Herniated Disc

Our world, our society, is completely influenced by scientific, social, political, religious and cultural concepts. This makes many ideas, many expressions of the exclusively medical or scientific field become terms of daily use in informal conversations in our society.

Everyone has an approximate notion of what a heart attack, appendicitis or a torn meniscus is, although many times the concept is more or less ambiguous and with the lack of specificity and rigor that the matter demands.

Scientific dissemination or popularization of science, as the Spanish scientist and Nobel Prize winner Santiago Ramón y Cajal liked to say, serves to spread this knowledge and also clarify its just meaning, avoiding ramblings or inaccuracies.

The vertebral disc is a circular and flattened structure similar to a hamburger or giant lentil, placed between the anterior and most solid part of the vertebrae: the vertebral bodies; which acts as a shock absorber and allows anteroposterior flexion-extension movements, also lateral and a certain degree of torsion.

It is composed of a fibrous peripheral part and a gelatinous central part. The external one gives consistency and the internal elasticity. Being two different parts, they act in a coordinated way, allowing the flexibility of the spine.

When excessive or sudden efforts, alterations in feeding or hydration, or even trauma, act on them, these discs can become dislodged, damaged and can, therefore, give rise to pathology and pain at that level, whether localized or irradiated.

These alterations of the vertebral discs range from just minimal disc degenerations, to small displacements, called protrusions, or large displacements, called hernias.

Therefore, we call disc herniation the degeneration, displacement and exit of the vertebral disc, almost always with injury and rupture of its structure, out of its place, usually giving rise to an affectation of neighboring structures.

It is accompanied by inflammation and pain of the structures of the vertebral canal: the spinal cord, the meninges, the cauda equina in the lumbar levels or also, the roots and dorsal ganglia that come out of the spine through the holes of conjunction.

A hernia with spinal involvement or root involvement almost always requires energetic, interventional treatment, often analgesic blocks, some decompression, release and fixation surgeries (laminectomy and arthrodesis).

Almost all minor injuries can be improved, even solved with modifications in lifestyle, diet, muscle tone, postural hygiene, etc. These are useful tips in these cases and also for the general population, we cannot and should not wait for the appearance of symptoms to promote healthy habits.

Finding a herniated disc in an imaging test does not necessarily imply pathology, but having low back pain and finding an image of a herniated disc almost always points to it as the cause of it.

Complementary imaging tests, such as magnetic resonance imaging, are excellent tools that allow us to specify the origin of a problem but, as we like to repeat, «we do not treat complementary tests, we do not treat MRIs, we treat patients», that is, It is the symptoms, the patient’s complaint that makes us seek treatment.

Having a MRI with abnormal images should guide us in the possibility, even in the probability, of having a problem, but not necessarily in the need for interventionism in pain clinic or at least surgery.

Our attitude in life and also in medicine is prudence and prevention. Remember that almost always «it is achieved more with tenacity in exercise and care, than with intensity» in curative treatments.

Publicado por Dr. Alfonso Vidal

Director de las Unidades del Dolor del Hospital LA LUZ (Madrid) y del Hospital SUR (Alcorcón, Madrid). Grupo QUIRÓNSALUD Profesor de Dolor en la Univ. Complutense Madrileña

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