Surgery to remove a hernia of the spine

A herniated disc develops in response to long-term degenerative-dystrophic changes or suddenly, when a high load is placed on the spine or it is injured. This disease is treated mainly by conservative methods, for which medicines, massage, manual therapy, and physiotherapy are used. When the pathology becomes complicated, removal of the intervertebral hernia is prescribed, and this is done in several ways.

The main indication for spinal surgery will be compression of the spinal roots with the risk of dysfunction of internal organs and limbs.

An operation to remove an intervertebral hernia is also needed for persistent pain syndrome, which cannot be eliminated by any conservative measures. For the purpose of pain relief, blockades and minimally invasive laser intervention are usually used, when the disc “evaporates”, thereby reducing in volume.

Open and endoscopic removal of a spinal hernia is a complex operation with a risk of unpleasant consequences. The decision to excise pathological tissues is made only after an assessment of the patient's condition by several specialists. The conclusion is made on the basis of the obtained MRI images, x-rays and laboratory tests.

How is a herniated disc removed?

Types of operations to remove a hernia of the spine:

1. Radical laminectomy and discectomy.
2. Minimally invasive - microdiscectomy, endoscopy, nerve destruction, cold plasma nucleoplasty, hydroplasty.
3. Laser - vaporization.

At what size of a hernia is surgical removal indicated:

• prolapse - displacement of 2-3 mm, the operation is not considered;
• protrusion - displacement by 5-15 mm, surgery is indicated;
• extrusion - loss of the disk, the operation is carried out as soon as possible.

Endoscopic discectomy

Removal of the vertebral hernia is performed by open and closed methods. In the first case, access to the focus is created through a wide skin incision above the spine. The endoscopic method is less traumatic, but has a number of contraindications. The operation with the use of an endoscope is performed under local anesthesia. A small incision is made in the skin through which the instrument is inserted.

An endoscope with a probe at the end is brought to the pathological focus, and the hernia is excised. The doctor monitors what is happening on the monitor . After tissue removal, the tube is removed and only a small puncture mark remains on the skin.

Endoscopic discectomy is indicated in such cases:

• sensory disturbance due to compression of the spinal cord;
• lack of results from the use of conservative treatment methods.

Endoscopy is contraindicated in the following pathologies:

• benign and malignant neoplasms in the spine;
• median hernia;
• narrowing of the spinal canal;
• infectious and inflammatory processes in the area of ​​the proposed operation.

Endoscopic surgery to remove a hernia of the spine has several advantages:

• a small incision in the skin;
• the ability to quickly return to normal life;
• preservation of the disk, removal of only its protruding part;
• reduction in the time of the operation;
• minimal blood loss;
• low risk of damage to nerve fibers;
• less tissue trauma near the pathological focus.

Traditional methods - laminectomy and discectomy

The standard operation for spinal hernia is discectomy. This is a way to eliminate the bulge by removing the disc. Instead of the excised cartilaginous tissue, a titanium endoprosthesis is installed. Over time, the vertebrae grow together, and the prosthesis ensures their stability. This technique has many disadvantages, including a wide wound on the skin, a long rehabilitation period, and the risk of soft tissue damage.

A laminectomy is an operation to partially remove a damaged intervertebral disc. This option of excision allows you to eliminate the factor of compression of the spinal cord and spinal roots.

There is a high risk of recurrence after laminectomy.

Discectomy and laminectomy are performed under general anesthesia. The patient is discharged from the hospital on the 7th-14th day. Strict measures are prescribed for a period of 2-3 months. At this time, it is forbidden to sit, engage in physical work and sports. In the early period of rehabilitation, a therapeutic diet, vitamin therapy, and medications for symptomatic treatment are prescribed.

Laser techniques

Vaporization is a treatment that involves "evaporating" a hernia. The laser beam deprives the damaged disc of moisture, causing it to shrink in size. This treatment option only temporarily eliminates the compression of the paravertebral structures, but soon the procedure will need to be repeated.

Laser vaporization is suitable at the initial stage of the pathological process.

The technique is better tolerated by young patients with a small hernia. Irradiation of diseased tissues with a laser stimulates the growth of cartilage tissue. The patient's condition improves, soreness and neurological symptoms disappear. This treatment option is also suitable after removal of a hernia in order to prevent its recurrence.

