2020-01-17 11:30:00
Very common, the sciatica attack leaves painful memories. It is due to a herniated disc, that is to say a small growth which compresses a nerve. Most often, the problem lies with the lumbar vertebrae. Although in most cases it disappears on its own, there are various ways to relieve it.
How to relieve a herniated lumbar disc?
“Most sciatica is caused by a herniated disc (80 to 90%) heal with medical treatment including relative restof the anti-inflammatories (possibly corticosteroids), muscle relaxers, and analgesics. This medical treatment can take 6 to 8 weeks to be effective,” indicates the Spine Center in Paris (source 1).
If anti-inflammatories and analgesics are not enough, corticosteroid infiltration
Of the corticosteroid infiltrations may be offered as a second step if the initial medical treatment does not provide sufficient relief for the herniated disc. If no improvement is seen after 6 to 8 weeksalternative solutions can be proposed.
But reducing the hernia or eliminating the pain is not enough to resolve the underlying problem, often linked to a bad posture. Strengthening the back muscles is always necessary regardless of the technique used.
Massages or physiotherapy sessions
Faced with a herniated disc, the attending physician may prescribe massages or physiotherapy sessions designed to prevent the muscles surrounding the damaged disc from remaining permanently contracted (due to pain), which increases pressure on the disc and contributes to painful symptoms. For this purpose, the physiotherapist can also use techniques using ultrasound.
Physiotherapy may be offered in pain phase, but also in postoperative or when the pain is gone in order to avoid new sciatica, specifies the Spine Center on its website.
In addition, the physiotherapist advises his patient exercises designed to relax muscles and strengthen your back and abs. It shows him the correct positions for lifting a load, bending, getting in and out of a car, cleaning, gardening, etc.
How to treat a herniated disc with surgery?
” The surgery only interveneslast resort, except in cases of emergency (paralysis of the foot, pain resistant to morphine, etc.). It relates to less than 10% of patients who have sciatica,” explains Dr. Stéphane Litrico, president of the French Society of Spine Surgery. The intervention, under general anesthesiaconsists of decompressing the nerve by removing the hernia, with 90% good results on pain.
We treat the painful episode, but the fragility of the disc remains. Surgery does not prevent recurrence, recalls Dr. Litrico, president of the French Society of Spine Surgery.
“A surgical operation allows remove the part of the nucleus pulposus which compresses the nerve, and generally relieves patients. But the tear in the annulus fibrosus persists and a new hernia may appear later. The intervertebral disc is also likely to deteriorate further,” indicates an article from the National Institute of Health and Medical Research (Inserm) (source 2).
A new endoscopic operation
A news endoscopy method (endoscopic surgery) is being developed in France to treat herniated discs. The surgical instruments are introduced through a small 5 mm incision made on the side. “This will allow us to generalize outpatient interventions », observes Dr Litrico. Not to mention that “the recovery time is shorter, with a quicker return to daily physical activities, including work”, notes the Espace Francilien du Rachis (source 3). “The size of skin scars is reduced which is a secondary benefit. The muscles are little damaged by this technique, which causes less postoperative pain and fewer analgesic medications.” The refund request is under review.
New treatments to reduce pain
New techniques have emerged in recent years to treat herniated discs.
First solution: Discogel®
Under local anesthesia and under radiological control, a needle is introduced into the intervertebral disc in order to injectgelled alcohol.
This gel spreads into areas of weakness. It lowers the pressure inside the disc and reduces inflammation, explains Professor Jacques Théron, neuroradiologist.
The pain from a herniated disc disappears within a few weeks. This injection takes place in a single session, outpatient (no need for hospitalization). Discogel® is not not covered by Social Security. “A session costs €2,600. Some mutual insurance companies can reimburse up to €800,” explains Professor Théron.
“We can say that Discogel® is a minimally invasive treatment compared to surgery, et not very restrictive for the patient since the intervention is carried out on an outpatient basis”, explain Dr M. De Sèze, doctor (functional rehabilitation department of the Pellegrin hospital in Bordeaux) and doctors C. Baudet and V. Philip (pharmacists at the pharmacy sterile medical devices, Haut-Lévêque Hospital, Bordeaux University Hospital) in a study (source 4).
Another solution: ozone injection
Ozone is a gas derived from oxygen that has a anti-inflammatory effect. The procedure takes place on an outpatient basis, under local anesthesia. “This technique consists of inject a gas (ozone O3) in the disc in order to cause a progressive disc dehydration. This results in a drop in intradiscal pressure, reducing root compression. A needle is positioned, under radiological control, in the central part of the intervertebral disc. Then, a few ml of ozone will be injected into the disc. A corticosteroid infiltration of the nearby nerve root can be carried out at the end of the procedure,” explains the website of the Interventional Neuroradiology Department of the Pitié Salpêtrière Hospital (source 5).
This technique, still little developed in France, is less expensive than le Discogel®, more not refunded neither. Scientific studies evaluating the effectiveness of ozone injection are still insufficient against the pain of herniated discs. In practice, we see more than 70% good results.
Hydrafil® gel, the latest discovery to treat sciatica
More recently, a new injectable gel into the intervertebral discs, called Hydrafil®, showed very encouraging results in relieving pain related to low back pain. American researchers tested its experimental formula on 20 patients suffering from chronic low back pain with disc degeneration. The results were presented at the annual meeting of the Society for Interventional Radiology in June 2022 (source 6): after the injection of the gel, their pain had significantly reduced.
An implant to regenerate the intervertebral disc
In 2019, an Inserm team announced promising results with a implant composed of fibrous lamellae to regenerate the operated tissues. Tested on animals, it has been observed to regenerate intervertebral disc tissue.
Indeed, “the most serious herniated discs are operable, but the surgical procedure leaves damaged tissue. A biomimetic implant in development would help them regenerate, thus preventing the appearance of new hernias,” explains the article.
By mimicking its onion-like structure, the researchers hoped that annulus fibrosus cells would colonize the implant and regenerate damaged tissue. And that’s exactly what they observed aliveon animal models, explains the Inserm article. “In just one month, the ring cells proliferated there while producing collagen,” said Catherine Le Visage, Inserm research director in the Regenerative Medicine and Skeleton laboratory in Nantes.
Stay at testing it in humans to treat herniated discs. “If necessary, it could consider clinical trials in order to offer this biomimetic implant to patients who, despite traditional treatments (anti-inflammatories, infiltrations, physiotherapy), continue to suffer,” concludes the article.
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