There are two different approaches in lumbar disk herniation treatment:
Surgery
Conservative
There have to be strict indications for the operation and has to be conducted in special clinics and divisions.
The main indications for surgery are:
Urinary bladder and rectum sphincters paresis or paralysis;
Intensive and persistent root pain in progress for two weeks; hernia size more than 7 mm, hernia with sequester;
Conservative treatment is not effective for 3 and more months;
Upper and lower limbs paralysis;
Muscular atrophy with no functional root activity.
Diagnostic and therapeutic achievements help people to avoid unnecessary and sometimes harmful surgery and give opportunity for effective conservative treatment of disk herniation.
The rate of negative results after surgery is about 10-20%, and rate of recurrences is about 10-28%, as some authors say. Complication rate is no more than 3-5% Complication rate could have been lesser if patients had had rehabilitation course after surgery in special clinics.
More than half of diagnosed disk herniations before surgery are not the only reasons of low back pain. Dr. Arutunov reported following: during hundreds of peoples’ autopsies who newer suffered low back pain, he found single and multiple disk herniations in 7th cases, and 4 cases had very large disk herniations. Among all diagnosed disk herniations only 10-12% of them needed surgery, and last ones had to be treated conservatively (including modern drugs and physiotherapy).
Absolute indications to surgery are: acute root compression, acute cauda equine compression, spinal compression (sphincters dysfunction, paresis). If 6–7–24 hours past, indications to the surgery become relative, because during this time all these changers become irreversible and secondly, if conservative treatment is started in time whole symptoms regress during 6 months period. The same period of regress can be seen after delayed surgery. All other indications are relative too. Western experience shows us increasing tendency of microsurgery treatment of disk herniation. Last one has more wide indications. CT signs of root compression together with clinical symptoms after unsuccessful conservative treatment are relative indications to the surgery.
Treatment has to be all-round and individual. All-round and individual approach means: several and different methods of treatment are being combined, for example drugs and physiotherapy or physiotherapy and physical culture and etc.
There are three main goals (directions) of treatment:
First – decrease pain, inflammation, edema, and increase limph and blood drainage;
Second – decrease trauma of neural structure;
Third – decrease hernias’ size.
To gain each goal, individual methods of DISK HERNIATION treatment are necessary.
1. Decrease pain, inflammation, edema, and increase limph and blood drainage:
1.1 .Anti-inflammatory and pain killing therapy;
1.2. Reduction of muscular spasm;
1.3. Increasing limph and blood circulation;
1.4. Local injections (anesthetics, glucocorticoids);
1.5. Physiotherapy;
1.6. Acupuncture.
2. Decrease trauma of neural structure:
2.1. Rest, right position treatment;
2.2. Spine traction;
2.3. Using orthopedic mattresses with traction function;
2.4. Behavioral teaching programs;
2.5. Physical training;
2.6. Psychotherapy.
3. Decrease hernias’ size:
3.1. Traction:
3.2. Local injections (homeopathic drugs);
3.3. Electrophoresis for hernia softening and hernia diminishing drugs.
Effectiveness of listed above methods of treatment approved. Somewhere only one direction is used, somewhere two and very rarely three. It is very important to use all of them simultaneously. It will be better to do in special clinics where experienced doctors examine patients and recommend them the best individual program of treatment, taking into consideration contraindications too.
For example:
anti-inflammatory therapy;
muscle relaxing therapy;
metabolic therapy;
physiotherapy (including acupuncture);
massage;
back-life, swing machine;
spine traction (manual, apparatus, auto gravity is better);
METHODS
