sign indicating degeneration intervertebral disc, is a decrease in its height, which can be both uniform - over the entire area of ​​​​the disk, and local - in the anterior, posterior, central or lateral sections. Very often in the disk one can observe the vacuum effect (“vacuum phenomenon”), which consists in the presence of gas inside the disk. This gas is nitrogen dissolved in the tissues, which becomes gaseous when the pressure in the disk is lower than in the surrounding tissues. The vacuum effect is observed in patients with pronounced changes in the form of osteochondrosis, as well as damage to the discs (as a result of trauma). Disc degeneration on CT scan of the spine also manifests itself in the form of changes in the parts of the vertebrae adjacent to the disc - they become compacted, sclerosed, with the presence of subchondral cysts and (often) Schmorl's nodes (hernias) - defects in the endplates due to a breakthrough of the nucleus pulposus into the vertebral body.

The images (CT scan of the lumbar spine) demonstrate the effect of vacuum in the intervertebral disc of the lumbosacral segment. The gas in the disk (marked with a blue arrow) appears as a narrow dark (sharply hypodense) band with a density of about -1000 Hounsfield units, or as a dark zone (dark flat "spot") on the scan in the axial plane of the body (left). Also try to describe the CT on your own - evaluate the reduction in disc height in the L5-S1 segment compared to the overlying segment (L4-L5). The difference is significant and noticeable already "by eye". All these are signs of osteochondrosis on CT (in an advanced stage).

Another observation demonstrating the "vacuum phenomenon": the image in the center shows a deformity of the vertebral body in the form of a wedge - a compression fracture of the spine. The intervertebral discs are deformed, their height is extremely uneven, gas inclusions are visible in the structure of the discs - a “vacuum phenomenon”. A CT scan of the spine was performed in a patient with an old injury (compression of the vertebra due to osteoporosis). Formed pathological kyphosis. In conclusion - compression spondylopathy of the 2nd and 3rd lumbar vertebrae with wedge-shaped deformities of the body L3, osteochondrosis in the segments L1-L2, L2-L3, the "vacuum" phenomenon.

Herniated and protruded discs on CT

A hernia (extrusion) of the disc is understood as a rupture of the fibrous ring with the release of part of the nucleus pulposus to the outside. In this case, the exit can occur both in the direction of the spinal canal, lateral canals, radicular canals, sideways or anteriorly, as well as into the body of a superior or non-overlying vertebra (Schmorl's hernia). Posterior disc herniation on CT (when the nucleus pulposus ruptures towards the spinal canal) can be median (along the midline), paramedian (near the midline of the disc, as well as towards the lateral canals), foraminal (spreading into the root canals). This is the most dangerous variant in terms of the development of radicular symptoms, in which compression of the roots of the spinal cord can occur with the development of a pronounced pain syndrome. Anterior and lateral disc herniations, as well as Schmorl's hernias, often do not manifest themselves clinically and are asymptomatic.

Protrusion is a condition when a weakened fibrous ring cannot hold the pressure of the nucleus pulposus and swells to the sides or backwards, but without violating integrity. Disc protrusion on CT differs from intervertebral hernia in the form of a protruding area - with protrusion it is part of a large radius arc, with disc herniation it is small, located in a limited area (usually about 1 cm). With a herniated disc, one can also see - in the images in the sagittal plane - the nucleus pulposus hanging in the form of a "drop" or part of it. The hernia can also compress the roots, which is indirectly evidenced by the visualization of the hernial "sac" in the root canals - foraminal. The difference between disc herniation and protrusion also lies in the size of the protruding part - with hernias it is often more than 6 ... 8 mm, with protrusions it is usually less (although there are exceptions).

An example of protrusion of the intervertebral disc during computed tomography of the spine: the arrow marks the protruding edge of the disc, which has a characteristic appearance of disc protrusion. Note (in the right image) the detachment of the posterior longitudinal ligament near the bodies of the 4th and 5th lumbar vertebrae.

An example of a left-sided paramedian disc herniation on CT scan of the spine, with foraminal extension and compression of the left root in the L5-S1 canal. The hernial protrusion on the axial section has a "triangular" appearance, the anterior-posterior size is about 12 mm. IVD hernia provokes the development of a pronounced radicular syndrome in this patient - in the form of pain and paresthesia in the left leg and buttock. There are also sensory disturbances.

A well-conducted diagnosis helps to detect the phenomenon, on which the choice of treatment methods depends.

The essence of the violation in the spinal column

Features of the phenomenon are not yet fully understood. In particular, scientists continue to study:

• reasons for the vacuum phenomenon of the spine;
• its physical essence;
• clinical significance of pathology.

How is the process developing? The release of nitrogen occurs when the space between the surface of the joints of the spinal column is forced to stretch. At the same time, the pressure of the fluid present inside the space drops, and the dissolution of nitrogen sharply decreases, as a result, it is released into the joint cavity.

The intervertebral disc is similar to a shock-absorbing "pillow": in the center is the nucleus pulposus, and around it is a dense fibrous ring. Some physicians call the vacuum phenomenon the “phantom nucleus pulposus”.

Most frequent place localization of the violation - the lower part of the lumbar or neck area.

Diagnostic methods

To detect the vacuum effect of the intervertebral disc is carried out:

1. X-ray examination allows you to establish the presence of instability in the spine and the nature of the course of the pathology;
2. Computed tomography (CT) is better at diagnosing the disease than MRI. The image shows dense gas chambers with clear boundaries. If the patient takes a different position, the phenomenon persists.
3. On MRI, the vacuum effect in the examined segment is seen as a soft-tissue volumetric formation, which has a density similar to adipose tissue. MRI shows only the phenomenon that is in the structure of the disk.

Benefits of computed tomography:

• Quite often the gas cavity is formed in a lumbosacral segment L5-S1. CT clearly demonstrates its presence. In addition, the technique can show gas bubbles, both in the disc and in the adjacent epidural space;
• Shows a more accurate picture, on MRI the phenomenon can be confused with a sequestered hernia.

As a result of the accumulation of gas bubbles in the discs, there are signs of a neurological nature.

What should I do to fix the violation?

Some physicians explain the formation of gas bubbles in the epidural space by the presence of intervertebral hernias, while the phenomenon indirectly indicates a rupture of the posterior longitudinal ligament.

In such situations, with the development of compression of the nerve roots, patients may be prescribed surgery.

1. Surgical manipulations relieve back discomfort and gas accumulations.
2. After the elimination of the pathology, conservative therapy is carried out, due to which the condition of the patients becomes satisfactory.

