Herniated discs

Herniated discs: when should you operate?

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As soon as alarming symptoms such as paralysis or difficulty urinating occur, an operation should be considered. But this is still rare.

Most often, it is not necessary to operate. Analgesic drugs, anti-inflammatories and muscle relaxants help to overcome the painful crisis. It can also be combined with physiotherapy and infiltrations. With such treatments, the hernia disappears on its own eight out of ten times. Still, if the pain persists beyond six to eight weeks, or if there is some paralysis in the foot, knee or sexual organs, then the operation is necessary.

Herniated discs originate from our anatomy. Between each of our 24 vertebrae are discs that act as a shock absorber and each have a gelatinous core enclosed in a ring of fibers. Sometimes this ring cracks and releases part of its contents as a protrusion. However, this hernia can then compress the roots of nerves located along the spine, in the spinal canal. Hence a potential inflammatory reaction and, therefore, pain: the latter may nevertheless be absent, or disappear after healing when the hernia persists…

What treatment?

Although sometimes concerning the cervical, it is most often at the level of the lumbar that these pains are declared, where the roots of the sciatic nerve come out. They then spread from the buttocks to the toes, passing through the thigh and the calf. And in rare cases, it happens that the hernia leads to more or less significant paralysis in the leg. Even more rarely, the patient has difficulty urinating and having a bowel movement or, on the contrary, to hold back. Two situations for which it is necessary to go directly to the emergency room, as Professor François Rannou, rheumatologist at Cochin hospital in Paris, and researcher at Inserm, reminds us.

Several techniques can be implemented to remove the hernia and loosen the compressed nerves. One, classic, consists in making an incision of about 5 cm at the height of the damaged disc: the surgeon takes off the muscle of the vertebra, enters the spinal canal and puts the nerves aside, then he removes the hernia and , sometimes a small piece of disk. The other, more recent technique is based on smaller incisions, through which are introduced small pipes where the surgeon can slide an optical camera, a suction drain and instruments allowing him to operate.

What part of heredity in back pain?

No all-out operations

Interest of this type of so-called minimally invasive intervention, according to Professor Rannou: “it probably reduces muscle damage”. Another advantage: it can exempt the patient from hospitalization, which can be performed on an outpatient basis. However, there is no question of multiplying this type of intervention, reserved for the most serious cases but also for easily operable hernias. Because even if the risk is minimal, the possibility of an infection exists. Moreover, out of ten people operated on, five are cured but only three are satisfied.

Finally, there is the risk of recurrence, estimated at about fifteen cases out of a hundred. This is why the neuroradiologist Jacques Théron defends another type of intervention: the intradiscal injection of gelled radiopaque alcohol, which is practiced on an outpatient basis and obtains positive results for the patient in at least 70% of the cases treated. According to him, “Barring severe neurological signs, this should be the step to take after failure of drug treatment and before any surgical option.”

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