Surgery To Remove A Herniated Disc Of The Spine - Indications, Consequences, Types Of Surgery

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Herniated disc surgery

Content:

• Indications for the operation
• Ways to remove an intervertebral hernia
• Consequences of the operation
• When and what can you do?
• Rehabilitation

An operation to remove an intervertebral hernia is one or another type of surgical intervention aimed at correcting and restoring the displaced nucleus pulposus of the intervertebral disc in case of rupture of the annulus fibrosus.

Most often, it is required to eliminate a hernia located at the level of the lumbosacral spine, somewhat less often at the level of the cervical spine, and extremely rarely in the thoracic spine. Such statistics are associated with the frequency of hernia formation in the spinal column: 48%, 46% and 6%, respectively.

Despite the fact that herniated disc rarely requires removal, the operation is performed at regular intervals, and every year new techniques are developed to make the surgical intervention safer and less traumatic for the patient.

Indications for an intervertebral hernia surgery

The indications for surgical correction are as follows:

• Sequestration of a hernia (prolapse of a disc element) and its compression pressure on the spinal cord. This indication is absolute for the implementation of surgical intervention, as it will eventually lead to multiple dysfunctions of the pelvic organs and paralysis of the limbs. Among them: severe pain, localized on the back of the thigh and in the pelvic area, their intensification with coughing, fecal and urinary incontinence, reproductive disorders, impotence. Another similar condition is characterized by doctors as compression of the cauda equina.
• Development of neurological disorders.
• Severe pain syndrome, which cannot be eliminated with the help of medicinal effects.
• Lack of effect from conservative therapy for four months.

The decision on whether to send a particular patient for surgery or not is made by several doctors after receiving all the necessary data on his state of health. In particular, after taking X-rays, CT or MRI, ECG and blood tests.

Ways to remove an intervertebral hernia

There are many ways to remove an intervertebral hernia, including: laser, microsurgical, endoscopic removal, as well as some other possible options for surgical intervention.

But there are also such modern techniques that relate to minimally invasive modern methods, including cold plasma nucleoplasty, hydroplasty and intraosseous blockade

Cold plasma nucleoplasty of intervertebral hernia This method boils down to the fact that the hernial tissue is removed by exposure to cold plasma. It is fed to the damaged area through a thin needle, and due to ultra-low temperatures destroys hernial tissue. The advantages of this method are many, for example: immediate elimination of pain, the speed of the operation (no more than 30 minutes), the location is an outpatient clinic (the patient does not have to go to the hospital), rehabilitation is not needed. However, a very significant drawback of this method is the high probability that the hernia will recur.

Hydroplasty of an intervertebral hernia Through a special cannula, a nucleote is supplied to the intervertebral hernia, through which physiological solution enters under high pressure. It flushes out hernial tissue without leaving scars. The advantages of hydroplasty are low trauma, the ability to prevent necrosis, and relieve the patient from pain. However, it can be performed only if the size of the formation is small and does not exceed 6 mm. In addition, there are other contraindications, in particular: pronounced damage to the annulus fibrosus, infectious processes localized in the area of exposure, oncological diseases.

Intraosseous block It consists in puncturing the spinal section with a special hollow needle through which a medicinal solution is injected, which helps relieve pain. Despite the frightening puncture, this method is absolutely safe and very effective. The patient only needs local anesthesia. The effect is achieved instantly, the internal organs are not endangered, as the drugs are administered pointwise. After the procedure, the patient will have to lie down for 6 hours. The effect of intraosseous blockade is felt by 50% of patients instantly. Often, patients in the office "forget" canes and crutches. In 30% of patients, pain relief is noted the next day. In 15% of patients - one to two weeks after the end of treatment. In 5% of patients, intraosseous blockade is ineffective. To obtain a stable and long-term effect, a course of 5-7 intraosseous blockages is required with an interval between procedures of 1-3 days. The pain relieving effect will last for 1.5 to 5 years, depending on your lifestyle.

Microsurgical removal of intervertebral hernia Microsurgical treatment is performed using special instruments and a microscope. This method allows you to remove a hernia completely, or that part of it, which is located in the spinal canal. Prepare for the intervention in advance. To do this, you will have to give up food for 8 hours, undergo an MRI scan and an examination by an anesthesiologist. The essence of the operation is as follows: an incision is made on the skin, access to the tissues of the intervertebral disc is cleared, its part located under the nerve roots is removed, laser irradiation is carried out to prevent possible relapse and early recovery. Then the incision is sutured. In the cervical region, replacement of the removed cartilage with a prosthesis is most often required. The patient, after he regains consciousness, will need to get up and walk. Within 2 months, he will need to wear a semi-rigid corset, or a cervical head holder, depending on the place of removal of the disc. Physical activity is allowed one month after the intervention, nonphysical - after a week or two.