When gas cavities are formed in the spine, a special role is given to diagnostics. It is possible to develop a treatment regimen only thanks to accurate examination data.

By the way, now you can get my free electronic books and courses to help you improve your health and wellness.

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Vacuum phenomenon in the spinal canal is the cause of neurological symptoms requiring surgical treatment

V.N. Karp, Yu.A. Yashinina, A.N. Zabrodsky

5th Central Military Clinical Hospital of the Air Force, Krasnogorsk, Moscow Region

An important symptom of disc degeneration is the "vacuum phenomenon" or "vacuum effect", manifested by the presence of gas bubbles of various sizes in the thickness of the disc. The gas inside the disk has mixed composition dominated by nitrogen. Disk protrusions are often absent.

The accumulation of gas in the intervertebral discs is usually detected by computed tomography (CT). This sign is poorly visualized on MRI, due to the physical basis of the method. At CT, the "vacuum phenomenon" is manifested by foci of air density (from -850 to -950 N) with clear contours. When changing the position of the body and the load on the spine, it does not disappear.

We did not find a description in the literature neurological symptoms due to the accumulation of gas in the epidural space ("gas cyst") in the absence of sequesters of disc herniation, which was confirmed intraoperatively.

We present our observations.

Patient M., born in 1954, was admitted to the neurosurgical department of the 5th Central Military Clinical Hospital of the Air Force with complaints of weakness in the legs, numbness in both feet and burning in them, persistent moderate pain in the lumbosacral spine, radiating to both legs, more to the left. For the first time, pain in the lumbosacral spine occurred about 11 years ago after physical activity. Outpatient and inpatient treatment with a positive result. Since December 2004 without apparent reason began to notice increased pain in the lumbosacral spine, radiating to the legs. Gradually developed numbness and weakness in the feet.

AT neurological status- hypoesthesia on the outer edge of both feet. Knee reflexes of normal liveliness, uniform, Achilles - are not called. Moderate weakness in plantar flexion of both feet. Lasegue's symptom on the left from an angle of 45°, on the right - from 65°.

A CT scan on August 24, 2005 (Fig. 1) visualized a gaseous cavity in the L5-S1 disk - the "vacuum effect". In the epidural space at the same level, on the right, there is an accumulation of gas measuring 15 x 10 mm; paramedianally, on the left, there is a subligamentous soft tissue component with inclusions of small gas bubbles. An MRI scan of the lumbosacral region dated August 26, 2005 (Fig. 2) shows an epidural accumulation of gas at the level of the L5-S1 disk, which looks like a soft-tissue mass (corresponding to adipose tissue in density), deforming the dural sac.

Considering clinical manifestations, as well as CT and MRI data, the diagnosis was made: osteochondrosis of the lumbosacral spine, complicated by protrusion of the L5-S1 disc with accumulation of gas in the spinal canal (epidurally and subglottically), epidural fibrosis with compression of the roots of the cauda equina.

On September 13, 2005, the operation was performed: interlaminar meningoradiculolysis of the S1 root on the left, opening of the subglottic "gas cyst".

No sequestration was detected during the operation. The dural sac and S1 root are surrounded by dense epidural tissue and are fixed by adhesions on the disc and do not move. Performed meningoradiculolysis. After separation of the adhesions on the ventral surface of the dural sac and root, the latter was displaced medially. Disc moderately bulges, stony density. The posterior longitudinal ligament is ossified and covered with scar-modified epidural tissue, which is excised. When dissecting the posterior longitudinal ligament, gas bubbles were released, the tension of the ligament decreased. Revision of the spinal canal in the caudal and cranial directions and along the root did not reveal any mass formations. The spine is free, easily shifted.

In the postoperative period, regression of neurological symptoms was noted. Discharged on the 10th day after surgery with improvement.

Patient G., aged 47, was admitted to the department with complaints of pain in the lumbosacral spine, radiating to the left leg along the posterior-outer surface, aggravated by movement.

In the neurological status: decreased strength of the plantar flexion of the left foot, deep reflexes of average liveliness, equal, except for the Achilles and plantar reflexes on the left, which are depressed. Hypesthesia in the zone of innervation of L5 and S1 roots on the left. Lasegue's symptom on the right - 60°, on the left - 50°. Weakness of the muscles of the left buttock. Percussion and palpation of the spinous processes and paravertebral points are painful at the level of L4-5 and L5-S1 on the left, there is also muscle tension. Movement in the lumbar region is limited due to pain. When walking, he limps on his left leg.

The above complaints appeared a month before the current hospitalization after lifting weights. Conservative treatment without effect. 2 weeks before hospitalization, frequent urination appeared.

On CT scan in the L4-5 segment, there is a posterior circular protrusion up to 2-3 mm with lateralization to the left half of the spinal canal and the left lateral foramen. The spine is thickened at this level. In the L5-S1 segment, there are pronounced degenerative changes - the intervertebral disc is significantly reduced in height, gas bubbles are determined in its structure - the "vacuum effect" (Fig. 3). In addition, a gas bubble is located in the left half of the spinal canal in the projection of the left nerve root under the posterior longitudinal ligament, deforming the anterior-left contour of the dural sac, squeezing the nerve root. Signs of spondylarthrosis are determined.

A comprehensive conservative treatment. The effect was not obtained, the clinic of S1 root compression on the left and L5 radicular syndrome on the left remained.

05/06/04 operation - L5 hemilaminectomy on the left, opening of the subglottic gas cavity (cyst), compressing the root and dural sac, meningoradiculolysis of S1 and L5 roots. When dissecting the posterior longitudinal ligament, which was the wall of the gas cyst, gas bubbles were released without color and odor. Ligament sunk, compression of the root and dural sac is eliminated. Postoperative period smooth, the wound healed by primary intention. Continued conservative therapy. The condition improved, regression of radicular syndrome. The movements in the limbs are preserved, the strength and tone are good, he walks freely, the background of the mood has increased.

In a satisfactory condition, he was discharged under the supervision of a neurologist at the place of residence. A follow-up examination and a course of inpatient conservative treatment were recommended. rehabilitation treatment after 6 months in neurosurgical department 5 CVCG Air Force, but the patient did not arrive.

1. "Vacuum phenomenon" in the disc may be accompanied by accumulation of gas under the posterior longitudinal ligament, causing compression or irritation of the roots, which requires surgical intervention.

