nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2023-5-46-53nnp-2104Research ArticleCLINICAL OBSERVATIONSКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯMetamorphosis of a herniated lumbar discМетаморфоз грыжи межпозвоночного поясничного дискаhttps://orcid.org/0000-0003-4950-144XИсайкинА. И.IsaykinA. I.

Алексей Иванович Исайкин - кафедра нервных болезней и нейрохирургии.

119021, Москва, ул. Россолимо, 11, стр. 1

Alexey Ivanovich Isaykin - Department of Nervous Diseases and Neurosurgery.

11, Rossolimo St., Build. 1, Moscow 119021

alexisa68@mail.ruhttps://orcid.org/0000-0002-7384-6715АхмеджановаЛ. Т.AkhmedzhanovaL. T.

119021, Москва, ул. Россолимо, 11, стр. 1

11, Rossolimo St., Build. 1, Moscow 119021

https://orcid.org/0009-0007-9194-200XФедосеевС. Р.FedoseevS. R.

119021, Москва, ул. Россолимо, 11, стр. 1

11, Rossolimo St., Build. 1, Moscow 119021

https://orcid.org/0009-0000-8461-1084ЗаграничнаяВ. Д.ZagranichnayaV. D.

119021, Москва, ул. Россолимо, 11, стр. 1

11, Rossolimo St., Build. 1, Moscow 119021

Института клинической медицины им. Н.В. Склифосовского ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияN.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)Russian Federation2023231020231554653Copyright © Isaykin A.I., Akhmedzhanova L.T., Fedoseev S.R., Zagranichnaya V.D., 20232023Исайкин А.И., Ахмеджанова Л.Т., Федосеев С.Р., Заграничная В.Д.Isaykin A.I., Akhmedzhanova L.T., Fedoseev S.R., Zagranichnaya V.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/2104

Compression of nerve roots by herniated intervertebral discs (IVD) is a major cause of lumbosacral radiculopathy and often causes problems in patient management. We present a case report of a patient whose initial pain was axial discogenic in nature, probably due to a fissure of the annulus fibrosus, and who later developed LIII–IV radiculopathy. The timing of formation of a sequestered IVD hernia was recorded on MRI. There was no prolonged gradual formation of IVD hernia (bulging, fissure, protrusion, extrusion/sequestration), an acute formation of disc herniation occurred. Conservative treatment, including nonpharmacological (McKenzie gymnastics, educational program) and drug treatment (nonsteroidal anti-inflammatory drugs, anticonvulsants), as well as minimally invasive measures (epidural administration of local anesthetics and glucorticoids), allowed rapid regression of clinical symptoms and improvement of functional and emotional status. MRI of the lumbar spine performed six months after onset showed complete resorption of the IVD hernia. The patient follows ergonomic recommendations and performs therapeutic exercises (Nordic walking); no deterioration was observed within 9 months.

Компрессия нервного корешка грыжей межпозвоночного диска (МПД) является основной причиной пояснично-крестцовой радикулопатии и часто вызывает проблемы при ведении пациентов. Представлено наблюдение пациентки, у которой боль в дебюте носила аксиальный дискогенный характер, вероятно, вследствие трещины фиброзного кольца, а в последующем развилась радикулопатия LIII–IV. Был зафиксирован момент образования секвестрированной грыжи МПД по данным МРТ. Не наблюдалось стадийности образования грыжи МПД (выбухание, трещина, протрузия, экструзия/секвестрация), пролонгированного во времени, – произошло острое образование грыжи диска. Консервативное лечение, включающее немедикаментозные (гимнастика МакКензи, образовательная программа) имедикаметозное лечение (нестероидные противовоспалительные препараты, антиконвульсанты), атакже малоинвазивные мероприятия (эпидуральное введение местных анестетиков сглюкокортикоидами), позволило достичь быстрого регресса клинических симптомов, улучшения функционального иэмоционального статуса. ПриМРТ поясничного отдела позвоночника, выполненной через полгода от дебюта заболевания, выявлена полная резорбция грыжи МПД. Пациентка соблюдает рекомендации по эргономике, выполняет лечебную гимнастику в виде скандинавской ходьбы; в течение 9 мес не наблюдается обострений.

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The authors declare that there are no conflicts of interest present.