Why a herniated disc of the lumbar spine in most cases does not need to be operated on

About 66% of lumbar disc herniations resolve spontaneously

Many people think that if they have a herniated disc, then this is forever and cannot be done without surgery. Meanwhile, studies show that up to 2/3 of herniated lumbar intervertebral discs go away on their own. This phenomenon is called spontaneous resorption.

Scientific publications on spontaneous resorption of herniated intervertebral discs have appeared regularly since 1984 and are confirmed by CT and MRI data. On average , about 66% of lumbar disc herniations resolve spontaneously. And according to data from the United Kingdom – in more than 80% of cases. In most cases, the terms of resorption are from 3 to 12 months. As a rule, the symptoms disappear much sooner.

This is due to the body’s natural reactions. For example, an inflammatory reaction to fragments of the nucleus pulposus of the disc that make up the hernia (phagocytosis, enzyme influence), immunological reactions, or due to dehydration (dehydration) of the prolapsed fragment (the inner core of the disc is 80% water).

How to tell if your symptoms are caused by a herniated disc

According to MRI studies, disc herniations are often found in people without symptoms, that is, without pain in the back and legs . If there is still pain in the back, then a hernia on an MRI scan may not be the source of this pain.

Clinically, herniated intervertebral discs are manifested by radicular (radicular) syndrome or radiculopathy (the outdated name is sciatica). Patients are more concerned about pain in the leg than in the lower back. The pain usually radiates below the knee in a band. They may also be bothered by a feeling of numbness, tingling, or a crawling sensation in the leg.

In 70% of patients with clinically significant disc herniation who received non-surgical (conservative) treatment, symptoms resolve within 4 weeks (regardless of the type of treatment). In 90% – within 12 weeks.

Disc herniation: WHEN TO DO OPERATION

Surgical treatment requires no more than 5% of patients with herniated discs, which turn out to be radicular syndrome .

Surgery for a herniated lumbar intervertebral disc is unquestionably needed in the development of symptoms of compression of the cauda equina roots. This happens with acute massive prolapse of herniated discs.

The symptoms that occur in this case are numbness in the legs and pelvic area (in the perineum), and urination is possible. In this case, the pain may stop. It is this symptomatology that is the basis for an urgent MRI study. If the diagnosis of disc herniation is confirmed, urgent surgery is needed. Fortunately, such situations are extremely rare (less than 1%).

Other indications for surgery, not so urgent: increasing (progressive) weakness in the muscles of the leg, severe pain syndrome, cannot be stopped by any conservative methods, including epidural blockades.

In all other cases, you need to start with conservative treatment. This involves taking anti-inflammatory and pain medications, maintaining motor activity, special exercises, epidural blocks if there is severe pain. And only if there is no effect from complex conservative treatment after 6-8 weeks, the option of surgical treatment can be considered.

Patients can use this text as a guide or mini-plan to prepare for a conversation with a doctor. The better you understand your body and symptoms, the easier and faster you can overcome the problem.


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