Spinal disc herniation occurs when the intervertebral disc or nucleus pulposus displaces, which can result in pressure being put on the nerve root, leading to possible neurological damage. This displacement occurs when the intervertebral disc, whose function is to absorb loads and impacts, suffers a tear in the annulus fibrosus. This occurs especially when there is prior disc degeneration with the consequent presence of arthrosis and limited mobility. Its clinical manifestations include sciatica, affecting sciatic nerve S1, and lumbago, in nerve L5, and can occur in any of the vertebrae, even in the cervical vertebrae. Disc herniation is classified according to the type of displacement of the nucleus pulposus:
Disc protrusion. The annulus fibrosus suffers posterior or posterolateral deformation caused by the impact of the nucleus pulposus.
Prolapse. Rupture of the nucleus pulposus through the annulus fibrosus without passing through the longitudinal ligament.
Extrusion. The posterior side of the nucleus pulposus passes through the annulus fibrosus and even the longitudinal ligament.
Sequestration. The extruded segment breaks free from the spinal canal due to tears in the annulus fibrosus’ collagen fibres.
Pain in the lumbar region due to inflammation of the vertebral periosteum, dura mater, annulus fibrosus, ligaments etc., usually as a result of sudden movements or excessive overloading in the incorrect position.
Tingling, loss of feeling with motor irritability and severe pain, which can radiate through the anterior, posterior and lateral thigh due to compression of the nerve roots.
Rehabilitation techniques are, in conjunction with orthotic supports, the conservative treatment of herniated discs. Different types of orthosis produce a realignment of the lordotic curve through abdominal compression, while providing varying degrees of unloading and immobilisation. The orthoses and braces designed for this purpose provide a wide range of options.
Orthoses made from elastomers compress and reduce lordosis, as do belts and braces manufactured in fabrics of greater consistency , featuring reinforcing elements such as stays. Orthoses with posterior metal frames and thermoplastic plates, such as Knight, Taylor, MZ and Williams braces, provide greater unloading and partial immobilisation of the vertebral segment. Fully-rigid braces completely immobilise on all planes, realign the physiological curves and partially decompress with a high degree of unloading.
In surgery cases, braces are very useful during pre- and postoperative periods as a method of containment and support during the patient’ s rehabilitation.