Main cause of sciatica , the herniated disc is mainly located at the lumbar level. Surgical intervention is only necessary in 10% of cases. Intense and persistent pain is a determining criterion.
When should a herniated disc be operated on?
Most sciatica is cured with medication
In case of persistent pain: MRI or scanner
Herniated disc: a minimally traumatic surgery
The decision to operate belongs to the patient
More common among active 25-45 year olds, a herniated disc is a leading cause of sciatica . Of disc origin, sciatica is due to the mechanical failure of an intervertebral disc which, no longer ensuring its role of shock absorber between the vertebrae of the lower back, will cause compression and inflammation of the sciatic nerve .
The major symptom is pain that starts in the back and radiates to the thigh and calves . 80 to 85% of herniated discs are located at the lumbar level and 10 to 15% at the cervical level. In very rare cases, an emergency operation is necessary, otherwise it is discussed.
Most sciatica is cured with medication
Very often, rest associated with taking analgesics and anti-inflammatories comes to the end of sciatica of disc origin . “The literature shows that 95% of sciatica will heal within a year and most often after six weeks of serious medical treatment” , says Professor Jean-Marc Féron, head of the orthopedic and traumalogical surgery department at the Saint Antoine Hospital (Paris).
But if the pain persists beyond six weeks of well-conducted medical treatment, but without effect, the majority of surgeons believe that intervention should be considered.
In case of persistent pain: MRI or scanner
A medical imaging examination is a must to accurately visualize the herniated disc and its consequences on nerve compression.
A scanner, easier to obtain in an emergency, is often requested, but an MRI (non-irradiating) is the examination of choice.
The results of the imaging will of course guide the indication for surgery, but not only… Because in the absence of alarming symptoms, the operation of a herniated disc is not mandatory and there is no no loss of luck if the operation occurs several months later.
Herniated disc: a minimally traumatic surgery
Conventional surgery is currently moving towards minimally invasive techniques that are not very traumatic for the muscles. “Most often, an incision of a few centimeters is made in front of the diseased disc in order to open the spinal canal to remove the herniation or the disc fragment with the help of a microscope and a lighting device” , says Dr. Orabi.