Herniated disc surgery yes or no?

Neurosurgeons warn of insecurity of patients

04/29/2014

Does a herniated disc have to be operated on or is conservative therapy enough? The need for intervertebral disc surgery is controversial, because while conventional medicine considers surgery in many cases to be the best remedy, holistic-oriented physicians assume that a combination of exercise, massage and physiotherapy is the most promising long-term therapy. Since the pros and cons of spinal surgery are causing more and more uncertainty among patients, the German Neurosurgical Society (DGNC) has now made a statement on this topic in the run-up to its 65th Annual Meeting. Accordingly, conservative therapies in a herniated disc are the method of first choice - if there are no neurological deficits such as paralysis or feelings of numbness.

Necessity of surgical procedures on the spine is controversial
The discussion about the necessity and benefits of surgical interventions on the spine - such as the intervertebral disc - is omnipresent and leads to ever more uncertainty among patients. For this reason, the German Society for Neurosurgery (DGNC) has now made a clear statement in advance of its 65th Annual Meeting in Dresden, when an intervention from a medical point of view is indicated and when not. Consequently, the DGNC guideline on lumbar disc herniation would suggest that conservative treatment approaches always take precedence over surgical treatment. But in some cases surgery for a herniated disc is essential, and then, „if symptoms of paralysis occur or the bladder or bowel can no longer be controlled“, so Professor med. Bernhard Meyer, Director of the Neurosurgical Clinic of the Technical University of Munich at the Klinikum rechts der Isar. „In all other cases you can operate, but you do not have to“, explains the expert further - accordingly, in each individual situation must be thoroughly weighed.

Studies show that patients are faster pain-free
According to Professor Meyer, assistance with the balancing could offer two studies on the treatment of the herniated disc, the „[...] have created clear facts and should be relevant in advising patients.“ These are on the one hand to the so-called „Sciatica study“ of 2007, in which scientists divided patients with a severe lumbar disc herniation into two groups - one treated conservatively and the other at an early stage. The result: After one year, the subjects of both groups were mostly equally well, but the operators had recovered relatively faster from the incident and also had no more pain faster. According to the DGNC, the Spine Patient Outcomes Research Trial (SPORT), which is one of the largest clinical studies on spinal disorders, had come to similar conclusions a year earlier. It had been shown that two years after one group had undergone early surgery and the other had received conservative treatment, there was no significant difference in health status, but both the recovery of patients and the improvement in their physical functioning progressed faster.

Rate of minor complications is at two to four percent
Accordingly, it must be decided on a case by case basis, because „In the treatment of herniated discs, irreversible nerve damage is neither increasingly caused by long-term conservative therapies, nor is the surgical treatment above average risky“, Professor Meyer continues. According to the two studies mentioned above, minor complications would occur in about two to four percent of cases. Therefore, patients should be advised by a second doctor in case of doubt, the recommendation of Professor Dr. med. med. Gabriele Schackert, Director of the Department of Neurosurgery at the University Hospital Dresden and President of the 65th Annual Meeting of the DGNC.

Every year, five out of every 1,000 people suffer a herniated disc
The uncertainty affects more and more patients, because a gangplate incident is now one „people suffering“ According to Professor Meyer, it affects five out of every 1,000 people in industrialized countries every year. It is a disease of the spine, in which the inner, gelatinous core of the intervertebral disc (discus vertebralis) shifts and breaks through the protective connective tissue ring. As a result, the escaping jelly mass can press on the nerves emerging from the spinal cord and cause discomfort such as arm pain, leg pain or neurological deficits. Such an incident is usually triggered by overloading or age-related degenerative changes in the intervertebral discs, because these are like cushions between the vertebrae and act as a kind of elastic shock absorbers and spacers. As the water content decreases with age, the intervertebral discs also lose elasticity, which can cause the fibrous ring to crack slightly: „Painkillers and physiotherapy help many people - but about one third of the patients do not achieve sufficient analgesia over the long term with these conservative methods and yet need surgery“, so Professor Meyer. How long should first be attempted to successfully treat the conservative way, depending on the physician always depends on the will and the personal situation of the person affected. (No)