[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"disease-index":3,"disease-4":121,"navigation-categories":617,"navigation-categories-fr":737},{"data":4,"meta":117},[5,11,17,23,28,34,40,46,52,58,64,70,76,82,88,94,100,106,111],{"id":6,"attributes":7},4,{"title":8,"title_en":9,"slug_en":10},"Hernie discale lombaire","Lumbar Disc Herniation","lumbar-disc-herniation",{"id":12,"attributes":13},5,{"title":14,"title_en":15,"slug_en":16},"Prothèse totale de hanche ","Total Hip Replacement","total-hip-replacement",{"id":18,"attributes":19},7,{"title":20,"title_en":21,"slug_en":22},"ménisque","Meniscus","meniscus",{"id":24,"attributes":25},8,{"title":26,"title_en":26,"slug_en":27},"Hallux Valgus","hallux-valgus",{"id":29,"attributes":30},16,{"title":31,"title_en":32,"slug_en":33},"Pathologie dégénérative cheville","Degenerative Ankle Disease","degenerative-ankle-disease",{"id":35,"attributes":36},20,{"title":37,"title_en":38,"slug_en":39},"Prothèse épaule","Shoulder Replacement","shoulder-replacement",{"id":41,"attributes":42},19,{"title":43,"title_en":44,"slug_en":45},"Pathologies de la coiffe des rotateurs ","Rotator Cuff Disorders","rotator-cuff-disorders",{"id":47,"attributes":48},18,{"title":49,"title_en":50,"slug_en":51},"Rupture du tendon d'Achille","Achilles Tendon Rupture","achilles-tendon-rupture",{"id":53,"attributes":54},9,{"title":55,"title_en":56,"slug_en":57},"Le névrome de Morton ","Morton's neuroma","morton-s-neuroma",{"id":59,"attributes":60},22,{"title":61,"title_en":62,"slug_en":63},"L’instabilité d’épaule","Shoulder Instability","shoulder-instability",{"id":65,"attributes":66},23,{"title":67,"title_en":68,"slug_en":69},"Capsulite rétractile","Adhesive Capsulitis (Frozen Shoulder)","adhesive-capsulitis-frozen-shoulder",{"id":71,"attributes":72},11,{"title":73,"title_en":74,"slug_en":75},"La Pathologie Ligamentaire","Ligament Pathology","ligament-pathology",{"id":77,"attributes":78},17,{"title":79,"title_en":80,"slug_en":81},"La prothèse totale de genou ","Total Knee Replacement","total-knee-replacement",{"id":83,"attributes":84},24,{"title":85,"title_en":86,"slug_en":87},"Principes de rééducations ","Principles of rehabilitation","principles-of-rehabilitation",{"id":89,"attributes":90},14,{"title":91,"title_en":92,"slug_en":93},"Pathologie de la Rotule","Patellar Disorders","patellar-disorders",{"id":95,"attributes":96},21,{"title":97,"title_en":98,"slug_en":99},"Fracture épaule","Shoulder Fracture","shoulder-fracture",{"id":101,"attributes":102},15,{"title":103,"title_en":104,"slug_en":105},"Pathologie ligamentaire cheville","Ankle Ligament Pathology","ankle-ligament-pathology",{"id":107,"attributes":108},6,{"title":109,"title_en":110,"slug_en":110},"coxarthrose ","coxarthrosis",{"id":112,"attributes":113},10,{"title":114,"title_en":115,"slug_en":116},"Griffes d’orteils et métatarsalgies ","Toe claws and metatarsalgia","toe-claws-and-metatarsalgia",{"pagination":118},{"page":119,"pageSize":120,"pageCount":119,"total":41},1,100,{"data":122,"meta":616},{"id":6,"attributes":123},{"title":8,"content":124,"createdAt":383,"updatedAt":384,"publishedAt":385,"summary":240,"seoTitle":240,"seoDescription":240,"author":240,"reviewedBy":240,"medicalReviewer":240,"medicalReviewedAt":240,"associatedAnatomy":240,"title_en":9,"slug_en":10,"summary_en":240,"seoTitle_en":240,"seoDescription_en":240,"content_en":386,"associatedAnatomy_en":240,"ogImage":604,"pathologie_par_articulation":605,"sources":611,"relatedSurgeries":612,"possibleTreatments":614,"signsOrSymptoms":615},[125,137,140,144,147,151,154,158,161,165,168,172,176,179,183,187,192,196,199,203,206,210,214,218,222,225,229,271,275,279,283,286,290,293,297,300,304,307,311,314,318,322,327,331,334,338,341,345,348,352,355,359,362,366,369,373,376,380],{"type":126,"children":127},"paragraph",[128,131,136],{"text":129,"type":130},"","text",{"url":132,"type":133,"children":134},"https:\u002F\u002Fyoutu.be\u002Fo35J3nWUEW0","link",[135],{"text":132,"type":130},{"text":129,"type":130},{"type":126,"children":138},[139],{"text":129,"type":130},{"type":126,"children":141},[142],{"text":143,"type":130},"La