Traitement des lomboradiculalgies

Abstract

The fact that 95% of sciaticas evolve towards recovery without medical treatment of the herniated disk represents a major argument of the therapeutic strategy. The possibility of repeating scanography and magnetic resonance imaging allowed to show that a herniated disk may disappear after some months whatever its size; however many recoveries occur while the herniated disk is still present. The compression-induced radicular deformation is not the only mechanism factor of pain. In addition, an evidence of herniated disk may be found in about 20% of asymptomatic subjects. Long-term follow-up of patients with a discal lumbagosciatica in which surgery was indicated, shows at 1 year that the clinical course of patients who underwent surgery doesn’t differ significantly from that of patients who only received a symptomatic medical treatment. Thus, treatment of common sciatica should not exclusively focus on the diskoradicular compression conflict. Except in cases of surgical emergencies such as a cauda equina syndrome with genital-sphincter disorders, and radiculalgias with aggravating motor impairment, all available medical treatments for the herniated disk should be tried for at least 2-3 months before making decision for local treatment. It has never been evidenced that potential sciatica recovery could be jeopardized by the duration of radicular pain