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Face to face with Health

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Face to face with Health

Disc herniation: the real problem is the symptoms caused by compression of the nerve roots.

Dr talks about it. Carlo Cesana, neurosurgeon at the In Salus medical center in Lecco

LECCO – Talking about lumbosciatica means dealing with one of the most common ailments, with which many people have to deal at least once in their life. Unlike the even more common “back pain”, rarely and not necessarily caused by a herniated disc, lumbosciatica underlies a more complex pathological condition that requires a very specific diagnosis and treatment process.

“Before delving into the subject, let’s immediately dispel some myths – explains Dr. Charles Cesana, neurosurgeon among the professionals of the In Salus center in Lecco – The herniated disc cannot be ‘pushed in’ by manual treatment because this is anatomically impossible! There are others strategies to reduce compression exerted on the nerve roots and is not cured only with surgical treatment: spontaneous healing is a very frequent event and surgical treatment is reserved for cases that rebel against conservative therapy”.

“The problem with a herniated disc – says the doctor – is not so much the hernia itself as the symptoms it causes in case of compression of a nerve root. Many hernias are in fact completely asymptomatic, they exist but do not cause any unpleasant consequences and do not require treatment other than indications on correct lifestyle habits”.

The patients most affected by this pathology are aged between 30 and 55 years. “This happens because at this age the discs are still well hydrated and represented – remarks Dr. Cesana – The lumbar part of the spine is the one subjected to the greatest load and consequently lumbar hernias are by far the most frequent. There are no real causes responsible for disc herniation documented in each patient but a series of risk factors: obesity, sedentary lifestyle, strenuous work or sports, incorrect postures, incorrect and repeated movements, excessive efforts, lack of paravertebral muscles and personal predisposition”.

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“Based on where the pain radiates, the specialist is already able to hypothesize at which vertebral level the hernia may be. The condition becomes more serious if, in addition to the pain, there is tingling, a decrease or loss of muscle strength and sensitivity in the affected limb – adds the doctor – In the most serious cases it can lead to the so-called paralyzing hernia, i.e. the appearance of strength deficit in some muscle groups with difficulty in some specific movements such as walking on tiptoes (L5-S1 herniated disc) or on heels (L4-L5 herniated). Already thanks to the collection of clinical data and the medical examination, the diagnosis of disc herniation can be made, which must then be confirmed by instrumental tests, more commonly with a lumbosacral Magnetic Resonance”.

The reference figure in the case of lumbosciatica is the Neurosurgeon specialist who will trace out a treatment path for the patient involving other specialists such as the Neuroradiologist, the Physiatrist, the Physiotherapist and the Anesthetist pain therapist. Finally, if non-invasive treatments fail, he can then resort to surgery.

So how to cure a herniated disc? “The first response, if there are no relevant neurological deficits that could lead to surgery, is always conservative treatment: drugs and physiotherapy. In fact, the first objective is the management of the pain symptom – explains Dr. Cesana – Ozone therapy is also one of the recommended therapies in case of lumbosciatica. Once inflammation and pain have been fought, the patient will be able to devote himself to guided physiotherapy: fundamental and essential to return to normalcy, especially to prevent recurrences. This is a particularly important phase both for those who manage to cure a herniated disc without surgery and for those who have to resort to surgery instead”.

The Neurosurgeon specialist decides when to operate on the herniated disc. It indicates surgical treatment in the event that, after attempting conservative therapy, symptoms persist beyond 8-10 weeks or persistent pain is associated with neurological deficit.

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“Currently the two most advanced surgical techniques for hernia removal are all in all minimally invasive operations and characterized by a rapid post-operative recovery – remarks the In Salus specialist – The patient must in any case be aware that the operation eliminates the cause of the pain (hernia) but does not eliminate the cause for which the intervertebral disc is herniated”.

In healthDr. Carlo Cesana, neurosurgeon
In Salus – Multi-specialist Medical Center
Lecco – Corso Carlo Alberto 17/A
Tel. 0341 367512


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