Lumbar Disc Hernia: when do we have to operate?

Disc herniation symptoms usually start for no apparent reason. Or they may occur when a person lifts something heavy and/or twists the lower back, motions that put added stress on the discs.

Lumbar herniated discs are a widespread medical problem, most often affecting people age 35 to 50.

How a Lumbar Disc Herniates?

A tough outer ring called the annulus protects the gel-like interior of each disc, known as the nucleus pulposus.

Due to aging and general wear and tear, the discs lose some of the fluid that makes them pliable and spongy. As a result, the discs tend to become flatter and harder. This process—known as disc degeneration—starts fairly early in life, often showing up in imaging tests in early adulthood.

When pressure or stress is placed on the spine, the disc’s outer ring may bulge, crack, or tear. If this occurs in the lower back (the lumbar spine), the disc protrusion may push against the nearby spinal nerve root. Or the inflammatory material from the interior may irritate the nerve. The result is shooting pains into the buttock and down the leg.

About 90% of people who experience a lumbar herniated disc will have no symptoms six weeks later, even if they have had no medical treatment.

Symptoms:

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Most herniated disks occur in your lower back (lumbar spine), although they can also occur in your neck (cervical spine). The most common signs and symptoms of a herniated disk are:

• Arm or leg pain. If your herniated disk is in your lower back, you'll typically feel the most intense pain in your buttocks, thigh and calf. It may also involve part of the foot. If your herniated disk is in your neck, the pain will typically be most intense in the shoulder and arm. This pain may shoot into your arm or leg when you cough, sneeze or move your spine into certain positions.
• Numbness or tingling. People who have a herniated disk often experience numbness or tingling in the body part served by the affected nerves.
• Weakness. Muscles served by the affected nerves tend to weaken. This may cause you to stumble, or impair your ability to lift or hold items.

You also can have a herniated disk without knowing it — herniated disks sometimes show up on spinal images of people who have no symptoms of a disk problem.

In some serious circumstances, surgery is urgent.

The absolute and urgent indications of the treatment of Sciatica By Herniated Disc are:

• Hyperalgique Sciatica (very painful)
• Ponytail syndrome
• Motor deficit

1. Sciatica Hyperalgique:

It is defined by very intense root pain difficult to bearable by the patient despite the use of morphine at optimal doses and sometimes requires a very uncomfortable analgesic position.

The combination of other treatments (NSAIDS,infiltrations) makes it possible to make this situation rare and to avoid emergency surgery. When carrying out an epidural infiltration in these circumstances, the operator who performs epidural infiltration must be very careful not to make an epidural breach so as not to interfere with possible early surgery.

2. Ponytail syndrome:

It's a surgical emergency. It is characterized mainly by the emergence of sphinctériens disorders with the type of difficulty to urinate, urinary incontinence, but also by intestinal disorders including abdominal pain, or even anal incontinence in serious forms.

3. The Motor deficit:

It may concern either the lifting of the foot (difficulty in walking on heels corresponding to a l5 injury) or the extensor of the foot (difficulty in walking on the tip of the feet corresponding to an infringement of s1).

To sum up, a sciatica, ponytail syndrome or engine deficit require urgent exploration in radiology and a surgical opinion.

Indication of scheduled surgery:

Apart from urgent situations, the indication of surgery may be over 6 TO 8 weeks of evolution. The Indications of surgery depend on many factors:

- intensity of symptoms (pain, functional incapacity),

- the impact of sciatica on the life of the patient (professional activity, social life, etc. ),

- treatments received before,

- associated diseases (operating risk).

- patient preferences and probably more or less objective information provided to the patient who could influence his decision.

Studies show that surgery (regardless of surgical technique) provides a faster relief of pain than continued medical treatment in the first months of evolution.

these information is for educational & entertainment purposes only, please seek a qualified spine surgeon if seeking consultation.