2. Accumulation of gas epidurally or subglottically is not always accompanied by a disc herniation.

3. With MRI, the "gas cyst" is poorly visualized, which is due to the physical basis of the method and can be mistaken for a sequestered disc herniation.

4. The method of choice for diagnosing an epidural "gas cyst" is computed tomography.

1. Computed tomography in clinical diagnostics. - Gabunia R.I., Kolesnikova E.K., M.: "Medicine", 1995, p. 318.

2. Computed tomography in the diagnosis of degenerative changes in the spine. Vasiliev A.Yu., Vitko N.K., M., Vidar-M Publishing House, 2000, p. 54.

3. General guide to radiology. Holger Petterson, NICER Anniversary Book 1995, p. 331.

4. Magnetic resonance imaging of the spinal cord and spine. Akhadov T.A., Panov V.O., Eichhoff W., M.,

5. Practical neurosurgery. A Guide for Physicians, edited by Corresponding Member. RAMS Gaidar B.V., St. Petersburg, publishing house "Hippocrates", 2002, p. 525.

6. Puncture laser vaporization of degenerated intervertebral discs. Vasiliev A.Yu., Kaznacheev V.M. -

NEUROSURGERY, № 3, 2008

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Vacuum effect (phenomenon) of a disc burr.

Hello Doctor. On April 30, my father underwent a CT scan (there is only a CT scan in our city). Please comment:

On May 2, dad went on vacation, please advise what procedures need to be done this month, dad is determined to be treated. Thank you very much!

2. A protrusion above the first one indicates that the person does not move correctly and overloads the upper vertebrae and a new hernia is forming there. She, most likely, will not be if she learns to behave correctly (correctly, does not mean doing nothing, but doing everything, but correctly)

Here are the main directions of treatment and methods. See what you can agree on:

1. Reducing pain, inflammation, swelling and improving lymph and blood flow.

2. Reducing the traumatization of the neural structure.

3. Reducing the size of the hernial protrusion.

1.1. Anti-inflammatory and analgesic therapy;

1.2. Reducing spastic muscle tension;

1.3. Improving lymph and blood flow;

1.4. Local injection therapy (injections of anesthetics, glucocorticoids);

1.7. Antioxidant therapy.

2.1. Rest, treatment with the correct position;

2.2. Wearing bandages, corsets to immobilize the affected area of ​​the spine;

2.3. Manual therapy and massage;

2.4. Traction, traction of the spine;

2.5. The use of orthopedic mattresses with the function of preventive traction;

2.6. Training programs for the correct behavior of patients;

2.7. Physical exercises;

2.8. Psychological correction.

3.1. Surgical decompression;

3.2. Local injection therapy (injections of homeopathic remedies);

3.3. Electrophoresis of drugs that soften and reduce disc herniation (karipazim).

Iplikator Kuznetsova - Yes!

Peripheral disease nervous system.

Neurological manifestations of osteochondrosis of the spine of any localization.

Mono- and polyneuritis.

Injuries peripheral nerves upper and lower extremities.

Neck and shoulder syndrome. Bronchitis, bronchial asthma.

· Neurosis, impotence, frigidity.

· Dyskinesia of the esophagus, gastritis, duodenitis, functional disorders of the stomach and intestines.

Injuries and degenerative-dystrophic diseases of the joints during the recovery period.

The applicator should not be used when the following diseases: pregnancy; malignant neoplasms; epilepsy; skin diseases (if there is a skin lesion in the area of ​​the intended impact); sharp inflammatory processes and infectious diseases. With great care, applicators should be used for the following diseases (detailed recommendations are given in the instructions): myocardial infarction; lung and heart failure I and II degrees; varicose veins veins; stomach ulcer (in the projection above it both in front and behind).

Procedures should be carried out, as a rule, sitting or lying down, at a temperature comfortable for the patient.

1. Select a reflex zone for exposure, taking into account the type of disease.

2. The position of the patient during the procedure should; be as convenient and comfortable as possible. If necessary, to fit the applicator to the curves of the body, it is necessary to enclose pads or rollers, which are easy to make from terry towels.

3. In a sitting position, apply the applicator to the selected reflex zone and, pressing the applicator to the body, take a lying position. In this case, the applicator is located under the reflex zone, and the impact is carried out due to the pressure of the body weight on the applicator.

4. It is possible to use the applicator on the move. In this case, the applicator is tightly attached to the body. elastic bandage or a belt.

5. The strength of the impact is regulated by the degree of softness of the substrate under the applicator and the ability to apply an overlay (thin fabric, such as a sheet).

6. The exposure time, depending on the type of disease, ranges from 5 to 30 minutes. If it is necessary to stimulate the body or organ, increase efficiency, eliminate mild soreness, then the time is minimized to 5-10 minutes. Strong pain, high blood pressure, increased blood supply, general relaxation (sedation) requires a longer procedure, minutes. A peculiar sign of effectiveness in this case will be a feeling of warmth that appears during the procedure.

7. As a rule, a 2-week course of treatment is carried out, 1-4 sessions per day. Breaks between courses 1-2 weeks. Daily use is also possible, but with the recommendation to change the zone and method of exposure every 2 weeks.

Restore the spine for 1 RUBLE!

phenomenon vacuum phenomenon

All body tissues contain gases, their solubility in media depends on pressure. This can be well imagined by decompression sickness or when a person is flying on an airplane. The pressure changes with the composition of the blood and gas.

There is a certain amount of gel (fluid) between the articular surfaces of the spine and the ligamentous apparatus.

When this space is forcibly stretched, the volume of the fluid tends to increase and the pressure drops, as a result of which the solubility of nitrogen decreases, and the gas is released into the joint cavity.

At a young age, the disc normally acts as a tight shock-absorbing cushion, consisting of a strong fibrous ring inside which there is a pulpous nucleus. With age or with diseases of the spine, the ring weakens and gas accumulates.

Diagnostics

The vacuum effect is detected mainly when examining the spine for MRI, CT. The accumulation of gas in the intervertebral discs is the cause of neuralgic symptoms and requires surgical intervention. The vacuum effect is an indicator of the unstable state of the spine.

The FRI radiology method allows the radiologist to track the instability of the spinal column, the course of the pathological process. The solution of a number of problems depends on the correct diagnosis, including the choice medical method, employment, forecast, sports and professional orientation.

