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Why suffer with a herniated disc?
Francisco J. de Moura Theophilo, M.D.,
Ph.D.
There is
an old medical issue on the herniated disc, which asks whether the best treatment is rest, physical therapy, medicine, acupuncture,
chiropractic, traction, or opposite the conservative medicine, surgery.
The
answer to this old question is by analyzing a number of factors that make it unique within the so-called diseases can be
cured surgically.
First: The clinical manifestations
of disc herniation in the case of the cervical spine are neck and neck with radiation into one or both arms in the lumbar
spine and the famous low back pain (pain-in-back) also radiating to one or both legs, may also be part of other
diseases or symptoms, so these symptoms require medical clarification.
Second:
A herniated disc is not a disease that leads to death.
Third:
Since this disease whose main symptom is pain, and pain is a subjective biological phenomenon, this pain manifests itself
in different individuals with different intensities and different reactions to pain.
Unlike a brain aneurysm for example, that the surgical indication
is absolutely necessary (if not, the patient may die), the disc herniation is presented very rarely acute, with repeated
episodes of most of the time, thereby allowing that its bearer think enough in their disease, listen to various
opinions and ultimately decide how much their treatment.
A
herniated disc disease is a degenerative type (cue depends on an individual's genetic or tendency to happen) that a weakening
of the intervertebral ligaments and loss of flexibility of the intervertebral disc, the same at any given time out of your
seat and enters into the spinal canal, where its presence is compressing a nerve root causing the pain as described
above and other manifestations of neurological dysfunction of this compressed root.
Now, knowing the cause of the symptom, the best way to treat
it is to eliminate what is causing this case removing the herniated disc that is. But for that to happen absolutely
right, you need to know with certainty whether there is a herniated disc. Previously, to have this assurance
was necessary to refer the patient to a contrast examination of the spinal canal, myelography, which was an aggressive examination,
with some risk of infection or unpleasant symptoms for the loss of some amount of liquid from the spine. The
doctors then thought long and hard before taking an aggressive state, and before that tried to treat the patient with physical
therapy, anti-inflammatories and rest. Only the repeated cases openly and were of sufficient intensity to
myelography and then taken to surgery, which was also a large procedure with the patient suffering from a prolonged hospital
stay and recovery. Hence the historical reason of fear popular as a herniated disc.
Now, physical therapy, chiropractic care, rest and anti-inflammatory
drugs only work in cases of "protrusion" of the disk, where it responds to pressure from vertebrae "out"
a little place, without breaking the ligament and therefore the conservative treatment, returning to her seat
and the patient is asymptomatic. In cases of "prolapse" or herniated disc, the disc herniation does
not return to their original place in any way, and the patient has only chance of cure with surgery. Those
patients actually herniated disc that does not operate, follow the course of the disease with repeated attacks, which improve
when they take anti-inflammatories and rest, because the drug decreases the reaction of the resting nerve and prevents movements
cause greater compression of the nerve . When the patient improved and returned to their normal
physical activities, the process begins again generating a new crisis. The thing goes well until the disc prolapsed
(herniated) dehydrate (lose volume due to dehydration), which occurs in about one year, or nerve compression definitely
die, stopping the pain, but ultimately causing a motor deficit and other sensitive, which for some may mean
a move less in the hand / arm or foot / leg.
Nowadays,
the situation changed drastically. First, because the diagnosis is made on a non-aggressive means of computed
tomography and magnetic resonance imaging (risk-free examination and noninvasive), allowing the doctor to make sure there
is a herniated disc or other disease such as spinal tumors, neuritis or even an arthrosis of the spine. According
sealed because once the diagnosis, you know the natural course of disease, surgery and shorten the course. Third,
because the neurosurgical techniques now allow the patient to undergo corrective microsurgery, taking a short-term intravenous
anesthesia (awake in the room), take your herniated disc excised through tiny incisions, receive a waterproof bandage and
can even go to the pool hydrotherapy on the day of operation. In cases of herniated cervical modern
technology allows the use of a titanium implant with bone graft powder modifying the hip causing pain postoperatively, which
was the removal of block graft from the hip. In both cases, cervical and lumbar spine, the patient goes home
today on the final day of the operation or the next morning, being mobilized almost immediately after the procedure.
Finally, the arguments presented
herein are intended solely to clarify that for real cases of herniated disk, is certainly the best surgical intervention,
which for their safety, speed of resolution and efficiency, caused by modern techniques of microsurgery allies the
diagnostic certainty of the images, and require the patient's suffering prolonged bed rest, the side effects of anti-inflammatory,
and successive crises.
Today,
it is very common to hear the recently operated patient, who has spent time submitting to alternative treatments before
the operation, which was well known that, had not lost so long and suffered so much. From my own experience
as a patient of disc herniation: How good is going to the pool on the day in which we are free from such pain.
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News: Professor Francisco
de Moura Theophilo works no longer in Bad Kissingen. He has moved to Munich where he is, from february 1st. 2018, the Chairman
of the Neurosurgical Clinic at the Helios München-Perlach Hospital
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An interview with Prof. Francisco Theophilo
in
"Programa do Jô"
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 Parte 1 Parte 2
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Welcome
speech of Prof. Francisco Theophilo to former Health Minister José Gomes
Temporão on awarding of the Tiradentes Medal
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See a presentation of Prof. Francisco Theophilo about the surgery for stenosis of the spinal canal
at
the XI Spinal Surgery Congress São Paulo (2011)
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See a presentation of Prof. Francisco Theophilo "trans-unco-discal access to the cervical spine"
at the X Spinal Surgery Congress São Paulo (2010)
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