Back surgery often does not make sense

When are operations on a herniated disc really useful

26.04.2012

More and more patients with a herniated disc undergo surgery. In the last five years, the number of intervertebral disk interventions has increased by almost 43 percent. Critics say over half of the invasive procedures are unnecessary. But when is a surgery really useful and can not be performed other gentle treatments?

Rapid increase in back surgeries
Hardly anyone likes to operate. However, back pain, because of problems with the spinal disc, many people undergo invasive surgery. In many cases, gentler procedures such as back pain exercises, osteopathy or physiotherapy could achieve significant results. Many pain patients apparently lack the patience and the pressure of some orthopedic surgeons often shows effect. An evaluation showed that from 2004 to 2009, the intervertebral disc surgery increased by about 43 percent. There is a suspicion that many surgeries are actually superfluous and are only undertaken to provide financial benefits to clinics or doctors. These and other topics are currently being discussed controversially at this year's congress of the German Society of Surgery in Berlin from 24 to 27 April.

Even without surgery, good treatment results
However, those who take their time and specifically carry out non-invasive treatments can achieve at least as good results as with surgery. This is also confirmed by some studies that have been written on this subject so far. „In the long term, the statistically recorded results are the same for patients with and without surgery.“, says the future chairman of the German Society for Orthopedics and Orthopedic Surgery, Professor Bernd Kladny.

Backhands are now a mass phenomenon in today's highly technology-based society. Depending on the evaluation, between 70 and 85 percent of all Germans experience problems with their backs at least once in their lives. Many suffer a lifetime of pain. For physicians, clinics and physiotherapists, the widespread disease herniated disc means enormous financial potential. Often physicians therefore resort to the scalpel rashly.

Back jokes can disappear even without surgery
A herniated disc does not always have to be the cause of recurring pain. The most common diagnosis is tension or banal back-jokes due to bad posture and too little exercise. Therefore, a more accurate diagnosis is not always necessary, „because the pain usually disappears on its own.“, explains Kladny. Temporarily painkillers can also be used. This method has been reinforced because scientists have recently found that relieving does not relieve back pain. Rather, regular exercise can improve suffering in the short term. Bed rest and protection, according to the expert with unspecific back fools often even aggravate the symptoms.

No slow action but active movement
Slow down is the worst form of therapy. The less patients move, the more the back muscles are broken down. The lack of exercise causes the muscles to become weaker and weaker. Too long a one-sided load, the pain can then come back quickly. Therefore, the most important therapy in back-joking movement, warns the orthopedist. „The job of physicians is to protect those affected from this vicious circle of inactivity. The most important measure for the prevention and treatment of back pain is exercise.“ Doctors should therefore prescribe targeted back training for their patients. It does not have to be an outpatient therapy, even swimming and longer walks can help with harmless back problems. Because „every movement helps to prevent the pain“.

Chronic pain requires holistic treatment
If the pain in the back has manifested and is already chronic, exercise may be advisable, but this alone is the pain no longer defeat. Therefore, treatment should also pay attention to social and psychological factors such as the patient's environment. Continuing stress in the family and / or at work can have an adverse effect on the pain progression. „Relaxation techniques such as meditation or autogenic training can relieve stress and relieve pain“, also says Hermann Peters, naturopath from Kiel.

A one-sided therapy, which is fixed only on the removal of the organic pain, is accompanied usually with chronic course only by a small success rate. The pain has already changed according to Kladny. For chronic back-jokes „the pain has lost its warning function“, explains the doctor. The complaints exist, „although there is no acute damage.“

The goal of relieving pain in chronic conditions no longer comes first. Rather, an improvement in the patient's performance can be achieved. Targeted movement therapy, changes to the most unhealthy lifestyle and psychological support can often alleviate the suffering of the afflicted.

Preventive measures to protect the intervertebral disc
In the herniated disc, prevention is not always possible. Even young people can already suffer an incident. A disc herniation occurs when a sudden or slow displacement of the intervertebral disc occurs rearward or laterally to the rear. This can lead to paralysis or emotional disorders, because the pressure of the discs one or more nerve roots are affected. Conditional ischialgia is a painful irritative symptom with radiations into a leg due to a disc curl or herniated disc. Prophylaxis of herniated discs is difficult because the „Stability and strength of the intervertebral disc is also genetically predetermined“, explains Professor dr. Norbert Haas, Head of Orthopedics and Traumatology at the Charité University Hospital in Berlin. „Physical activity associated with severe spinal vibration can increase the risk of a herniated disc.“ Triggers are often sports such as gymnastics or horseback riding. These sports activities should no longer be performed by the patients.

Basically, a reduction of overweight, as far as available and unusually strong physical effort to avoid. Regular and guided gymnastics to strengthen the muscles is recommended, so that the spine is relieved.

The diagnosis of herniated discs is usually more difficult than assumed by laymen. Not every MRI can provide a clear result. Sometimes organic findings do not cause pain. On the other hand, there are often no visible changes, although the patient suffers from severe pain. Therefore, first the symptoms of the patient in diagnostics are groundbreaking.

When a doctor's visit is urgently indicated
In an acute herniated disc should not take too much time until a specialist is visited. Complaints like „Abnormal sensations and numbness in certain areas of the body“ indicate an incident. „Also, muscle weakness in the arm and legs may indicate a herniated disc. In such cases, patients should have their complaints cleared up to the doctor.“, reminds Prof. Kladny. Such neurological complaints are a clear indication that surgery is necessary to prevent worse. If other organs such as the bladder or intestine are affected, the intervention must even be very timely. Otherwise, severe conditions such as incontinence and organ damage can be left behind.

Shrinking processes qualify herniated discs
The surgical decision becomes difficult if, during the diagnosis, a herniated disc is detected, but the pain in the patient is missing. „A visible on MRI herniated disc of course, like to an operation.“ says Haas. Experience shows, however, that disc herniations are relativized by so-called shrinkage processes after some time. „In such cases, the symptoms improve completely by itself, even without therapy.“ reports the doctor.

Despite this, more and more patients are more likely to undergo surgery, although alternative therapies such as osteopathy, physical exercise, or spay therapies can provide pain relief. It is unclear whether more doctors urge their patients to the step of surgery for financial reasons or whether patients „for lack of time“ prefer invasive surgery instead of spending time on lengthy therapies. However, stakeholders should be aware that operations involve some significant risks. Not a few patients had infections, instability or scarring. These in turn lead to secondary diseases and may lead to further interventions. (Sb)

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