plupart des sciatiques par hernies discales (80 %) guérissent par un traitement médical .",{"type":126,"children":145},[146],{"text":129,"type":130},{"type":126,"children":148},[149],{"text":150,"type":130},"Le traitement médical comporte un repos relatif, , des anti-inflammatoires (voire des corticoïdes), et des antalgiques. Ce traitement médical peut demander 6 à 8 semaines pour être efficace.",{"type":126,"children":152},[153],{"text":129,"type":130},{"type":126,"children":155},[156],{"text":157,"type":130},"En cas d’inefficacité de ce traitement, des infiltrations lombaires de corticoïdes peuvent être proposées.",{"type":126,"children":159},[160],{"text":129,"type":130},{"type":126,"children":162},[163],{"text":164,"type":130},"Une intervention chirurgicale appelé dissectomie ne sera envisagée que :",{"type":126,"children":166},[167],{"text":129,"type":130},{"type":126,"children":169},[170],{"text":171,"type":130},"    si le traitement médical est insuffisant à soulager la douleur",{"type":126,"children":173},[174],{"text":175,"type":130},"    s’il existe une situation d’urgence avec risque de lésion neurologique irréversible : déficit moteur (sciatique paralysante), douleur intolérable non soulagée par les morphiniques (sciatique hyperalgique), syndrome de la queue de cheval (troubles périnéaux, dysfonctionnements sphinctériens en particulier urinaires)",{"type":126,"children":177},[178],{"text":129,"type":130},{"type":126,"children":180},[181],{"text":182,"type":130},"Une hernie discale découverte de manière fortuite sur le scanner ou l’IRM et ne donnant aucun symptôme ne doit pas conduire à une intervention.",{"type":126,"children":184},[185],{"text":186,"type":130},"L’élément principal conduisant à proposer une intervention chirurgicale, en dehors des 3 situations d’urgence décrites, est l’intolérance du patient à la douleur.",{"type":188,"level":12,"children":189},"heading",[190],{"text":191,"type":130},"Objectifs de la chirurgie et bénéfices escomptés",{"type":126,"children":193},[194],{"text":195,"type":130},"Le but de l’intervention est de libérer la racine nerveuse comprimée par la hernie discale, et de faire disparaître la douleur de sciatique. Cet objectif est atteint dans environ 85% des cas.",{"type":126,"children":197},[198],{"text":129,"type":130},{"type":126,"children":200},[201],{"text":202,"type":130},"Il n’est jamais possible d’assurer que les troubles sensitifs ou moteurs disparaîtront complètement : la racine nerveuse peut avoir été comprimée trop longtemps et avoir été abîmée.",{"type":126,"children":204},[205],{"text":129,"type":130},{"type":126,"children":207},[208],{"text":209,"type":130},"L’intervention ne remet pas le disque à neuf. Les lésions de dégénérescence discale persisteront et une partie plus ou moins importante des douleurs lombaires persistera après l’opération.",{"type":126,"children":211},[212],{"text":213,"type":130},"Aucune intervention ne remet l’organisme à neuf. Aucun résultat n’est jamais garanti à 100%.",{"type":188,"level":12,"children":215},[216],{"text":217,"type":130},"Deroulement de l’intervention",{"type":126,"children":219},[220],{"text":221,"type":130},"Le but de l’intervention est de libérer la racine nerveuse de la compression.",{"type":126,"children":223},[224],{"text":129,"type":130},{"type":126,"children":226},[227],{"text":228,"type":130},"Elle se déroule  sous anesthésie générale. Le chirurgien accède au canal rachidien entre 2 vertèbres par une courte incision (4 cm), puis au disque intervertébral en réclinant latéralement la ou les racines. Il retire la hernie discale et vide