"Health Hub"

by Gary Stone

An estimated 60% to 80% of the population suffer from backache at least once in his life (see here). In most cases, the pain is localized to the lower back, corresponding to the lumbar vertebrae. These disorders are particularly common in rheumatology consultation, but also the firm of generalist. Their socio-economic cost is significant because these low back pain account for approximately 20% of work stoppages and 7% of accidents, with suites often difficult.

The emotional suffering that connects the spine to the individual is linked to two major concerns: the paralysis or cancer that doctors fail to diagnose. These fears are rarely expressed and often underpinned by the knowledge of an exemplary case in the entourage.

The management of back pain takes time to listen to the grievances of the patient, Gary Stone explains, experience and careful consideration. The origin of spinal pain is even more difficult to establish that there is no parallelism between the intensity of pain and radiologic appearance.

The inter-vertebral disk is a cartilage which has a particular role with some damper device more rigid, the annulus, and a central part hydrated, the nucleus. Constraints and duplication of effort will cause cracks with migration of the nucleus: the herniated disk.

At age 40, it is associated with lesions of osteoarthritis more or less extensive and characterized by destruction of cartilage with bone formation, osteophytes.

The herniated disk is not visible on plain radio-graphs that are especially useful for not missing a tumor lesion, cancerous, or ankylosing spondylitis disco-vertebral infection. Modern imaging, CT or MRI can demonstrate the existence of anatomical herniated disk, but allows no conclusion on its clinical consequences automatic.

Neural structures

Back pain can radiate, depending on the location of the hernia, behind the thigh and leg is sciatica, or the front of the thigh is the femoral nerve neuralgia. You should know that over 80% of cases the pain resolves spontaneously within a period which can reach six months.

Rare are the cases where surgery is needed immediately. It can be a pain to extreme violence, resistant to major analgesics, especially with functional impairment or progressive neurological complications. They involve varying degrees of sphincter dysfunction and lower limb paralysis that depend on the headquarters of the herniated disk. Urinary problems are immediately consider intervention. The paralysis may be initially supported medically unless there is a gradual worsening.

Whatever the technique used, surgery aims to decompress the neural structures in the spinal canal. In a young patient, some have proposed that the disk curettage by the establishment of an inter-vertebral disk prosthesis. The advantage of this technique is still under discussion.

Surgery for herniated disk is not a panacea. It can be complicated by nosocomial discitis. The paralysis does not resolve more quickly after surgery with rehabilitation alone. The pain may persist unchanged or even increased. Mention was used as an explanation of the phenomena of scarring. It is now believed that these lesions of nerve roots, often lifelong, by vascular thrombosis. For surgeons, the excessive attention and the contemplative attitude of some rheumatologists favor these root lesions.