Laser removal of intervertebral hernia Laser removal aims to vaporize or reconstruct altered discs. If we are talking about vaporization, then it is aimed at the destruction of the damaged dick with a laser beam. Due to the evaporation of disc cells, it decreases in size and no longer presses on nerve endings and tissues. This method is applicable for young people with a hernia under the age of 50. Age limitation is due to the fact that at a later age, a person experiences degenerative changes in the spine and on the part of hernial tissues; it is simply impossible to stop them with a laser beam. Anesthesia is local, the time of the operation is no more than an hour. The patient will have to stay in the hospital under the supervision of a doctor for about two more hours, after which he can go home. The advantage of laser vaporization is that connective tissues are formed at the site of removal, which further prevent the regeneration of the hernia. Laser disc reconstruction. Another option for laser surgery is disc reconstruction. The essence of the impact is reduced to its heating, due to which the growth of cartilage occurs. The tissue fills in the cracks and the pain disappears. It is advisable to use this method in the early stages of the development of the disease.

Endoscopy of herniated disc Endoscopic removal of an intervertebral hernia is performed using a special device - an endoscope. It is removed through the lateral intervertebral foramen in order to install the tube, an incision is made in the skin, all tissues are pushed back to gain access to the disc, everything that happens is reflected on the monitor screen, which allows the doctor to control the entire process. The hernia and the nucleus pulposus of the disc are removed without affecting the spine; the operated site is treated with a laser. Local anesthesia is an anesthetic method - epidural anesthesia. The operation time takes on average 40 minutes, in the most severe cases it can take up to 2 hours. The patient will have to spend up to 3 days in the hospital, then he is discharged and has the opportunity to start light physical labor. After a month and a half, you can return to normal life.

Destruction of intervertebral nerves Radio frequency destruction. It is used for facet (pain) syndrome and consists in blocking the pinched nerve by exposing it to the method of thermocoagulation with special electrodes. Among the disadvantages of this method is the recurrence of painful sensations, however, the method of exposure can be repeated after a certain time. In this case, the patient goes home an hour after the intervention. Among the contraindications: drug, alcohol and drug addiction, circulatory disorders, age restrictions (over 75 and under 18).

Vertebroplasty (sclerotherapy) of an intervertebral hernia Vertebroplasty refers to a low-traumatic procedure that allows you to stop the growth of protusions and their transformation into a herniated disc. It is important to perform sclerotherapy before the nerve fibers are affected. Local anesthesia is required. The essence of the operation is reduced to the introduction through a spinal catheter into the affected area of the modeling composition, which is stabilized by pulses from an infrared laser. The mixture hardens, cracks and gaps are filled and fixed. Three-time sclerotherapy gives a guarantee for 10 years or more, however, MRI is recommended at least once every 5 years, since hernias can form in other places.

Herniated disc laminectomy This type of surgical intervention boils down to the removal of a site of bone tissue of the vertebra, which is located under the nerve root and part of the intervertebral disc. As a result, the formation of a large space surrounding the nerve, the restoration of its blood supply and the elimination of pain. The technique will require the introduction of general anesthesia; the operation itself can last up to 3 hours. Control is carried out using X-ray images. The patient can stay in the hospital for up to 5 days, the time of restriction of mobility is negotiated individually, which depends on the patient's age, the severity of the operation, etc.

Herniated disc discectomy Discectomy is a classic method of removing a large hernia, in the presence of fragments or in violation of the innervation of the pelvic organs during sequestration. For discectomy, general anesthesia will be required. Most often, surgeons remove the entire disc or most of it, which has a pronounced effect on the spinal cord and nerves. Leaving a damaged disc is fraught with remission. To prevent the vertebrae from losing mobility due to the absence of a disc, prostheses made of titanium alloys are inserted into the patient. In addition, a bone (iliac) disc plastic is required. The patient will have to adhere to bed rest, on average, five days. Riding in transport, heavy physical activity, lifting weights - all this is prohibited for 30 days. The first few days after the operation, you will need to wear a support corset, which will facilitate a speedy recovery. It should be understood that discectomy is performed only when conservative methods are powerless, and other operations are impossible. There is a risk of bleeding and infection, in addition, the vertebrae often grow together motionlessly, which poses a threat to the formation of a hernia in another section.

