大部分の症例では症状の自然軽快が期待できます。変性度の高い椎間板からの

大部分の症例では症状の自然軽快が期待できます。
変性度の高い椎間板からの脱出ヘルニアでは高頻度でヘルニア腫瘤の縮小とともに疼痛が軽減し、脱落所見も改善してくる症例が多く認められます。MRIによる経時的なヘルニアの観察では6～15ヶ月で約2/3の症例でヘルニアの消腿が認められ、椎間板ヘルニアの腫瘤が大きいほどヘルニア腫瘤が縮小することが認められています。
一方、膨隆型や小さいヘルニアでは縮小の度合いが少ないようです。1年間の保存療法で遊離・脱出型は76％、膨隆型では26％に症状の改善を認めたとの報告もあります。
保存療法と手術療法の成績は治療後1年以内では手術療法の方が成績が優れていますが、治療後4年以上経過すると両者の差がなくなるともいわれています。
少なくとも3ヶ月は保存療法を徹底的に行い、症状の改善が認められない時に手術療法が選択します。ただ社会的要因（仕事を長期に休むことができない、早期スポーツ復帰が望まれるばあい）により保存療法をどの程度の期間行うかは個々により判断されます。
（ 保存療法 ）

安静、薬物療法、理学療法（温熱、牽引、腰痛体操）、装具療法、神経ブロック療法があります。
（ 手術療法 ）

下記例では、手術が必要です。
1. 馬尾症状（排尿障害など）を呈する例
2. 高度麻痺例
3. 保存療法によって症状が軽減しない例
（ 手術療法 ）

1. 皮的髄核摘出術（特殊な器械による方法、レーザー照射による方法）
2. 内視鏡視下髄核摘出術
3. 観血的髄核摘出術

当院では可及的小切開による観血的髄核摘出術を行っています。

文責：菅原 誠

ผลลัพธ์ (อังกฤษ) 1:

Spontaneous remission of symptoms in most cases you can expect.Many may be case of hernia the escape from the high degree of degeneration of intervertebral disc in high frequency and reduces the pain, hernia, tumor reduction, will improve the dropout findings. By MRI observation of herniation of the 6-are allowed in 15 months in about 2/3 of cases showed off thigh hernia, hernia tumor shrinks the herniated mass larger.On the other hand, bulging or small hernia reduction makes it less so. Even by conservative therapy for one year free escape-76% in bulging 26% improvement in symptoms was reported.Is said eliminates the difference between the two results of conservative and operative treatment after treatment in less than a year of operative therapy for grades are better, but after more than four years after the treatment.When no improvement in symptoms, at least 3 months conservative therapy we thoroughly choose surgery. Or just by social factors (when it can't get off work in the long term, early sport return is desired) how long to conservative treatment determined by the individual.(Conservative)Bed rest, medication, physical therapy (heat, traction, lower back pain exercise), splinting, nerve block therapy.(Surgery)In the following example, surgery is required.1. cases presenting with cauda equina symptoms (dysuria, etc)2. high degree of hemiplegic patients3. example of conservative therapy does not reduce the symptoms(Surgery)1. percutaneous myelin nucleus resection (special instrument method, using laser-induced)2. endoscopic vision under the myelin nucleus resection3. watch blood myelin nucleus resectionIn our view-friendly and relatively small incisions through engaged in noninvasive myelin nucleus resection.Prepared by: Sugawara-Seiji

ผลลัพธ์ (อังกฤษ) 2:

You can expect the natural light of the symptoms in the majority of cases.
In the escape hernia from a higher degree of modification disc pain is reduced along with the reduction of hernia mass at a high frequency, dropout findings also observed many cases coming to improve. Consumption thigh of hernia is observed in about 2/3 cases of 6 to 15 months in the temporal hernia of observation by MRI, it is permitted to be shrinking hernia mass the greater the mass of a herniated disc.
On the other hand, it seems that small degree of reduction in the bulging type or small hernia. 1 year of free-escape-type 76% in the conservative treatment, in the bulging type There is also a report that showed an improvement of symptoms in 26%.
Results of conservative treatment and surgical treatment is better grades is more of surgery therapy within one year after the treatment, but it is also said that the difference between the two is lost after a lapse of more than four years after treatment.
At least three months conducted a thorough conservative therapy, surgery therapy will be selected when the improvement of symptoms is not observed. But social factors is whether to perform how much of the period the conservative therapy by (can not rest on the long-term work, if the early sport return is desired) will be judged by the individual.
(Conservative therapy)

rest, medication, physical therapy (heat, traction, low back pain gymnastics), brace therapy, there is a nerve block therapy.
(Surgery therapy)

In the following example, you must have surgery.
1. cauda equina symptoms example exhibits (such as dysuria)
2. advanced paralysis example
example that does not alleviate the symptoms by 3. conservative treatment
(surgery therapy)

1. percutaneous nucleus pulposus hysterectomy (a method by a special instrument, the method according to the laser irradiation )
2. endoscope viewing under the nucleus pulposus hysterectomy
3. invasive nucleus pulposus hysterectomy

in our hospital we are invasive nucleus pulposus hysterectomy by as much as possible small incision.

Censure: Makoto Sugawara

ผลลัพธ์ (อังกฤษ) 3:

In most cases with spontaneous remission of the symptoms can be expected.Because of the high degree of degeneration of the intervertebral disc hernia with high frequency in the herniated mass and reduced pain reduction after the falling opinion will bring many cases were improved. In MRI with time in the observation that thigh hernia hernia was recognized in about 2 / 3 of the case 6 to 15 months, there was a mass of intervertebral disk herniation is larger, the reduced mass.On the other hand, bulging and small type hernia is low degree of reduction. Conservative treatment for 1 year free and escape type 76 percent bulging mold 26 reported that the improvement of the symptom was recognized in between.Conservative treatment and surgical treatment results of within 1 year after the treatment outcome of surgical therapy is excellent, but said that after treatment for more than four years, and there is no difference between them.The conservative treatment is carried out for at least three months, there is no improvement of the symptom is selected by surgical treatment. Social factors, it is desired that athletes can"t work for a long time to rest. By the conservative treatment is carried out for any length of time it will be determined by the individual.(conservative treatment.Bed rest, drug therapy, physical therapy, traction, heat treatment for low back pain, the nerve block therapy.(operation)In the following example, surgery is needed.Cauda equina syndrome (1 case of urination disorder)2 cases severe paralysis3 does not relieve symptoms by conservative treatment(operation)One case: percutaneous (method using a special method, by laser irradiation.Nucleus pulposus excision, endoscopic3. The nucleus pulposus excision of invasiveIn this hospital is performed with small incision in the surgical removal of nucleus pulposus.Copyright: Makoto Sugawara