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Treatment of pain syndromes and neurological disorders is divided into conservative and surgical treatment.
Indications for surgical treatment is divided into absolute and relative.
Absolute indications for surgical treatment for herniated disc – this 1) compression of the spinal cord herniation cervical or thoracic with the development of progressive myelopathy accompanied tetraparesis or paraparesis, violation of the pelvic organs; 2) compression “horse’s tail” in the lumbar ( “pony tail” – terminal strands of the lumbar spinal cord, forming the lumbar-sacral plexus) with the formation of the lower paraparesis and disturbance of pelvic organs;
3) To conditionally absolute indications include – not the effectiveness of conservative treatment for 1-1.5 months with progressive pain, radiculopathy with progressive paresis of the lower limbs with impaired foot function.
All other indications are relative, that is – the presence of a herniated disc pain and active desire of the patient to be operated.
Absolute indications for surgery are not more than 3-5% of all pain syndromes, and neurological disorders in the pathology of intervertebral disc hernia. In 95-97% of cases, the hernia pathology patients can successfully help the conservative therapy, subject to recommendations on patient orthopedic regime.
Pain and neurological disorders in a herniated disc, often are not caused directly by the herniation, and most are a consequence of aseptic inflammation and secondary autoimmune response with subsequent edema (vsledvtsii extruded nucleus pulposus outside the gap of the intervertebral disc annulus fibrosus, which is perceived by the immune system as endogenous antigen), trauma zadneprodolnoy ligament secondary compression venous plexus with subsequent venous stasis and edema, naruschenii korechka Biochemistry and axonal transport due to the presence of inflammatory mediators. All this irritates the nerve sinuvertebralny Lyushka, thus also formed a short spasm of deep paravertebral muscles with subsequent breach of the regional blood flow of the vertebral-motor segment.
To be continued…