Vacuum phenomenon of the spine

Spine. Vacuum phenomenon in the spinal canal is the cause of neurological symptoms requiring surgical treatment

V.N. Karp, Yu.A. Yashinina, A.N. Zabrodsky 5th Central Military Clinical Hospital of the Air Force, Krasnogorsk, Moscow Region An important symptom of disc degeneration is the "vacuum phenomenon" or "vacuum effect", manifested by the presence of gas bubbles of various sizes in the thickness of the disc. The gas inside the disk has a mixed composition with a predominance of nitrogen. Disk protrusions are often absent.

A buildup of gas in the intervertebral discs is usually found on a computed tomography (CT) scan. This sign is poorly visualized on MRI, due to the physical basis of the method. On CT, the “vacuum phenomenon” is manifested by air density foci (from -850 to -950 N) with clear contours. When changing the position of the body and the load on the spine, it does not disappear.

Rice. 1. CT scan of the lumbosacral region (L5-S1). In the disk L5-S1, a gas cavity is visualized - a "vacuum effect", as well as an accumulation of gas in the epidural space on the right.

Rice. 2. MRI of the lumbosacral region: epidural accumulation of gas at the level of the L5-S1 disk looks like a soft-tissue volumetric formation (corresponding to adipose tissue in density), squeezing the dural sac and root, the vacuum effect is visualized only in the disk structure. Long-term observation of such patients shows the impossibility of a significant reduction in the severity of the "vacuum phenomenon". Some authors point out that a similar accumulation of gas in the epidural space can be observed with a herniated disc and is an indirect sign of rupture of the posterior longitudinal ligament. In these situations, gas helps to visualize the formation, since the protrusion itself is poorly differentiated. In the literature, we did not find a description of neurological symptoms caused by accumulation of gas in the epidural space (“gas cyst”) in the absence of disc herniation sequesters, which was confirmed intraoperatively. Here are our observations. B olny M., born in 1954, was admitted to the neurosurgical department of the 5th Central Military Clinical Hospital of the Air Force with complaints of weakness in the legs, numbness in both feet and burning in them, constant moderate pain in the lumbosacral spine, radiating to both legs, more to the left. For the first time, pain in the lumbosacral spine occurred about 11 years ago after physical exertion. Outpatient and inpatient treatment with a positive result. Since December 2004, for no apparent reason, he began to notice an increase in pain in the lumbosacral spine, radiating to the legs. Gradually, numbness and weakness in the feet developed. In the neurological status - hypesthesia along the outer edge of both feet. Knee reflexes of normal liveliness, uniform, Achilles - are not called. Moderate weakness in plantar flexion of both feet. Lasegue's symptom on the left from an angle of 45°, on the right - from 65°. At CT scan on August 24, 2005 (Fig. 1), a gas cavity is visualized in the L5-S1 disk - the "vacuum effect". In the epidural space at the same level, on the right, there is an accumulation of gas measuring 15 x 10 mm; paramedianally, on the left, there is a subligamentous soft tissue component with inclusions of small gas bubbles. MRI of the lumbosacral spine on August 26, 2005 (Fig. 2) epidural accumulation of gas at the level of the L5-S1 disk looks like a soft tissue volumetric formation (corresponding to adipose tissue in density), deforming the dural sac. Taking into account the clinical manifestations, as well as CT data and MRI, the diagnosis was made: osteochondrosis of the lumbosacral spine, complicated by protrusion of the L5-S1 disc with accumulation of gas in the spinal canal (epidurally and subglottically), epidural fibrosis with compression of the roots of the cauda equina.

On September 13, 2005, the operation was performed: interlaminar meningoradiculolysis of the S1 root on the left, opening of the subglottic "gas cyst".

Rice. 3. CT scan of the lumbosacral spine on the disc and spinal canal.

No sequestration was detected during the operation. The dural sac and S1 root are surrounded by dense epidural tissue and are fixed by adhesions on the disc and do not move. Performed meningoradiculolysis. After separation of the adhesions on the ventral surface of the dural sac and root, the latter was displaced medially. Disc moderately bulges, stony density. The posterior longitudinal ligament is ossified and covered with scar-modified epidural tissue, which is excised. When dissecting the posterior longitudinal ligament, gas bubbles were released, the tension of the ligament decreased. Revision of the spinal canal in the caudal and cranial directions and along the root did not reveal any mass formations. The root is free, easily displaced. In the postoperative period, a regression of neurological symptoms was noted. He was discharged on the 10th day after the operation with improvement. Bolny G., 47 years old, was admitted to the department with complaints of pain in the lumbosacral spine, radiating to the left leg along the posterior-outer surface, aggravated by movements. In the neurological status: the strength of the plantar flexion of the left foot is reduced, deep reflexes of average liveliness are equal, except for the Achilles and plantar reflexes on the left, which are depressed. Hypesthesia in the zone of innervation of L5 and S1 roots on the left. Lasegue's symptom on the right - 60°, on the left - 50°. Weakness of the muscles of the left buttock. Percussion and palpation of the spinous processes and paravertebral points are painful at the level of L4-5 and L5-S1 on the left, there is also muscle tension. Movement in the lumbar region is limited due to pain. When walking, he limps on his left leg.

History of surgery - interlaminar removal of sequesters herniated disk L5-S1 on the right-va (December 1992). The postoperative period is smooth. Pain in right leg and the lumbosacral spine were not disturbed.

the level of the L5-S1 segment with a vacuum effect in the intervertebral The above complaints appeared a month before the present hospitalization after lifting weights. Conservative treatment without effect. 2 weeks before hospitalization, frequent urination appeared. On CT scan in the L4-5 segment, there was a posterior circular protrusion up to 2-3 mm with lateralization to the left half of the spinal canal and the left lateral foramen. The spine is thickened at this level. In the L5-S1 segment, there are pronounced degenerative changes - the intervertebral disc is significantly reduced in height, gas bubbles are determined in its structure - the "vacuum effect" (Fig. 3). In addition, a gas bubble is located in the left half of the spinal canal in the projection of the left nerve root under the posterior longitudinal ligament, deforming the anterior-left contour of the dural sac, squeezing the nerve root. Signs of spondylarthrosis are determined.

The patient was diagnosed with osteochondrosis, spondylarthrosis of the lumbosacral spine, complicated by accumulation of gas in the subglottic space with compression of the S1 root and L5 radicular syndrome on the left. Condition after interlaminar removal of sequesters of L5-S1 disc herniation on the right (1992).