le centre du disque, afin d’éviter qu’un fragment libre ne se mobilise et entraîne une récidive de la compression. Le disque n’est jamais entièrement enlevé. ",{"type":230,"image":231,"children":269},"image",{"ext":232,"url":233,"hash":234,"mime":235,"name":236,"size":237,"width":238,"height":239,"caption":240,"formats":241,"provider":266,"createdAt":267,"updatedAt":268,"previewUrl":240,"alternativeText":236,"provider_metadata":240},".png","https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002FCapture_d_ecran_2024_08_05_183544_9d5e84257f.png","Capture_d_ecran_2024_08_05_183544_9d5e84257f","image\u002Fpng","Capture d’écran 2024-08-05 183544.png",80.98,771,636,null,{"small":242,"medium":250,"thumbnail":258},{"ext":232,"url":243,"hash":244,"mime":235,"name":245,"path":240,"size":246,"width":247,"height":248,"sizeInBytes":249},"\u002Fuploads\u002Fsmall_Capture_d_ecran_2024_08_05_183544_9d5e84257f.png","small_Capture_d_ecran_2024_08_05_183544_9d5e84257f","small_Capture d’écran 2024-08-05 183544.png",140.91,500,412,140911,{"ext":232,"url":251,"hash":252,"mime":235,"name":253,"path":240,"size":254,"width":255,"height":256,"sizeInBytes":257},"\u002Fuploads\u002Fmedium_Capture_d_ecran_2024_08_05_183544_9d5e84257f.png","medium_Capture_d_ecran_2024_08_05_183544_9d5e84257f","medium_Capture d’écran 2024-08-05 183544.png",281.58,750,619,281584,{"ext":232,"url":259,"hash":260,"mime":235,"name":261,"path":240,"size":262,"width":263,"height":264,"sizeInBytes":265},"\u002Fuploads\u002Fthumbnail_Capture_d_ecran_2024_08_05_183544_9d5e84257f.png","thumbnail_Capture_d_ecran_2024_08_05_183544_9d5e84257f","thumbnail_Capture d’écran 2024-08-05 183544.png",24.72,189,156,24715,"local","2024-08-05T16:36:40.525Z","2024-08-05T16:37:04.464Z",[270],{"text":129,"type":130},{"type":126,"children":272},[273],{"text":274,"type":130},"Dans d’autres cas, l’abord peut être plus large et la libération de racine peut exiger un geste de libération complémentaire. Il est parfois nécessaire d’enlever une partie de la vertèbre (foraminotomie, arthrectomie, laminectomie) pour libérer suffisamment la ou les racines comprimées.",{"type":188,"level":12,"children":276},[277],{"text":278,"type":130},"Les suites opératoires",{"type":126,"children":280},[281],{"text":282,"type":130},"Les suites sont peu douloureuses bien contrôlées par le traitement analgésique.",{"type":126,"children":284},[285],{"text":129,"type":130},{"type":126,"children":287},[288],{"text":289,"type":130},"La douleur de sciatique disparaît soit dès le réveil, soit après quelques jours ; la paralysie demande au moins plusieurs jours à récupérer ; les troubles de la sensibilité demandent souvent plusieurs semaines avant de régresser. Une récupération complète des troubles sensitifs ou moteurs n’est jamais certaine.",{"type":126,"children":291},[292],{"text":129,"type":130},{"type":126,"children":294},[295],{"text":296,"type":130},"Le lever est possible dès le soir ou le lendemain de l’opération.",{"type":126,"children":298},[299],{"text":129,"type":130},{"type":126,"children":301},[302],{"text":303,"type":130},"Si un drain a été placé, il sera retiré le surlendemain de l’intervention.",{"type":126,"children":305},[306],{"text":129,"type":130},{"type":126,"children":308},[309],{"text":310,"type":130},"Le retour à domicile est possible 2 jours après l’opération. La marche est recommandée. La voiture est déconseillée pendant 3 semaines. Il n’y a pas besoin de porter de corset. La rééducation peut être intéressante mais n’est pas systématique et débute généralement 1 mois après l’intervention .",{"type":126,"children":312},[313],{"text":129,"type":130},{"type":126,"children":315},[316],{"text":317,"type":130},"L’arrêt de travail est de 2 semaines à 3 mois selon les professions.",{"type":188,"level":12,"children":319},[320],{"text":321,"type":130},"Quels sont les éventuels