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Minimal Invasive Treatment of Discal Hernia in Young Patients 2013

Category Interventional Francisco Aparisi Rodriguez
Maria Pilar aparisi gomez
Purpose Describe  an  easy technique, non invasive, without side effects and cheap for the conservative treatment of hernial disk for young patients.The hernia is a serious complication that becomes obscure the future of the intervertebral disc. The complete rupture of the fibrous disc is the first step of a  intervertebral instsability that impose a surgical  with instrumentation. The intervertebral disc have not vessels and their capability to make scars is nealy null. However in the perifery of the disc, subligamentous area, there are a zone able to reaction and produce granulation tissue and may be scar. The invasive treatments around the disc are nearly Essentials to aboid the compresive effect due to herniated disc. However we know that this can be  a misleading solution. A important curetaje can accelerate the instability and a scanty  cleaning  have te risk of a new hernia. Materials & Methods To solutionate this problem we have minimal invasive interventional procederes that  respect as much as possible the lateral extensión of common posterior vertebral ligament. Moreover microsurgery and percutaneous herniotomy we incluye the discal injections. Following this conservative idea, we treated discal hernias by injecting in the subligamentous area steroids, able to decrease the inflammation and provide the scar formation. During the last five years we treated 42 patients with seemingly hold discal hernia, using as selection criteria the MR image, showing a non migrated hernia involving only young people. To localize the lesion we use the CT and to injection a 25-27 G needle with double cánula, using always a transligamentous approach reserving the dural sac. We inject 0,7 cc  of lidocaine and triamcinolone half and half proportion. After cross the ligament we inject slowly the mixture ,avoiding a deep discal injection. Results To evaluate the results we consider the decrease or full disapearance of symptoms in one months, using as evaluation method the VAS scale. The follow up with a direct interview or phone call. The number of significative relief of symtoms during the first two weeks was 71,42%, 30 patients,. However 83,3%, 25 patients, before one month, needed a new punction. After the second injection 59,5%, 25 patients, remains without symptoms after one month after this second attempt.  Only 14,2% of the list, 6 patients, leave the method early way and surgical  treatment was needed. The strict follow up in our series was not possible and do not know the clinical situation after one year. Conclusion We lack of data that can probe if the good results are due to steroids injections or due to natural good evolution in non migrated hernias. This type of lesion do not permit a pathological analysis. At the moment we consider that the peripheral steroid injection improve the symptoms for a significative number of patients and canavoid or delay the surgical treatment without uncían new complications. A significative number of patients can return to sportives activities withou surgical treatment and minor risk of intervertebral instability. References Langston T. Holly, M.D., James D. Schwender, M.D., David P. Rouben, M.D. and Kevin T. Foley, M.D. Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications Neurosurg Focus 20 (3):E6, 2006 Foley KT, Smith MM: Microendoscopic discectomy. Tech Neurosurg 3:301–307, 1997 J.V. Martínez-Quiñones, J. Aso-Escario, F. Consolini y R. Arregui-Calvo Spontaneous regression from intervertebral disc herniation. Propos of a series of 37 cases Neurocirugía v.21 n.2 Murcia abr. 2010 Understanding Disc Hernia Surgery, Spinal Disc Hernia Treatment.www.placidway.com/subtreatment. Buy X, Gangi A. Percutaneous treatment of intervertebral disc herniation. Semin Intervent Radiol. 2010 Jun;27(2):148-59. Yeung AT, Yeung CA. Orthop Clin North Am. 2007 Jul;38(3):363-72; abstract vi. Minimally invasive techniques for the management of lumbar disc herniation. Jonathan Cluett, M.D., Herniated Disc TreatmentWhat is the treatment for a herniated disc?About.com .Guide Updated March 23, 2012