Minimally invasive removal

Microdiscectomy is the removal of pathological tissues using a special surgical microscope. Such an operation is indicated for a herniated disc. Microsurgical technique almost completely eliminates the risk of nerve injury. The patient after the operation is discharged from the hospital for 2-5 days, and after 14-21 days can return to work.

Destruction of the facet nerves is a procedure aimed at combating pain. Removing the nerves of the intervertebral joints will be a good way to relieve pain that goes away immediately after surgery. This type of intervention does not affect the hernia itself. Before the procedure, the doctor evaluates the potential benefit, deciding whether to injure the tissues to eliminate the pain syndrome, or whether it is better to perform a partial removal of the disc, which will give the best results.

Nucleoplasty is a method of removing the nucleus pulposus of the disc by inserting a needle into it. The operation does not require incisions or stitches. Anesthesia is carried out by intravenous administration of a sedative drug. The needle is inserted under the skin under visual X-ray control, and the patient's condition is monitored by devices for measuring pressure and oxygen levels. During nucleoplasty, the patient feels slight pressure and pain when the needle enters the disc. How long the operation lasts will depend on the volume of the removed pathological focus, on average it takes from 25 to 45 minutes.

During the procedure, it is possible to perform nucleoplasty of one disc, but then it is possible to repeat the operation.

After nucleoplasty of the lumbar, thoracic and cervical regions, it is necessary to apply a cold compress to the wound for half an hour. In the first weeks, it is not recommended to sit for a long time, drive a car, make sharp turns and tilts. A few days after nucleoplasty, the patient is disturbed by mild soreness. Possible complications include bleeding, infection of the wound, aggravation of the symptomatic complex.

Hydroplasty is a minimally invasive way to remove pathological tissues with a high-speed fluid jet. As a result, there is a decrease in pressure on the nerve, causing pain to go away. This variant of tissue excision is distinguished by low trauma and the absence of adverse reactions. To create access to the hernia, a small puncture is made.

An important feature of hydroplasty will be the absence of high temperatures affecting the tissues of the spine.

The indications for surgery are the following conditions:

• an increase in the symptomatic complex;
• deterioration in the quality of life, inability to perform physical work;
• nerve damage, severe weakness, impaired sensitivity;
• persistent pain syndrome for a month.

Such an operation is contraindicated in case of disc sequestration, when the nerve roots are already compressed and there is a significant deformation of the spinal column. Relative limitations to the operation will be spinal fusion, fracture, stenosis of the spinal canal, compression of the nerves by scars that have arisen after a previous operation.

Advantages of hydroplastics:

• rapid recovery of the body;
• performed under local anesthesia;
• emergency discharge from the hospital;
• absence of pain;
• Possibility of outpatient treatment.

After hydroplasty, the patient relieves chronic pain, the symptoms of numbness of the limbs and muscle weakness disappear.

Compliance with the regimen after the intervention will help to increase the effectiveness of the procedure. Doctors recommend less time to be in a sitting position, learn how to lift heavy objects correctly, distributing the load on all muscles. You may need to take medication for a week to eliminate the effects of the operation in the form of mild soreness and discomfort.

A week after the operation, it is recommended to start physiotherapy exercises, perform stretching and muscle strengthening exercises.

Rehabilitation after hernia removal

How long does recovery take after spinal surgery?

• endoscopic removal - 2-4 weeks;
• complete removal of the disc - 4-8 weeks;
• laser vaporization - 1-2 weeks;
• minimally invasive intervention - 1-4 weeks.

General recommendations in the postoperative period:

• bed rest on the first day after surgery;
• refusal of physical activity for 1-8 weeks, depending on the type of operation;
• diet, restoring the balance of vitamins and trace elements;
• wearing a postoperative bandage prescribed by the doctor for a period;
• therapeutic exercises after tissue healing;
• taking symptomatic medicines;
• regular examination by a neurologist and vertebrologist.

Possible complications after excision of a herniated disc:

• infection of the wound, suppuration of the surgical scar;
• inflammation of the spinal cord, which can lead to meningitis
• recurrence of the disease, which often occurs after minimally invasive techniques;
• paresis and paralysis of the limbs.

In case of recurrence of the pathology, the patient is scheduled for a second operation. If the disc has been previously vaporized or partially removed, the next intervention will be indicated for the complete excision of the damaged cartilage.