¿Es cierto que una Hernia de Disco puede llegar a desaparecer?

La contestación a esta pregunta es que sí: una hernia discal puede llegar a desaparecer de forma natural.

La creencia popular es que cuando uno se hernia, lo hace para toda la vida y su dolencia suele ir empeorando a lo largo del tiempo. En realidad esto es lo que ocurre con las hernias inguinales, es decir, aquellas que ocurren por un defecto músculo-aponeurótico de la pared abdominal. Indudablemente la sabiduría popular ha hecho extensible ésta realidad a todo tipo de hernia.

El disco intervertebral evoluciona de forma distinta. Con el paso del tiempo éste disco puede perder sus características "naturales", tornándose de color oscuro (el llamado "disco negro", en contraposición del color blanquecino que presenta un disco sano en las imágenes de resonancia magnética de columna), por deshidratación (pérdida de agua) progresiva. Al perder estas carácterísticas, el anillo que contiene al disco se debilita y a su través puede desarrollarse una hernia discal. En el momento que esto se produce, el organismo pone en marcha una serie de mecanismos reparadores, que buscan equilibrar la anómala situación, y si la dolencia es soportable para el que la sufre, puede llegar a desaparecer.

Ahora bien, los médicos no sabemos en qué pacientes este fenómeno va a acontecer (aunque en todos es factible), por lo que es imprescindible que toda persona que crea que se ha herniado acuda a su médico para que descarte las condiciones que precisan de un tratamiento quirúrgico urgente.

Para más información sobre el tema, visite esta dirección:
http://www.ncbi.nlm.nih.gov/pubmed/20442973

Dr. Martínez Quiñones. Neurocirujano.

Abstract

INTRODUCTION:

The intervertebral disc disease (IDD) is one of the most common muscle-skeletal 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 require 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 symptoms 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 cephaloarchidian liquid against 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, suspended 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 unsatisfactory. The second one (operative), excepting "need-to operate" 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.