Le ernie del disco

Abstract

Disc herniation is a problem frequently found in clinical practice; its treatment involves, for various reasons, most health figures. Although this is not an issue of recent acquisitions, it is still of tremendous relevance; modern diagnostic investigations, while led to a better definition of the relations between the bony and neurologic spinal structures, in some cases have led to the tendency to rely almost exclusively on diagnostic images, ignoring or underestimating the importance of the predominant clinical findings. This has led to the development of methods of treatment which have proven ineffective over time, with no validity and then quickly abandoned. The natural history of lumbar disk herniation reveals that large herniations typically reabsorb with time, and symptoms will improve in most patients with conservative management alone. Most patients with lumbar disk herniations have symptoms improvement with conservative management during a 4–6-week period. However, imaging and invasive procedures may be considered if symptoms persist after 4–6 weeks or if neurologic function worsens. When the anatomic level of disk herniation on imaging studies correlates with physical findings of nerve root irritation at the same level, and when the result of a straight-leg raise test is positive, surgical diskectomy may lead to symptom improvement or resolution more quickly than continued conservative management. The goal of surgery is to relieve nerve root compression or irritation from herniated disk material. The success of the treatment of disc herniation is not possible without a thorough clinical evaluation and a careful selection of patients and a fair indication remain the basic elements from which — rather than a surgical technique — depend on the success of treatment.