risques encourus ? ",{"type":188,"level":12,"children":323},[324],{"text":325,"type":130,"italic":326},"Les risques inhérents à toute intervention chirurgicale",true,{"type":126,"children":328},[329],{"text":330,"type":130},"-La survenue d’une phlébite compliquée d’une embolie pulmonaire est possible. En cas de terrain favorisant un traitement anti coagulant est donné.",{"type":126,"children":332},[333],{"text":129,"type":130},{"type":126,"children":335},[336],{"text":337,"type":130},"– Les troubles de la cicatrisation sont très rares, mais peuvent imposer une nouvelle intervention.",{"type":126,"children":339},[340],{"text":129,"type":130},{"type":188,"level":12,"children":342},[343],{"text":344,"type":130},"    Les risques liés  à une chirurgie pour hernie discale lombaire",{"type":126,"children":346},[347],{"text":129,"type":130},{"type":126,"children":349},[350],{"text":351,"type":130},"– Un hématome peut survenir sur le trajet de l’intervention. S’il est volumineux il peut comprimer les nerfs et provoquer douleurs, paralysie, troubles sphinctériens. Une réintervention pour évacuation de l’hématome est nécessaire.",{"type":126,"children":353},[354],{"text":129,"type":130},{"type":126,"children":356},[357],{"text":358,"type":130},"-Des complications neurologiques peuvent survenir : troubles sensitifs, troubles moteurs avec paralysie, très rare, souvent d’origine ischémique (défaut d’irrigation sanguine). Ces troubles sont le plus souvent transitoires, très rarement définitifs.",{"type":126,"children":360},[361],{"text":129,"type":130},{"type":126,"children":363},[364],{"text":365,"type":130},"-Une brèche dans l’enveloppe qui entoure les nerfs (méninge) est possible et  peut provoquer une fuite du liquide contenu dans les méninges. Elle est le plus souvent réparée par le chirurgien. En cas de persistance de fuite, il peut être nécessaire de réintervenir.",{"type":126,"children":367},[368],{"text":129,"type":130},{"type":126,"children":370},[371],{"text":372,"type":130},"-L’infection du site opératoire est rare (0,1 à 1%). Une nouvelle intervention pour nettoyage local est parfois nécessaire. Les infections profondes (Spondylodiscite = infection du disque) sont rares. Des séquelles douloureuses peuvent persister.Les précautions d’asepsie et les antibiotiques ont permis de fortement diminuer le taux de survenue de ces complications.",{"type":126,"children":374},[375],{"text":129,"type":130},{"type":126,"children":377},[378],{"text":379,"type":130},"-Une lésion des gros vaisseaux abdominaux situés en avant du rachis peut entrainer une hémorragie grave et à l’extrême le décès.",{"type":126,"children":381},[382],{"text":129,"type":130},"2024-08-05T16:39:28.344Z","2024-10-18T23:17:34.338Z","2024-08-05T16:39:33.456Z",[387,394,397,401,404,408,411,415,418,422,425,429,433,436,440,444,448,452,455,459,462,466,470,474,478,481,485,493,497,501,505,508,512,515,519,522,526,529,533,536,540,544,548,552,555,559,562,566,569,573,576,580,583,587,590,594,597,601],{"type":126,"children":388},[389,390,393],{"text":129,"type":130},{"url":132,"type":133,"children":391},[392],{"text":132,"type":130},{"text":129,"type":130},{"type":126,"children":395},[396],{"text":129,"type":130},{"type":126,"children":398},[399],{"text":400,"type":130},"Most sciatica caused by herniated discs (80%) are cured by medical treatment.",{"type":126,"children":402},[403],{"text":129,"type":130},{"type":126,"children":405},[406],{"text":407,"type":130},"Medical treatment includes relative rest, anti-inflammatories (or even corticosteroids), and analgesics. This medical treatment may take 6 to 8 weeks to be effective.",{"type":126,"children":409},[410],{"text":129,"type":130},{"type":126,"children":412},[413],{"text":414,"type":130},"If this treatment is ineffective, lumbar infiltrations of corticosteroids may be