In which cases an operative pain treatment should be considered and when it should be done urgently?

At this occasion I just want to give you the answer about one indication: the acute disc prolapse as the absolute most common cause for spinal operations.

Acute pain by itself should be never  an indication for an acute operation, if caused by an disc prolapse whit an inflammed nerveroot, even if the pain seems unbearable. But if the patient also suffers from progredient neurological deficits, in worst case an acute operation should take place within about 6 hours. But what is meant by "progredient neurological deficite"? That means major paresis of leg muscles, e.g. when trying to stand on the toes or the heel, change in urinating habits like the inability to hold back urin consciously or loss of normal sensitivity directly at the anus.

But how often does this occur? If we take all the "bad" causes of back pain together, like massive disc prolapse, tumor, infection, fracture, narrowing of the spinalchannel, etc. - less then 1 out of 100 back pain patients show these massive neurological findings - luckily! And if we just look to severe disc prolapses, just 5 to maximum 10% of the patients have to be operated at the end of the day.

Disc pain without neurological deficites should just then be considered for an operation, if adequate conservative treatment did fail after a certain period of time - mostly 3 months! Adequate means guided nerveroot infiltrations, antiinflammatory medication, activity instead of lying in the bad and a number of other therapeutic modalities. 

In most cases of spinal pain either from the cervical or the lumbar spine, the surgical way as the solution of the backproblem is not indicated  and inadequate.




Zurück