EDITORIAL
Radiculopathy
Radiculopathy associated with disc herniation
1 Université François-Rabelais de Tours, EA 3853 IPGA (Immuno-Pharmaco-Génétique des Anticorps thérapeutiques), France
2 Service de Rhumatologie, Hôpital Trousseau, CHRU de Tours, 37044 Tours cedex 9, France
Correspondence to:
Correspondence to:
Professor P Goupille
Service de Rhumatologie, CHU, Hôpital Trousseau, 37044 Tours cedex 9, France; goupille@med.univ-tours.fr
Accepted 13 November 2005
Should we treat it with anti-TNF
agents or is TNF only one piece of the puzzle?
Keywords: chemical irritation; disc herniation; radiculopathy; tumour necrosis factor; nucleus pulposus
| The first 150 words of the full text of this article appear below. |
The treatment of radiculopathy associated with disc herniation by anti-tumour necrosis factor (TNF) agents is currently being examined.1–3 However, although the rationale appears to be sound, there is no proof of the efficacy of such a treatment and its use still has not been validated.
Since 1934, when a link was demonstrated between disc herniation and sciatica,4 it has been accepted that compression of the nerve root by disc herniation explained the sciatica. Surgical treatment therefore became standard when medical treatment failed. It now seems that "chemical" factors have a central role in sciatica.
The clinical arguments supporting the "chemical" theory are numerous. Laminectomy is sometimes ineffective, the long term success rate being 40–80%,5 and reintervention rates are reported to be 5–25%.6 A considerable amount of asymptomatic disc herniation7 and severe sciatica without visible root compression has been reported8; there is poor correlation between the severity of
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