Conducted a complex conservative treatment. No effect was obtained, the clinic of S1 root compression on the left and L5 radicular syndrome on the left remained. When dissecting the posterior longitudinal ligament, which was the wall of the gas cyst, gas bubbles were released without color and odor. Ligament sunk, compression of the root and dural sac is eliminated. The postoperative period is smooth, the wound healed by primary intention. Continued conservative therapy. The condition improved, regression of radicular syndrome. The movements in the limbs are preserved, strength and tone are good, he walks freely, the mood background has increased. He was discharged in a satisfactory condition under the supervision of a neurologist at the place of residence. A follow-up examination and a course of inpatient conservative rehabilitation treatment was recommended after 6 months in the neurosurgical department of the 5th CVCG of the Air Force, but the patient did not arrive. Conclusions1. "Vacuum - phenomenon" in the disc may be accompanied by accumulation of gas under the posterior longitudinal ligament, causing compression or irritation of the roots, which requires surgical intervention.2. Accumulation of gas epidurally or subglottically is not always accompanied by disc herniation.3. With MRI, the "gas cyst" is poorly visualized, which is due to the physical basis of the method and can be mistaken for a sequestered disc herniation.4. The method of choice for diagnosing an epidural gas cyst is computed tomography. REFERENCES1. Computed tomography in clinical diagnostics. - Gabunia R.I., Kolesnikova E.K., M.: "Medicine", 1995, p. 318.2. Computed tomography in the diagnosis of degenerative changes in the spine. Vasiliev A.Yu., Vitko N.K., M., Vidar-M Publishing House, 2000, p. 54.3. General guide to radiology. Holger Petterson, NICER Anniversary Book 1995, p. 331.4. Magnetic resonance imaging of the spinal cord and spine. Akhadov T.A., Panov V.O., Eichhoff W., M., 2000, p. 510.5. Practical neurosurgery. A Guide for Physicians, edited by Corresponding Member. RAMS Gaidar B. V., St. Petersburg, publishing house "Hippocrates", 2002, p. 525.6. Puncture laser vaporization of degenerated intervertebral discs. Vasiliev A.Yu., Kaznacheev V.M. -

NEUROSURGERY, № 3, 2008

MRI ENCYCLOPEDIA

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CALCIFICATION OF THE INTERVERTEBRAL DISC AND VACUUM PHENOMENON

• In 5-6% of people over the age of 50, degeneration of the intervertebral discs is observed, namely, calcification of the intervertebral discs and a vacuum phenomenon.
• Calcification of the intervertebral discs most often occurs in thoracic region spine
• In children, calcification of the intervertebral discs and a vacuum phenomenon often occur in the cervical spine (usually after an injury).
• Etiology, pathophysiology, pathogenesis
• Disc degeneration leads to the release of gas (nitrogen) from the disc substance (vacuum phenomenon)
• Vacuum phenomenon of the spine - a pathognomonic sign of disc degeneration, occurs in the lower part of the lumbar or cervical spine
• Disc degeneration also leads to the deposition of calcium (hydroxyapatite, calcium pyrophosphate), usually in the annulus, rarely in the nucleus pulposus.

Imaging data

• Front or side projection
• In a vacuum phenomenon, gas inclusions are observed, usually within the disk
• Calcification of the intervertebral disc appears as osteophytes or homogeneous deposits of calcium in the disc (usually in the annulus fibrosus).

• Data similar to X-ray data.

• Gas gives weak signal on T1- and T2-weighted images
• Calcium deposits usually give a weak signal on T1- and T2-weighted images.

Differential diagnostics (You can choose the optimal diagnostic MRI and / or CT center according to the parameters in our directory of clinics.)

Calcification of the intervertebral discs

• Metabolic disorders (pyrophosphate and hydroxyapatite arthropathy, gout, diabetes, hyperparathyroidism)
• post-traumatic

• Attention: possible imposition of intestinal loops

Rice. 3.19 a, b X-ray of the lumbar spine, lateral view. Reducing the height of the disk at the LIIISI level with a vacuum phenomenon in each disk. Subchondral osteosclerosis (Modic III) and LIV-LV degenerative spondylolisthesis (Meyerding stage I) with osteophytes are also seen. Posterior osteophytes at the level of L LII -L III

Rice. 3.20 X-ray of the lumbar spine (preparation). Narrowing of the disc at the LIII-LIV level. Severe disc calcification at the level of LII-LIII and LIV-Lv Degenerative spondylolisthesis LIII-LIV

Rice. 3.21 X-ray in lateral projection at the level of LI-LII (fragment). Disk calcification. Schmorl's hernia in the superior endplate of vertebra LII.

Diffuse idiopathic skeletal hyperostosis

KSS. "Vacuum phenomenon" in X-ray studies

Redchenko E. V. Regional radiologist clinical hospital Saratov.

In this case, the effect does not have dire consequences, but rather some diagnostic value. In various joints of the body, there is a certain amount of fluid (gel) enclosed between the articular surfaces and limited by the ligamentous apparatus. With violent stretching in the joint, the volume of its cavity (if the ligamentous apparatus allows) tends to increase with the same amount of content, and the pressure of the liquid content drops rapidly, as a result of which the solubility of nitrogen sharply decreases, and it is released into the joint cavity.

"Vacuum effect" is used in pediatrics in children who have begun to limp to determine the presence of effusion in the cavity hip joint. The technique is simple: with the help of a special device, the lower (sick, naturally) limb is traction until a characteristic click occurs, after which an x-ray is taken. In the presence of an excess amount of fluid, the joint space expands, but there is no gas in the joint. Normally, the effect described above takes place with the formation of free gas in the joint cavity.

The second method known to me of applying this effect in diagnostics was developed on the basis of the Department of Radiology of the Saratov medical institute and was a method of pneumoarthrography knee joint without the introduction of gas from the outside; the technique is similar to the one above. In the vertebral discs, the picture is somewhat different, one might say, the opposite. Normally (more often at a young age), the intervertebral disc is like a tight shock-absorbing pillow, consisting of a fibrous ring containing a pulpous nucleus in the center. The fibers of the annulus are very strong and, when supported from the inside by the nucleus pulposus, provide the vertebral segment with good stability.

But with dystrophic processes in the disc, the nucleus decreases in size, the ligaments of the fibrous ring weaken without support from the inside, and hypermobility occurs in the segment - the so-called orthopedic stage of osteochondrosis.

The body of the overlying vertebra acquires an additional degree of freedom, and can shift in the horizontal plane more often posteriorly, which is due to the structure of the facet joints (the so-called "degenerative shift"). In addition, the vertical mobility of the edges of neighboring vertebrae also increases, which, during forced flexion and extension, leads to negative pressure in the “cavity” of the intervertebral disc and, as a result, to the appearance of a “vacuum phenomenon”.

