The main surgical treatment for a herniated disc is discectomy surgery - removal of the intervertebral disc with herniation, which causes compression of the nerve. Before performing the discectomy, your doctor may remove a small piece of the affected vertebra - the so-called laminectomy. This operation allows the surgeon greater access to the disc vertebra.
Currently, surgeons are increasingly resorting to microdiscectomy. This operation is performed using special operating microscopes. This technique allows the operation to remove intervertebral disc through a small incision, thereby causing injury to surrounding tissues.
The operation discectomy is the removal of the intervertebral disc, which is broken, and hernia sticks out into the lumen of the spinal canal. In addition, while the doctor examines the space between the vertebrae and remove therefrom loose fragments of disc.
Usually discectomy surgery (or mikrodisketkomii) is performed under general anesthesia.
Microdiscectomy surgery is more effective in the treatment of pain from the lower limb (the so-called radiculopathy) than back pain.
Preparation for surgery discectomy (microdiscectomy)
Like any other surgery, a discectomy is required training. It is to conduct blood and urine tests, surveys spine - MRI or CT. Before the operation the patient for 8 hours should not have. In addition, the patient and the anesthesiologist examines. He chooses the most appropriate method of anesthesia, said patients have chronic heart and lung diseases, and allergic reactions to drugs in the past.
How is the surgery microdiscectomy
Microdiscectomy surgery performed through an incision length of 2.5 - 4 cm in the middle of the lumbar spine.
Initially, the surgeon lifts the special hooks the arm straightening his back. This muscle does not have to cross a scalpel, because it is easily dismissed.
After this, the surgeon may already have access to the spine, removing the membrane on the nerve roots (the so-called yellow ligament). In order to see the nerve roots, used an operating microscope.
Often, a small portion is removed and the inner surface of the facet joint to facilitate access to the nerve root and remove the pressure on the nerve.
Further, nerve root gently moves aside, and intervertebral disc tissue is removed from under the nerve root.
It is important to note that since most of the joints, ligaments and muscles are unaffected, microdiscectomy surgery does not violate the mechanical structure of the spine patient.
When the operation is shown microdiscectomy
Usually, if the pain in his leg in a patient after conservative treatment gradually subside, then it can completely pass through the 6 - 12 weeks. And if a patient there may endure this pain, it is recommended to postpone surgery for a short period of time, to see whether the situation is resolved without surgery.
If conservative therapy does not provide any relief, it is necessary to resort to surgery to release the nerve root, compressing disc herniation. Discectomy urgently required only in cases where the disc herniation is accompanied by dysfunction of the bladder and bowel (incontinence).
Microdiscectomy is shown in cases where conservative treatment is ineffective for at least 6 weeks. However, in this case should not delay the operation for a long time (more than 3 - 6 months).
After surgery, microdiscectomy
Usually, microdiscectomy can be performed on an outpatient basis, with no need to remain patient in the hospital. Some neurosurgeons recommend a restriction in terms of lifting, bending of the spine the first 6 weeks after surgery. However, because the mechanics of the spine in a patient after a microdiscectomy remains the same, the patient may be quite safely return to their previous physical activity immediately after surgery. In the literature there is evidence that the resolution of the load immediately after the operation does not increase the recurrence of disc herniation or complications.
The effectiveness of microdiscectomy surgery reaches 90-95%, which means that 5-10% of patients in the future, yet there may be a recurrence of a herniated disc.
Recurrence of a herniated disc can occur immediately after surgery and after a few years after that. However, in most cases of recurrent hernias to occur in the first three months after surgery. In the case of recurrent disc herniation is usually audit microdiscectomy is as effective as the first operation. However, after re-operation risk of recurrence is higher (15-20%). In patients with multiple recurrences of a herniated disc in order to prevent further recurrences can be effective is surgery like fusion. Spinal fusion - the removal of the intervertebral disc and the "merging" of two adjacent vertebrae, which guarantees the absence of any further recurrence of disc herniation. If the posterior facet joint is not struck, and all other appropriate criteria, it is possible to hold the replacement of the destroyed an artificial intervertebral disc.
It is believed that the occurrence of recurrent herniated disk is not connected directly with the level of the patient. It is mainly due to the fact that within the disk space available, which contain fragments of the disc, and they, in turn, can go outside.
Unfortunately, at the back of microdiscectomy can be removed only 5% -7% of the intervertebral disc and most of the disk can not be seen. In addition, a hole, which is held in the thickness of the disk (annulotomiya) never grows with yourself, as fibrous disc has no blood supply. In addition, there is no surgical methods to restore the outer (ring-shaped) part of the intervertebral disc.
Complications discectomy
As with any other surgical intervention, after discectomy and microdiscectomy are possible complications.
Break the spinal membranes. This complication may occur in 1-2% of cases and does not affect the results of the operation, but within a few days the patient is recommended bed rest, so that the shell is overgrown and there was no leakage of cerebrospinal fluid.
Damage to the nerve root.
Violation of bladder and bowel.
Bleeding.
Infectious complications.
Surgical treatment of a herniated disc, discectomy, microdiscectomy, indications, postoperative period, complications of discectomy
