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首页> 外文期刊>Neurocirugia >Regresión espontánea de hernias discales intervertebrales: A propósito de una serie de 37 casos
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Regresión espontánea de hernias discales intervertebrales: A propósito de una serie de 37 casos

机译：椎间盘突出症的自发消退：一系列的37例报告

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Introduction: The intervertebral disc disease (IDD) is one of the most common muscle-skeletic disorders, causing both high work disability and elevated healthcare costs. There are two specific origins of disk disease that should be kept in mind: degenerative (DDD) and traumatic (TDD). Concerning the TDD, nowadays it has not been determined which patients could gradually improve and which ones will requiere surgery. Some studies indicate that about 85% of lumbar and 90% cervical acute disc herniation will get better in an average of 6 weeks. Materials and methods: We conducted an observational, prospective study, over a group of 858 patients, with the following inclusion criteria: 1. MRI imaging indicating TDD, 2. No signs or symptons requiring urgent surgical treatment (cauda equina syndrome, progressive or serious motor deficit or unbearable pain) and 3. Development of progressively spontaneous symptoms remission. All of the patients included in our study were treated in our Department of Neurosurgery from 2006 to 2007. Patients were tested for disc herniation regression with a second MRI study. Results: A spontaneous regression of their hernia was appreciated as follow: 33 cases of lumbar hernia (29 male, 4 female), 3 cervical hernia (1 male, 2 female) and 1 dorsal hernia (male). Discussion: Research about other reported series was done, and the different factors that could take place in disc spontaneous regression were analyzed: a) lodgement of the herniated disc back into the intervertebral space; b) disappearance of the herniated fragment due to dehydration and retraction mechanisms; c) gradual resorption of the herniated tissue by phagocytosis and enzymatic degradation induced by an inflammatory reaction that appeared as the disc (acting the extrusion itself as an foreign body) and, d) pulsion of cephalorhachidian liquid againts the herniated portion. Conclusions: Disc herniation can regress, or even disappear, in a number of patients, rendering the radiological findings not to be taken as the only surgical indication criterium. We consider that the best treatment is the one relying on a good doctor-patient relationship, sustented in a balance between conservative and surgical treatment. According to clinical data, the first one (conservative) should not exceed the estimated time beyond which the surgical result would be insatisfactory. The seconde one (operative), excepting "need-tooperate" situations (such as cauda equina compression, progressive or serious motor déficit, or unbearable pain), should be prudently supedited to MRI regresión control, in particular in patients in which a clinical improvement is observed. Thus, the disc herniation conservative healing, both clinical as radiological, do exist, being a concept to widespread among clinicians and patients also.
机译：简介：椎间盘疾病（IDD）是最常见的肌肉骨骼疾病之一，导致高工作残疾和医疗费用增加。应牢记磁盘疾病的两个特定起源：退化性（DDD）和创伤性（TDD）。关于TDD，目前尚未确定哪些患者可以逐渐改善，哪些患者需要手术。一些研究表明，平均6周，大约85％的腰椎和90％的颈椎间盘突出症会好转。材料和方法：我们对一组858例患者进行了一项观察性，前瞻性研究，其纳入标准如下：1. MRI成像表明TDD，2。无体征或症状需要紧急手术治疗（马尾综合症，进行性或严重运动缺陷或难以忍受的疼痛）和3.逐渐出现自发症状缓解。从2006年至2007年，我们研究中包括的所有患者均在我们的神经外科部门接受了治疗。通过第二项MRI研究对患者进行了椎间盘突出症消退测试。结果：疝气自发消退如下：腰椎疝33例（男29例，女4例），颈疝3例（男1例，女2例）和背疝1例（男）。讨论：已经完成了对其他报道的系列的研究，并分析了椎间盘自发性退缩中可能发生的不同因素：a）椎间盘突出症回到椎间隙。 b）由于脱水和缩回机制而使突出的碎片消失; c）吞噬作用和由炎症反应引起的酶促降解使椎间盘组织逐渐吸收，炎症反应表现为椎间盘（将挤压物本身作为异物起作用），并且d）头孢池菌液的脉动再次使椎间盘突出。结论：椎间盘突出症在许多患者中可以消退甚至消失，因此放射学检查结果不应被视为唯一的手术指征标准。我们认为，最好的治疗方法是依靠良好的医患关系，坚持保守治疗和手术治疗之间的平衡。根据临床数据，第一个（保守）不应超过估计时间，否则手术结果将不令人满意。第二种（手术），除“需要手术”的情况（例如马尾神经受压，进行性或严重的运动障碍或难以忍受的疼痛）外，应谨慎控制MRI的控制，特别是在临床改善的患者中被观察到。因此，确实存在既有临床也有放射学意义的椎间盘突出症保守治疗，这也是在临床医生和患者中普遍使用的概念。

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