In the presence of a hernia of the intervertebral disc, gas can be determined in its cavity with computed tomography.

On x-rays, the effect is rarely detected. A 48-year-old male patient was admitted to the Department of Neurosurgery with pain in the lumbar spine and radicular complaints. Operated 4 years ago for a herniated disc L4-5 (hemilaminectomy L4). Plain images of the lumbar spine revealed signs of osteochondrosis, displacement of bodies L3, L4 posteriorly by 3 and 4 mm, respectively. To rule out hypermobility, functional radiographs were taken in the position of maximum flexion and extension, which showed no significant increase in listesis, and an increase in the vertical mobility of the vertebral bodies (mainly in the L3-4 and L4-5 segments).

In addition, in the projection of the disks L3-4, L4-5 and L5-S1, triangular-shaped enlightenment of gas density was visualized, which were regarded as a “vacuum phenomenon” (in this X-ray, the gas is clearly visible only in the disk L3-4)

This observation is presented by only one case and is intended to acquaint colleagues with it personally, since this effect is quite rare in the practice of a radiologist.

Computed tomography in the diagnosis of non-tumor diseases of the spine

Degenerative changes in the spine include:

Degeneration of the nucleus pulposus (destruction of the nucleus of the disc with its partial replacement with gas)

Protrusions (incomplete ruptures of the fibrous ring: concentric, radial, transverse)

Hernias (dorsal, ventral, lateral, Schmorl) with complete rupture of the fibrous ring

Combination of protrusion and disc herniation

Vertebrae (subchondral sclerosis of the bodies, marginal bone growths - osteophytes along the perimeter of the bodies)

Degeneration of the nucleus pulposus of the intervertebral disc

A sign of disc dystrophy on CT is a "vacuum phenomenon" inside the disc - these are foci of air density

Classification of herniated discs:

1. Schmorl's hernia - the introduction of the nucleus pulposus of the intervertebral disc into the spongy substance of the vertebral body with the destruction of its endplate. A new endplate is formed around the disc that has penetrated into the body of the vertebra.

2. Anterior and lateral - displacement of the intervertebral disc forward and laterally under the anterior longitudinal ligament.

3. Posterior hernias - posterior displacement of the intervertebral disc without / with rupture of the annulus fibrosus and posterior longitudinal ligament:

Median (median, central),

Foraminal and paraforaminal.

II. According to the degree of protrusion:

1. Protrusion (local protrusion) - bulging of the intervertebral disc without complete rupture of the fibrous ring.

Posterior (median, median-lateral, foraminal);

Front and side.

b) diffuse (circular):

2. Hernia (prolapse, extrusion) - bulging of the intervertebral disc with rupture of the fibrous ring.

Sequestered hernia (sequestration, free fragment) - bulging of the intervertebral disc with rupture of the annulus fibrosus and posterior longitudinal ligament;

Subligamentous sequester (subligamentous hernia) - a free fragment located under the posterior longitudinal ligament without rupture;

An intradural hernia is a rupture of the dura with the location of the hernia in the dural sac.

3. A combination of protrusions and herniated discs.

Protrusions of the intervertebral discs

Incomplete rupture of the fibrous ring of the disc.

With protrusion, it is considered that the height of the protrusion of the intervertebral disc outside the vertebral body does not exceed a third of the width of the protrusion.

Local protrusions and herniated discs

By direction they are divided into:

Posterior disc protrusions

Herniated discs

The integrity of the fibrous ring is broken

By direction they are divided into:

Degenerative changes in the lumbar spine

Schmorl's hernia and disc calcification

Posterolateral and foraminal disc protrusions

CT - SIGNS OF RUPTURE OF THE POSTERIOR LONGITUDINAL LIGAMENT

A rupture of the compacted ligament at the level of the hernial protrusion is a direct sign

Indirect signs: local protrusion of the disc to a depth of more than 5 mm

"vacuum phenomenon" in the epidural space

displacement of the nerve root by a hernia to the vertebral arch or yellow ligament

Sequestered disc herniation

Foraminal disc herniation

Sequestered disc herniation MPR SSD

Sequestered disc herniation L4-5. MPR

Inflammatory (rapid) disc degeneration

Hernias in the cervical spine

Osteochondrosis, deforming spondylosis, uncovertebral arthrosis cervical spine

Degrees of deforming spondylarthrosis

Grade 1 - uneven narrowing of the joint space (less than 2 mm) due to degeneration of the articular cartilage and superficial erosion of the articular surfaces

Grade 2 - hyperplasia of the articular processes due to exostoses, uneven joint space, loss of congruence of the articular surfaces, "vacuum phenomenon" in the joint cavity (clinically the most significant)

Grade 3 - morphological decompensation is expressed by cystic restructuring of the bone tissue of the articular processes, an intra-articular "vacuum phenomenon", subluxations in the joints and massive bone growths, asymmetry of the joint spaces, sometimes with an outcome in joint ankylosis.

Spondylarthrosis 1 degree

Spondylarthrosis 2 degrees

Spondylarthrosis grade 3

Thoracic spine. Deforming spondylosis and arthrosis of costovertebral and costotransverse joints

Thoracic spine. Osteochondrosis, deforming spondylosis. MNR

Hyperplasia of the yellow ligaments

Spondylolisthesis is an anterior displacement of a vertebra relative to the underlying vertebra due to spondylolysis (true) or due to a degenerative process (pseudospondylolisthesis).

I st. - the vertebra is displaced by 1/4 in relation to the underlying one;

II Art. - the vertebra is displaced by half

III Art. - the vertebra is displaced by ¾

IV Art. - the vertebra is completely displaced, slips anteriorly

Bilateral spondylolysis L5

Spinal stenosis

Relative (sagittal size mm)

Absolute (sagittal size less than 10 mm)

Stenosis of the intervertebral foramen

Circular (diffuse) protrusion of the L4-5 disc, congenital stenosis of the spinal canal. CT MG

Spine. Dystrophic-degenerative changes.

Computed tomography in the diagnosis of degenerative changes in the intervertebral discs of the lumbar spine

The advent of X-ray computed tomography has significantly expanded the possibilities of diagnosing these diseases. Computed tomography makes it possible to obtain transverse layered images of the spine, differentiate intraspinal structures, and reveal minor differences in the density of normal and pathologically altered tissues.

