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You are here: MEDICA Portal. Our Topics in 2009. Topic of the Month August: The Musculoskeletal System. Bladder.

Haste makes Waste

Haste makes Waste

Photo: Man gets physiotherapy

One year ago the German football fans were shocked: Bernd Schneider had to quit his career after slipping his disc a month before European championship 2008 for which he was expected to be part of the Germany squad. Although he underwent surgery the pain did not stop.

“Surgery is not necessary unless the patient shows specific indications”, says Michael Stoffel, senior consultant at the university neurosurgical hospital in Munich. Palsy in bladder, bowel or legs indicates surgery, for example, also heavy pain which does not improve as a result of a six week medical treatment or physiotherapy. In case of palsy, the nerve is not only irritated and hurts, but it is also damaged. Therefore, its self-regeneration is not possible.

Before any surgery, it has to be checked if a damaged spinal disc actually causes the pain in the back as it can have several origins. “A lot of prolapsed discs remain undetected”, says Ulrich Hubbe, neurosurgeon at the university hospital in Freiburg, Germany. In most cases pain appears when the spinal disc’s nucleus steps out of its tissue and pushes on a nerve in the vertebral canal. In these cases, a surgical procedure does not make any sense. The pain will not disappear, because it is caused by something else.

First aid: drugs and bed rest

However, if it is sure that the spinal disc causes the pain in the back, Stoffel recommends a conservative therapy in almost all cases. “Drugs can relieve acute pain.” Beside this, the physician advises bed rest for some days, because the body heals itself: it is possible that a damaged spinal disc recovers while absorbing water like a sponge out of the body. Acupuncture also could be a good alternative to reduce pain. Moreover, hardened back muscles – as a result of the pain - can be relaxed with drugs. To prevent the disc from slipping again the patient should undergo physiotherapy.

 
 
Photo: X-ray of the spine 
Spinal discs lie between the
bony vertebral bodies;
© Dieter Schulz/Pixelio.de

„Such conservative therapies can reduce pain in most of the cases”, says Stoffel and references to studies. However, he advises against minimal-invasive spinal catheter technique after Racz which is another non-surgical method: drugs are brought directly to the nerve via a catheter in order to reduce pain. “This method is not proven scientifically”, says Stoffel.

But conservative therapies need time which is problematic as many patients are impatient. “Nowadays scarcely anybody can afford to be away from work for six or eight weeks”, Stoffel says. However, also physicians’ financial interests sometimes have an important part. “If a physician has special surgical equipment, he certainly wants to make use of it instead of prescribing drugs to the patient”, Hubbe says. As a result of our health care system medicine becomes more service-oriented. Above all, the patient is perceived as a client.

However, conservative therapies sometimes are not effective and in these cases surgery is needed. Microsurgical procedures are standard: the tissue pushing on the nerve is removed through the vertebral canal. There also exist other methods, but they are not scientifically proven. Those methods are for example minimal-invasive procedures, artificial spinal discs or bone cement. Therefore, patients should ask the advice of some experts and take much time for recovery.

Simone Heimann
MEDICA.de

 
 

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