offered.",{"type":126,"children":416},[417],{"text":129,"type":130},{"type":126,"children":419},[420],{"text":421,"type":130},"A surgical procedure called a dissectomy will only be considered:",{"type":126,"children":423},[424],{"text":129,"type":130},{"type":126,"children":426},[427],{"text":428,"type":130},"if medical treatment is insufficient to relieve pain",{"type":126,"children":430},[431],{"text":432,"type":130},"if there is an emergency situation with risk of irreversible neurological damage: motor deficit (paralyzing sciatica), intolerable pain not relieved by opioids (hyperalgic sciatica), cauda equina syndrome (perineal disorders, sphincter dysfunctions, particularly urinary)",{"type":126,"children":434},[435],{"text":129,"type":130},{"type":126,"children":437},[438],{"text":439,"type":130},"A disc herniation discovered incidentally on the CT scan or MRI and giving no symptoms should not lead to intervention.",{"type":126,"children":441},[442],{"text":443,"type":130},"The main element leading to proposing surgical intervention, apart from the 3 emergency situations described, is the patient's intolerance to pain.",{"type":188,"level":12,"children":445},[446],{"text":447,"type":130},"Objectives of surgery and expected benefits",{"type":126,"children":449},[450],{"text":451,"type":130},"The goal of the intervention is to release the nerve root compressed by the herniated disc, and to make the sciatica pain disappear. This objective is achieved in approximately 85% of cases.",{"type":126,"children":453},[454],{"text":129,"type":130},{"type":126,"children":456},[457],{"text":458,"type":130},"It is never possible to ensure that sensory or motor disorders will disappear completely: the nerve root may have been compressed for too long and may have been damaged.",{"type":126,"children":460},[461],{"text":129,"type":130},{"type":126,"children":463},[464],{"text":465,"type":130},"The intervention does not restore the disk to new condition. The disc degeneration lesions will persist and a more or less significant part of the lower back pain will persist after the operation.",{"type":126,"children":467},[468],{"text":469,"type":130},"No intervention restores the body to new condition. No result is ever 100% guaranteed.",{"type":188,"level":12,"children":471},[472],{"text":473,"type":130},"Progress of the intervention",{"type":126,"children":475},[476],{"text":477,"type":130},"The goal of the intervention is to free the nerve root from compression.",{"type":126,"children":479},[480],{"text":129,"type":130},{"type":126,"children":482},[483],{"text":484,"type":130},"It takes place under general anesthesia. The surgeon accesses the spinal canal between 2 vertebrae through a short incision (4 cm), then to the intervertebral disc by reclining the root(s) laterally. He removes the herniated disc and empties the center of the disc, to prevent a free fragment from mobilizing and causing a recurrence of the compression. The disc is never completely removed.",{"type":230,"image":486,"children":491},{"ext":232,"url":233,"hash":234,"mime":235,"name":236,"size":237,"width":238,"height":239,"caption":240,"formats":487,"provider":266,"createdAt":267,"updatedAt":268,"previewUrl":240,"alternativeText":236,"provider_metadata":240},{"small":488,"medium":489,"thumbnail":490},{"ext":232,"url":243,"hash":244,"mime":235,"name":245,"path":240,"size":246,"width":247,"height":248,"sizeInBytes":249},{"ext":232,"url":251,"hash":252,"mime":235,"name":253,"path":240,"size":254,"width":255,"height":256,"sizeInBytes":257},{"ext":232,"url":259,"hash":260,"mime":235,"name":261,"path":240,"size":262,"width":263,"height":264,"sizeInBytes":265},[492],{"text":129,"type":130},{"type":126,"children":494},[495],{"text":496,"type":130},"In other cases, the approach may be wider and root release may require an additional release procedure. It is sometimes necessary to