NINE DISC HERNIES ON TEN TREAT WITHOUT SURGERY


When is it then necessary to be alarmed if one suffers from a herniated disc? And above all, what are the risks of ending up in a wheelchair?

Yulia Tymoshenko, who had just been released from the prison hospital, went to Maidan, Kiev's central square, to address the crowd. A spectacular first outing, after two and a half years of incarceration, where she appeared packed in a wheelchair. Because, say his relatives, the face of the Orange Revolution of 2004 and former Prime Minister suffers from a disc herniation.

A diagnosis more difficult to determine than it seems. Doctors estimate that between 30 to 40% of the population has a herniated disc, but that the vast majority ignores it and will never suffer. For a hernia is painful only if the root of the nerve that passes nearby is inflamed or compressed (see box). When the hernia is located in the lumbar region (nine times out of ten), this inflammation causes intense pain in the leg: sciatica, or more precisely root syndrome. If the hernia is located in the cervical area, which is more rare, the pain is felt in one arm. Note that the majority of sciatica heal themselves and what is often called "sciatic" are simple back pain not related to a herniated disc

Rare emergency operations
When is it then necessary to be alarmed? And above all, what are the risks of ending up in a wheelchair, like Yulia Tymoshenko? "It's a common fear among patients, but I've never seen that. In general, people make an episode of intense pain, which can last several months, but eventually heal on their own, "says Stéphane Genevay, rheumatologist, head of the program back to Geneva University Hospitals (HUG).

In 90% of cases, the herniated disc is treated by a non-surgical treatment to suppress inflammation. This includes various medications: classic painkillers and anti-inflammatories. In some cases, antiepileptics and antidepressants are also used because of their effectiveness in pain related to inflammation of the nerves. To fight the pain, you can still use a TENS, device that sends electric waves through the skin. Finally, in some cases, doctors practice infiltrations. "A method often misused in back problems, but indicated and effective in case of true sciatic herniated disc," says Stéphane Genevay.

These methods can be coupled, depending on the intensity of the pain, with specific physiotherapy for example. "The goal is not to accelerate healing but to relieve pain," says the doctor. A lonely person on a desert island will suffer martyrdom if she suffers a hernia, but she has a great chance to heal. So we try to calm the situation until the body has done its work! "In 5 to 10% of cases however, the situation does not evolve favorably, either because nothing relieves the pain, either because they are prolonged too much. The only solution is surgery to remove the herniated disc.

In rare cases, the emergency operation is required. First, when there is a rapid loss of strength of the muscles in the front of the leg and the patient can not, for example, walk on tiptoe or on the heels - this happens in about 2 in 5% of cases. Then, in less than one case out of 1000, when the patient has difficulties to urinate or go to stool, or on the contrary he does not control his sphincters anymore. "In addition to these emergencies, there is an intermediate area where surgery is not imperative," says Professor Heinz Fankhauser, neurosurgeon at the Cecil Clinic in Lausanne. It all depends on the patient. If he feels that he can not afford to wait, or if he does not respond to the pain treatment, then the operation is preferable. It is then necessary to remove the herniated disk to suppress the compression of the nerve. Remember also that, compared to an operation, drugs often have unpleasant side effects, or even potentially serious risks. "

According to international standards, it would be necessary to wait three months after the beginning of the pains before operating. However, studies have shown better results if one operates very quickly. "It may be true, but it is not a proof of effectiveness because in deciding for an intervention during the acute phase of sciatica, one also operates people who would not have needed it, remarks the professor. Some of them would have healed spontaneously. Patients must be well informed about what lies ahead. Out of ten people operated on, five are cured, three are satisfied and two are not. And the rate of recidi


When is it then necessary to be alarmed if one suffers from a herniated disc? And above all, what are the risks of ending up in a wheelchair?

Yulia Tymoshenko, who had just been released from the prison hospital, went to Maidan, Kiev's central square, to address the crowd. A spectacular first outing, after two and a half years of incarceration, where she appeared packed in a wheelchair. Because, say his relatives, the face of the Orange Revolution of 2004 and former Prime Minister suffers from a disc herniation.

A diagnosis more difficult to determine than it seems. Doctors estimate that between 30 to 40% of the population has a herniated disc, but that the vast majority ignores it and will never suffer. For a hernia is painful only if the root of the nerve that passes nearby is inflamed or compressed (see box). When the hernia is located in the lumbar region (nine times out of ten), this inflammation causes intense pain in the leg: sciatica, or more precisely root syndrome. If the hernia is located in the cervical area, which is more rare, the pain is felt in one arm. Note that the majority of sciatica heal themselves and what is often called "sciatic" are simple back pain not related to a herniated disc

Rare emergency operations
When is it then necessary to be alarmed? And above all, what are the risks of ending up in a wheelchair, like Yulia Tymoshenko? "It's a common fear among patients, but I've never seen that. In general, people make an episode of intense pain, which can last several months, but eventually heal on their own, "says Stéphane Genevay, rheumatologist, head of the program back to Geneva University Hospitals (HUG).

In 90% of cases, the herniated disc is treated by a non-surgical treatment to suppress inflammation. This includes various medications: classic painkillers and anti-inflammatories. In some cases, antiepileptics and antidepressants are also used because of their effectiveness in pain related to inflammation of the nerves. To fight the pain, you can still use a TENS, device that sends electric waves through the skin. Finally, in some cases, doctors practice infiltrations. "A method often misused in back problems, but indicated and effective in case of true sciatic herniated disc," says Stéphane Genevay.

These methods can be coupled, depending on the intensity of the pain, with specific physiotherapy for example. "The goal is not to accelerate healing but to relieve pain," says the doctor. A lonely person on a desert island will suffer martyrdom if she suffers a hernia, but she has a great chance to heal. So we try to calm the situation until the body has done its work! "In 5 to 10% of cases however, the situation does not evolve favorably, either because nothing relieves the pain, either because they are prolonged too much. The only solution is surgery to remove the herniated disc.

In rare cases, the emergency operation is required. First, when there is a rapid loss of strength of the muscles in the front of the leg and the patient can not, for example, walk on tiptoe or on the heels - this happens in about 2 in 5% of cases. Then, in less than one case out of 1000, when the patient has difficulties to urinate or go to stool, or on the contrary he does not control his sphincters anymore. "In addition to these emergencies, there is an intermediate area where surgery is not imperative," says Professor Heinz Fankhauser, neurosurgeon at the Cecil Clinic in Lausanne. It all depends on the patient. If he feels that he can not afford to wait, or if he does not respond to the pain treatment, then the operation is preferable. It is then necessary to remove the herniated disk to suppress the compression of the nerve. Remember also that, compared to an operation, drugs often have unpleasant side effects, or even potentially serious risks. "

According to international standards, it would be necessary to wait three months after the beginning of the pains before operating. However, studies have shown better results if one operates very quickly. "It may be true, but it is not a proof of effectiveness because in deciding for an intervention during the acute phase of sciatica, one also operates people who would not have needed it, remarks the professor. Some of them would have healed spontaneously. Patients must be well informed about what lies ahead. Out of ten people operated on, five are cured, three are satisfied and two are not. And the rate of recidi

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