Surgery for a hernia of the lumbar spine

Removal of a hernia of the lumbar spine is performed according to strict indications, when the patient has a stable serious condition. The reason for surgical treatment is a pronounced pain syndrome, which is not eliminated by conservative methods. Indications for surgery are limited, and whether it is worth doing is decided by the attending physician with the surgeon and other specialists, depending on the consequences of the pathology in the lumbar region.

surgical treatment of disc herniation

Prior to the radical approach, attempts are being made to reduce the herniated disc with conservative methods, which include manual therapy, massage, and medication.

The protrusion of the intervertebral disc in the lower back is the most common localization of the pathological process, and in this case, the operation is performed for most patients within a few months after the discovery of the disease. This is due to the fact that the lumbosacral region has the greatest load, and it reacts to every movement.

The operation to remove a hernia of the lumbar spine is aimed at eliminating compression of the nerve endings and the spinal cord of the pulp that has gone beyond the fibrous core. When the intervertebral disc bulges, its height decreases, because the vertebrae approach each other, and soft tissue compression begins.

You can fix this problem for a while, which is performed by a laser. Vaporization involves the "evaporation" of the pathological part of the damaged cartilage tissue. Such an operation for a hernia will be a temporary measure, after which a relapse is not ruled out.

Types of operations

With a hernia of the lumbar spine, the following methods are considered:

  1. Minimally invasive removal of part of the disc - hydroplasty, endoscopy, cold plasma nucleoplasty, microdiscectomy.
  2. Radical disc removal - discectomy, laminectomy.
  3. Laser removal - vaporization, destruction.

spinal surgery

The size of the lumbar hernia will influence the choice of surgical technique.

Laser irradiation, hydroplasty and endoscopy are indicated at the initial stages of the pathological process, when the disc protrudes by 2-9 mm. If the disc falls out by more than 9 mm, its partial or complete removal is mandatory. With sequestration, when parts of the annulus and pulp are torn off, migrating through the spinal canal, discectomy or endoscopic removal is performed. Laser treatment is also suitable in the postoperative period to prevent recurrence.

With pathology in the lumbar spine, the operation has risks, and each technique has a different percentage of complications. The safest are minimally invasive techniques and laser irradiation.

Recurrence and complications of lumbar disc herniation often occur after discectomy and laminectomy.

You can find out how microdiscectomy is performed in the Czech Republic on the Artusmed .

Indications

When to have surgery for a herniated disc in the lumbar region:

  • sequestration of the intervertebral disc is a condition in which parts of the disc are separated, and the dropped elements begin to compress the soft tissues, wandering along the spinal canal;
  • violation of the sensitivity of the legs - this is manifested by difficult flexion of the feet, this symptom will be the initial manifestation of paresis due to damage to the nerve roots, it ends with atrophic processes of muscle and nervous tissue, which without surgery threatens with complete failure of the lower extremities;
  • a large intervertebral hernia - over time, an increasing prolapse of part of the disc occurs, and the hernia can reach enormous proportions when the spinal cord is damaged without surgery;
  • the ineffectiveness of non-surgical treatment methods such as manual therapy, massage, medicinal and folk remedies;
  • severe pain syndrome , which is not eliminated by any other methods, including blockade of the spine;
  • pathology of the pelvic organs and rectile dysfunction in menwhen there is a risk of infertility.

hernia surgery

Before undergoing spinal surgery, the patient undergoes a series of examinations, including an MRI and an X-ray of the lumbar region. The patient must be assigned laboratory tests and examination by specialized specialists to exclude contraindications.

Traditional hernia removal methods

Discectomy is a radical way to treat a spinal hernia by completely removing the intervertebral disc and replacing it with a titanium implant. Such an operation has many contraindications and adverse reactions, therefore it is rarely performed.

Laminectomy is the partial removal of a damaged intervertebral disc. During the operation, the spine suffers greatly, there is a risk of damage to soft tissues and even parts of the vertebra. Laminectomy is effective for the treatment of a hernia, but after the operation, the patient has pain and discomfort for a long time.

The risk is so high that the patient may remain disabled. Much depends on the professionalism of the doctor and the quality of preparation for surgery.

endoscopic surgery

To prevent most of the consequences, a titanium implant is installed during the operation, which will replace the removed disk, but only partially, ensuring the mobility of the spine. During a laminectomy, the integrity of the spinal structure is disrupted, which can later cause scoliosis. Due to all the risks, such an operation to remove the intervertebral hernia remains unclaimed, and is performed only in some clinics.

Minimally invasive techniques

Microdiscectomy involves excision of the pathological focus without affecting the vertebra. During the operation, the surgeon makes a small incision with thin knives. Instruments are inserted through it, and the doctor observes what is happening with the help of a surgical microscope. This allows you to achieve maximum accuracy in all manipulations with minimal risks.

An important advantage of microdiscectomy will be the absence of wide scars on the back, which remain after discectomy and laminectomy. After the operation, the patient recovers faster, his state of health is stable, the pain syndrome does not disturb.

Endoscopic surgery to remove a herniated disc involves the use of a special instrument called an endoscope. The latter is inserted through an incision of about 5 mm. The neurosurgeon watches what is happening on the screen. After the intervention, the patient quickly returns to normal life, the rehabilitation period is from 1.5 to 2 months.

removal of a hernia of the spine

Hydroplasty involves the introduction of a special solution into the spine, which reduces the size of the gelatinous body. Thus, the nucleus pulposus ceases to compress the nerve endings, which makes the pain go away. Almost all patients who have undergone hydroplasty report a positive result.

Cold plasma nucleoplasty has a similar effect. Cold plasma is injected into the damaged segment of the spine, which destroys the pathological elements of the intervertebral disc. The protrusion decreases in size, and therefore ceases to squeeze the soft tissues. The patient after the operation does not feel pain due to exposure to a cold substance. Improvement is seen instantly. Immediately after the procedure, the patient notes an improvement in well-being.

Vaporization or "evaporation" of the disk with a laser is carried out at the initial stage of the disease in order to reduce pressure on the surrounding tissues. Irradiation leads to the evaporation of moisture, which reduces the hernia.

Rehabilitation

After the removal of the intervertebral disc in the lumbar region, a long and important stage of recovery begins. It includes three periods: early, late and delayed. The first one lasts from a week (with minimally invasive intervention) to a month (with radical methods). The late rehabilitation period takes several months. He still has many restrictions in terms of physical activity. Delayed is a period of a lifetime.

Prevention of complications and recurrence of intervertebral hernia never ends.

The initial period requires compliance with the following recommendations:

  • it is forbidden to sit, lift weights, play sports, sleep on a soft mattress;
  • you need to follow a therapeutic postoperative diet;
  • it is important to monitor your well-being and accurately describe your condition to the doctor;
  • bad habits should be abandoned;
  • it is required to wear a postoperative belt in accordance with the instructions of the doctor.

spinal hernia treatment

In the late period of rehabilitation, the following rules are required:

  • in a sitting position, you can be no more than 2-3 hours a day;
  • wear a support bandage during light physical work;
  • exclude heavy physical exertion;
  • take painkillers prescribed by a doctor;
  • regularly visit a doctor for examination;
  • lift weight no more than 3-5 kg;
  • exclude hitting the heels and hard landing on them when walking and running;
  • refuse sedentary work, do not jump.

After restoration of tissues and normalization of well-being, the doctor will recommend doing physiotherapy exercises, undergoing a course of massage and manual therapy. These are extremely important measures to prevent the recurrence of a hernia. At home, you can also do gymnastics after several workouts with a specialist.

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