The lumbar spine is most often subject to degenerative-dystrophic processes. The spinal cord barely reaches the second lumbar vertebra. Its continuation is the ponytail. Nerve roots, or the so-called roots of Nageotte (J. Nageotte - French anatomist and histologist), are separated from the dural sac behind and somewhat above the intervertebral disc and then diverge down and outward to the intervertebral foramina. Surrounded by a dura mater, they pass in close proximity to the dorsal part of the intervertebral disc.

Degeneration of the nucleus pulposus;

Combination of protrusion and hernia.

Degeneration of the nucleus pulposus refers to the destruction of the nucleus of the intervertebral disc with its partial replacement with gas. This condition is associated with premature disc involution. The intervertebral disc of an adult, like articular cartilage, loses its ability to regenerate. Insufficient nutrition, which occurs by diffusion, as well as a large load on the disks due to the vertical position, gradually lead to their aging processes. The most typical sign of dystrophy of the nucleus pulposus on computed tomograms is a "vacuum phenomenon" inside the disk: air-density foci (from -850 to -950 N) with clear contours. When changing the position of the body and the load on the spine, they do not disappear. Long-term observation of such patients shows the impossibility of a significant reduction in the severity of the “vacuum phenomenon”. The "vacuum phenomenon" is detected quite often and often accompanies other types of degenerative changes in the intervertebral discs. However, in cases of herniated discs, it is caused by the displacement of the nucleus pulposus through a gap in the annulus fibrosus.

The clinical significance of dystrophy of the nucleus pulposus is to reduce the height of the intervertebral foramen. As a result, the spinal roots converge with the upper articular processes of the underlying vertebrae and the lateral divisions of the yellow ligaments. With hyperplasia of these structures, the probability of compression of the root and ganglion in the intervertebral foramen increases.

In the case of protrusion (protrusion, protrusion of the disc), the integrity of the annulus fibrosus is preserved. We adhere to the following clinical and anatomical classification of protrusions of the intervertebral discs of the lumbar spine:

b) with lateralization

II. Circular: 85.5%

It should be borne in mind a certain conventionality of the classification, which is associated with the real variety of changes in the shape of the intervertebral discs. So, a combination of several local protrusions is possible. In addition, the shape of the protrusion may differ on successive scans. Therefore, further improvement of the classification is possible.

Foraminal protrusion manifests itself in the form of protrusion of the disc towards the intervertebral foramen. In this case, the hole is completely or partially narrowed. The formal picture of foraminal protrusions is similar to dorsal ones. Of greatest interest is the measurement of the distance between the head of the superior articular process of the underlying vertebra and the vertebral body, as well as the thickness of the lateral segment of the yellow ligament. This determines the main compression factor. Compression of the roots also contributes to arthrosis of the facet joints. There are three X-ray morphological degrees of this process.

I. Syndrome of damage to the articular surfaces.

a) destruction of the articular cartilage in the form of subchondral osteosclerosis of the articular processes, narrowing or uneven expansion of the intraarticular gap;

b) subchondral erosion in the form of serrations and excavations of the cortical surface of the joint.

II. Syndrome of hyperplasia of the articular processes. It is manifested by an expansion of the intra-articular gap with a loss of congruence of the articular surfaces, an increase in the size of the heads of the articular processes with the formation of exostoses, and the presence of an intra-articular “vacuum phenomenon.

Syndrome of morphological decompensation. It is defined as a cystic restructuring of the bone tissue of the heads of the articular processes, an intraarticular “vacuum phenomenon”, a pronounced incongruence of the articular surfaces with elements of organic subluxation, a significant increase in the intraarticular gap or signs of ankylosing. Practice shows that arthrosis of the second degree is the most relevant clinically.

Despite the large size of the heads of the articular processes and exostoses, in the third degree of arthrosis, signs of radiculopathy are less common, clinical symptoms are less pronounced. This is probably due to the adaptive capabilities of the spinal roots and surrounding bone structures. Osteophytes emanating from the edges of the vertebral body, unlike articular exostoses, rarely lead to radicular disorders. This is probably due to their stationary relationship with the spinal ganglion.

The occurrence of anterior and lateral deformities of the intervertebral disc is due to the uneven degenerative process in it, as well as congenital defects in the development of the annulus fibrosus and anterior longitudinal ligament. Quite often the specified changes in disks are combined with lumbalization. In most of the examined patients, pseudospondylolisthesis, expressed to one degree or another, is noted. Probably, hypermobility and instability in the spinal motion segments contribute to the formation of these forms of protrusions.

The main difference between lateral protrusion is the lateral deformation of the discs, in close contact with which the spinal nerves and their anterior branches are located. The semiotics of ventral protrusions is characterized by anterior disk deformation. However, their description in the study protocol is of academic interest only. The most common finding of a radiological examination is uniform circular protrusions. The very definition of this type of protrusion indicates a uniform degenerative-dystrophic process in the intervertebral disc. Uniform circular protrusions can play a very significant role in the occurrence of neurological symptoms. Uniform circular protrusion is characterized by a horizontal circular protrusion of the disc with a density of 75 to 105 N. The dimensions of the protrusion can vary from 3 to 12 mm, are not the same in all departments, but the difference is no more than 1 mm. The structure is often homogeneous, but often there is marginal calcification. The contours are even and clear, and in cases of a long-term process - less clear and scalloped. The volume of epidural tissue adjacent to the protrusion is reduced. Based practical experience, recommended Special attention give marginal calcification of the disc. Ceteris paribus, it is often the dominant factor in the origin of neurological disorders and determining the side of the lesion.

Circular-dorsal protrusions are the second in frequency of detection after uniform circular ones. This definition is used in the description of all circular protrusions, the magnitude of which is maximum in the dorsal segment. Computed tomograms in patients with circular-dorsal protrusions show deformity of the intervertebral disc in all directions, with a predominance in the dorsal region. The direct contact of the protrusion with the spinal roots of the underlying level is visible. Otherwise, the CT semiotics of circular-dorsal protrusions coincides with uniform protrusions. Circular-foraminal protrusions are quite common. Since the width of the outer part of the lateral canal is normally about 5 mm, the foraminal part of the protrusion does not exceed this value. According to our experience, the bilateral nature of circular foraminal protrusion occurs in approximately 16.0% of patients. In 62% of patients, left-sided lateralization of the process is detected, in 22.0% - right-sided. Computed tomograms reveal uneven circular bulging of the intervertebral disc with its maximum value in the foraminal region. As with foraminal protrusions, marginal growths of the vertebral bodies in the area of ​​the intervertebral foramina, calcification of the fibrous ring, hypertrophy of the lateral part of the yellow ligament and the head of the upper articular process of the underlying vertebra are clinically most significant. Herniated intervertebral discs, with the exception of intracorporeal ones, are formed due to rupture of the fibrous ring. More often, the nucleus pulposus moves to the dorsal side. Initially, it is located at the level of the disk, and then shifts down along the spine, less often up.

