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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.

News:

An interview with Prof. Francisco Theophilo

in "Programa do Jô"

fototheoejo.jpg  Parte 1
 
fototheoejo.jpg  Parte 2

Welcome speech of Prof. Francisco Theophilo

to former Health Minister José Gomes Temporão

on awarding of the Tiradentes Medal


 

TheoTemp1.JPG         

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)

TheoSPXI.JPG

See a presentation of Prof. Francisco Theophilo
"trans-unco-discal access to the cervical spine"
at the X Spinal Surgery Congress
São Paulo (2010)

foto12.JPG

 

 
 
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9:00am -6:00pm weekdays. Appointments can be scheduled with Mrs. Renata                        
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