THE HERNIATED DISC
Definition and cause
A herniated disc occurs when an intervertebral disc fragment is expelled from the disc. The exteriorization of this fragment occurs through one or more tears in the disc, and therefore cannot happen on a perfectly healthy disc.
A herniated disc is different from a disc protrusion which corresponds to a bulging of the disc, which occurs gradually, as the disc collapses.
A disc tear, herniated disc, and bulging disc are three consequences of discopathy or degenerative disc disease, which is widespread in the population, explaining the very large number of people with a herniated disc.
Course of the disease
Having a herniated disc is not necessarily serious or painful. Herniated discs are quite frequently found in people complaining of back pain. A herniated disc becomes painful when it compresses the nerve root, located just behind the disc in the spine.
Progress can occur naturally towards the disappearance of symptoms, even if the hernia itself does not disappear in most cases. Progress can also be towards worsening of pain and can sometimes even develop into paralysis.
Finally, in many patients, the course of the disease is cyclical, alternating between periods of pain and remission.
If there is no paralysis or urinary issues, there is never any urgency to operate on a herniated disc. The medical treatment to be implemented will combine rest, which is the crucial factor, with analgesic and anti-inflammatory drugs, and sometimes massages or infiltrations.
The aim of this treatment is to calm the inflammation around the compressed nerve root and to achieve a possible natural healing of symptoms. After a few weeks, the physician and the patient will get an idea about the effectiveness of this treatment and the chances of a spontaneous healing of the episode.
Principle of surgical treatment
If progress is not good, the surgeon, based on the severity of the patient’s symptoms, the duration of the disease, and the morphology of the herniated disc, will decide whether or not surgery is necessary to decompress the affected nerve root, by removing the hernia.
Most often, a simple removal of the expelled disc fragment under microsurgery is enough. In cases of recurrent hernia or hernia occurring on a disc that is already quite worn, the disc in its entirety will have to be removed and replaced by an implant.
In this case, the patients generally have a history of back pain, lumbago, or repeated attacks of sciatica.
Average hospitalization time
2 to 4 days (these are the durations most often reported).
A 4- to 6-week recovery period is essential following the surgery. Based on the severity of symptoms before the procedure, this period may be longer.
Recovery is not synonymous with bed rest. Physical exertion, carrying loads, and car trips must be limited during this period. Walking is often beneficial. Recurrence of pain during recovery is often the result of too much activity and will tend to disappear with rest.