Herniated disc, why does it hurt?
Fig.1
To understand what a herniated disc is, we must know how our column works. The vertebral column (fig.1), the support structure of our organism, is formed by 33 vertebrae that house the spinal cord in its inner canal, from which emerge the nerve roots that are directed to different areas of the body through the spinal cord foramina (holes) of intervertebral conjunction.
The intervertebral discs are arranged between the vertebrae, and exert a function of cushioning and distribution of the loads on the spine.
Channel stenosis
Fig.2
In normal conditions the nerve roots run without any conflict from the spinal canal through these foramina (fig.2, arrows).
When the intervertebral disc deteriorates it begins to lose its normal function of damping, decreasing its height and bulging towards the canal, which can narrow the exit holes of the nerves (stenosis) unilaterally or bilaterally, trapping them and producing a painful symptomatology (lumbosciatalgia), which depending on the level affected, is distributed by different areas of the lower extremities. Alterations of sensitivity in the form of paresthesias (tingling) are also usually associated.
Acute herniated disk
Fig.3
In the case of acute disc herniation (fig.3), usually produced in young patients after an important physical effort, the fragment of herniated disc compresses the nerve root abruptly, originating a very invalidating acute symptomatology, which can require hospital admission.
Significant warning signs in these cases are: loss of strength in the affected limb and sphincter alterations. These signs imply that an urgent assessment by the neurosurgeon must be made.
Herniated disc: treatment
The treatment indicated initially will be medical if there are no alarm factors. The patient’s rest should not be prolonged beyond 48 hours. The standard medication consists of analgesics-anti-inflammatories, modulating drugs such as gabapentin and occasionally corticosteroids such as dexamethasone.
In case of favorable clinical evolution, the patient can be followed up in outpatient consultations. There will be complementary tests that allow an adequate diagnosis for a correct therapeutic indication.
Usually, these tests consist of lumbar spine resonance (MRI), computed tomography (CT), and dynamic radiographs (flexion and extension). An evaluation of the state of the nerves is sometimes added by electromyography (EMG).
When the patient’s clinic is very disabling and / or associates any of the aforementioned warning signs, the neurosurgeon must assess the patient since it is a neurosurgical emergency, in which a lumbar microdiscectomy must be performed, which has as its purpose release the affected nerves as soon as possible to prevent the neurological deficit from being definitive.
Periodo de recuperación
The period of complete recovery after neurosurgical intervention is usually about one month. During this period, a progressive return to daily non-work activities of the patient is recommended, without major physical efforts.
Dr. Javier Sendra Tello