remove part of the vertebra (foraminotomy, arthrectomy, laminectomy) to sufficiently free the compressed root(s).",{"type":188,"level":12,"children":498},[499],{"text":500,"type":130},"The surgical aftermath",{"type":126,"children":502},[503],{"text":504,"type":130},"The consequences are not very painful and are well controlled by analgesic treatment.",{"type":126,"children":506},[507],{"text":129,"type":130},{"type":126,"children":509},[510],{"text":511,"type":130},"Sciatica pain disappears either upon waking up or after a few days; paralysis requires at least several days to recover; Sensitivity disorders often take several weeks to resolve. Complete recovery from sensory or motor disorders is never certain.",{"type":126,"children":513},[514],{"text":129,"type":130},{"type":126,"children":516},[517],{"text":518,"type":130},"Getting up is possible in the evening or the day after the operation.",{"type":126,"children":520},[521],{"text":129,"type":130},{"type":126,"children":523},[524],{"text":525,"type":130},"If a drain has been placed, it will be removed two days after the procedure.",{"type":126,"children":527},[528],{"text":129,"type":130},{"type":126,"children":530},[531],{"text":532,"type":130},"Return home is possible 2 days after the operation. Walking is recommended. The car is not recommended for 3 weeks. There is no need to wear a corset. Rehabilitation can be interesting but is not systematic and generally begins 1 month after the operation.",{"type":126,"children":534},[535],{"text":129,"type":130},{"type":126,"children":537},[538],{"text":539,"type":130},"The work stoppage is 2 weeks to 3 months depending on the profession.",{"type":188,"level":12,"children":541},[542],{"text":543,"type":130},"What are the possible risks involved?",{"type":188,"level":12,"children":545},[546],{"text":547,"type":130,"italic":326},"The risks inherent in any surgical intervention",{"type":126,"children":549},[550],{"text":551,"type":130},"-The occurrence of phlebitis complicated by pulmonary embolism is possible. In case of favorable conditions, anticoagulant treatment is given.",{"type":126,"children":553},[554],{"text":129,"type":130},{"type":126,"children":556},[557],{"text":558,"type":130},"– Healing disorders are very rare, but may require further intervention.",{"type":126,"children":560},[561],{"text":129,"type":130},{"type":188,"level":12,"children":563},[564],{"text":565,"type":130},"The risks associated with surgery for lumbar disc herniation",{"type":126,"children":567},[568],{"text":129,"type":130},{"type":126,"children":570},[571],{"text":572,"type":130},"– A hematoma may occur during the procedure. If it is large it can compress the nerves and cause pain, paralysis, sphincter disorders. Reoperation to evacuate the hematoma is necessary.",{"type":126,"children":574},[575],{"text":129,"type":130},{"type":126,"children":577},[578],{"text":579,"type":130},"-Neurological complications may occur: sensory disorders, motor disorders with paralysis, very rare, often of ischemic origin (defect in blood supply). These disorders are most often transient, very rarely permanent.",{"type":126,"children":581},[582],{"text":129,"type":130},{"type":126,"children":584},[585],{"text":586,"type":130},"-A breach in the envelope which surrounds the nerves (meninges) is possible and can cause a leak of the fluid contained in the meninges. It is most often repaired by the surgeon. If the leak persists, it may be necessary to intervene again.",{"type":126,"children":588},[589],{"text":129,"type":130},{"type":126,"children":591},[592],{"text":593,"type":130},"-Surgical site infection is rare (0.1 to 1%). A new intervention for local cleaning is sometimes necessary. Deep infections (Spondylodiscitis = disc infection) are rare. Painful after-effects may persist. 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