We use the following clinical and anatomical classification of dorsal herniated discs in the lumbar spine: median (10%), paramedian (75%), foraminal (15%). Paramedian hernias always predominate, but the proportion of foraminal and median hernias in different parts of the spine varies. In the lumbar region, according to our data, foraminal hernias are somewhat more common than median ones. Median and paramedian hernias can tear fibers of the posterior longitudinal ligament. In this case, the nucleus pulposus more often goes around it, penetrating into the epidural adipose tissue. On CT images, herniated discs appear as irregular, semi-oval bulges. Sizes are variable. So, median and paramedian can protrude into the lumen of the spinal canal up to 12–15 mm. The size of foraminal hernias is partially limited by the size of the intervertebral foramen of 5–6 mm. However, large foraminal hernias extend beyond the opening and exceed 6 mm. Some hernias are detected only at the level of the intervertebral disc. The criteria for their difference from protrusion are tuberous contours and the height of the protrusion, which exceeds a third of the width. Most hernias are longer than the thickness of the disc. On CT images, this is manifested by the presence of a similar protrusion at the level of the body above and (or) the underlying vertebra. Recently formed hernias have a relatively homogeneous structure, density 60–80 N, not always clear contours, long-term existence - heterogeneous structure, density up to 110 N, with elements of marginal calcification with a density of >120 N, with clear and scalloped edges. Unfortunately, attempts to distinguish a prolapsed nucleus pulposus from a ruptured annulus fibrosus by density indicators are untenable. CT allows you to determine the shape of the disc herniation, the width of its base, and hence the risk of sequestration. Teardrop hernias with a narrow base are at the greatest risk of separation from the disc. A herniated disc deforms the epidural fatty tissue. Dorsal hernias displace the roots backward and laterally. The affected root due to venous stasis may be edematous and thickened. At the same time, due to the local inflammatory process, the spinal root can be soldered to the disc herniation, then its visualization is extremely difficult. Paramedian hernias with severe lateralization may involve the roots of two adjacent homolateral segments. This reveals not only the displacement of the Nageotte root, but also the penetration of the hernia into the intervertebral foramen. The defeat of the homolateral segments is also possible with the development of a paramedian hernia against the background of a circular protrusion of the intervertebral disc.

The relationship of foraminal hernias with the spinal root is less demonstrative, since the root does not change its position. However, when a disc herniation is visualized at the level of the upper floor of the intervertebral foramen, and the boundary between the disc and the root is not defined, one can reliably speak of compression of the latter.

Additional information can be provided by sagittal and parasagittal reconstructions of axial images. They convincingly demonstrate the size and prevalence of the hernia, as well as the relationship of the disc with the spinal root along its length. Frontal reconstructions are used only for dorsal hernias and carry less information than sagittal ones.

Lateral and ventral forms of herniated discs are extremely rare and are more often associated with spinal injury. At the same time, only lateral hernias have significant clinical significance. In rare cases, they are able to stretch the spinal nerves and their anterior branches and cause neuropathy. CT semiotics of lateral and ventral hernias dorsally similar. In this case, frontal reconstructions are the most informative and help to visualize the contact of lateral hernias with spinal nerves. Hernias are often combined with circular protrusions of the intervertebral discs. Foraminal or paramedian hernia, which developed against the background of circular protrusion, often affects the spinal roots of two adjacent homolateral segments. CT reveals an uneven circular protrusion of the disc, which becomes localized at the level of the vertebral body and has an irregular semi-oval shape.

Intracorporeal hernias (Schmorl) are formed as a result of the introduction of the nucleus pulposus of the intervertebral disc into the spongy substance of the vertebral body with the destruction of its endplate. In this case, a zone of osteosclerosis is formed around the hernia. Schmorl's hernias indicate the severity of degenerative-dystrophic changes in the vertebral segment as a whole, but often do not have significant clinical significance. However, one should not forget about possible complication intracorporeal hernias - edema bone marrow vertebra, which is accompanied by local, but often quite intense pain syndrome. On CT images, Schmorl's hernia looks like a focus in the spongy substance of the vertebral body of an irregular round shape, adjacent to the endplate, of various sizes, relatively homogeneous structure, reduced to 50–60 N density, surrounded by a rim 2–3 mm wide, increased to 200–300 H density. Unfortunately, vertebral bone marrow edema does not show up on computed tomograms. A detailed study of the medical history of the subject, his clinical symptoms and comparison of these data with computed tomograms allows in the vast majority of cases to accurately establish the morphological causes of radicular disorders.

A.Yu. Vasiliev, N.K. Vitko. Degenerative-dystrophic changes are the most common lesions of the spine. Great importance in their recognition have radiation diagnostic methods, among which X-ray continues to play a significant role, including survey and functional radiography, layered tomography, epiduro- and myelography. Although etiopathogenesis lumbar radiculopathies is multifactorial, it should be noted the primary role in it of foraminal (toward the intervertebral foramina) protrusions of the discs. Factors of direct compression in the area of ​​the intervertebral foramina are ascending disc herniations, hyperplastic heads of the upper articular processes of the underlying vertebra, and hypertrophied medial sections of the yellow ligament. A special role also belongs to arthrosis of the facet joints. Degenerative changes in the intervertebral discs are divided into: protrusions; I. Local 14.5% ventral 1.0% Local protrusions are the result of uneven development of degenerative processes in the intervertebral discs. Their dorsal predisposition is due to anatomical prerequisites. Biokinematic processes in the spine during the performance of its inherent functions of support and movement are the initiating factor of disk deformation in the dorsal direction. The dorsal form of local protrusion on CT is visualized as a posterior protrusion of the disc by 3–10 mm of a homogeneous structure or with marginal calcifications, always with clear and even contours. The deviation of the top of the protrusion from the sagittal line determines the direction of neurological symptoms. The protrusion density is 60–95 N, which corresponds to the density of the fibrous ring of the disc. Additionally, hypertrophy of the medial component of the yellow ligament up to 5–7 mm, Schmorl's hernia, can be detected. Calcification of the posterior longitudinal ligament, dorsal exostoses of the edges of the vertebral bodies, primary stenosis of the spinal canal, and hypertrophy of the medial sections of the yellow ligaments also contribute to the tension of the Nageotte roots.