Consequences of an operation to remove an intervertebral hernia

The consequences after any surgical intervention to remove an intervertebral hernia are divided into positive and negative.

Among the pluses:

• Removal of pain syndrome;
• The likelihood of complete recovery from the disease;
• Rapid return to normal work activity;
• Short-term rehabilitation period.

Possible complications, even after minimally invasive procedures:

• The risk of rupture of the spinal cord and leakage of cerebrospinal fluid, inability to get out of bed until the tissues are completely healed;
• Inflammation of the injured disc;
• Development of bleeding;
• The risk of infection;
• Nerve root trauma;
• Fecal and urinary incontinence;
• The risk of disease recurrence;
• The development of a hernia in other parts of the spine.

That is why the decision on the need for surgical intervention should be balanced and made only after a thorough examination of the patient.

When and what can you do after a herniated disc surgery?

Most patients before and after surgery are asked a number of questions, the most popular of which are:

• When can I sit down after having herniated discs removed? Sitting down after the operation is most often allowed no earlier than 6 weeks later. Such a limitation is due to the fact that the damaged tissues will need to heal, the scar itself should heal, the nerve endings during this period will gain sensitivity, the functions of the spine will recover as much as possible. Therefore, the patient needs to create the most comfortable conditions for the injured part of the back, without additional stress on it. When it is allowed to sit down, then it is impossible to stay in this position for more than half an hour. You will need to take breaks of 10 minutes, during which you will need to stand or lie down.
• When can you get pregnant after having hernia removed? Women should not worry about the inability to get pregnant after having herniated discs removed. However, this can be done only after the complete restoration of the spinal section. As a rule, the rehabilitation process takes up to a year. After this time, it is necessary to undergo a complete examination, including CT or MRI. If new formations have not appeared, and the site of surgery has healed, then you can plan a pregnancy in the near future. However, a year is a mandatory period of time that must pass before a woman can carry a child without complications.
• Numbness of the leg after removal of the intervertebral hernia. An often observed complication after surgery is limb numbness. It is possible that this sensation will pass when the recovery period ends. Alternatively, complete death of sensitive fibers could have occurred even before the surgical intervention, since the nerve root was compressed by a hernia for a long time. Therefore, if a feeling of numbness occurs, it will be necessary to undergo an additional therapeutic course that can return the lost sensitivity. It can be taking neurostimulants, physiotherapy, massage.
• How long does the operation take? The answer to the question of how long the operation takes depends on the choice of a specific technique. Cold plasma nucleoplasty - no more than 30 minutes, hydroplasty - up to 20 minutes, intratural blockade will take no more than 25 minutes, laser removal of a hernia - no more than 30 minutes, microdiscectomy and endoscopy - up to 2 hours, destruction of intervertebral nerves - no more than an hour, vertebroplasty - up to an hour, laminectomy and discectomy - up to 3 hours. Depending on the complexity of the operation, the time can be reduced or slightly increased.
• When can the seam be wetted? The time when the seam can be wetted is usually indicated by the attending doctor. However, this should not be done before removing the bandage. Most often, after two days, without complications, the patient is allowed to take a shower, without the risk of infection. However, in order to avoid the development of possible complications, you must first consult with your doctor.
• Sex and sports after hernia repair. Sports are usually limited to a period of up to 3 months. In this case, we are not talking about heavy physical exertion, which a patient with an intervertebral hernia is prohibited at all. However, the minimum physical exercises from the complex of physiotherapy exercises must be started after a few days. However, they must be strictly regulated and dosed, the complex itself must be selected by the attending doctor. With regard to having sex, the entry into unforced sexual intercourse is possible a week after surgery.
• Do you give disability after removal of the intervertebral hernia? It is possible to get a disability after an operation, but it is given in especially severe cases. That is, one should not hope that even the third group of disability will be given after, for example, intraosseous blockade. To do this, the patient will have to undergo ITU, to which he will be sent by a doctor immediately after a major operation. However, even if the disability is given, it will not be lifelong. Disability is often removed after full recovery.

On the subject: Spinal traction - types and consequences

Rehabilitation after removal of intervertebral hernia

Rehabilitation depends on the complexity of the surgery, as well as on the condition of the patient himself. However, rehabilitation measures should not be ignored in any case.

General recommendations boil down to the following:

• The patient is prohibited from sitting for at least a month and a half.
• Avoid sudden movements such as: jumping, twisting the body, twisting, hitting
• Travel by public transport should be avoided, the time limit is 3 months. If it is not possible to avoid transportation, then the patient should lie, and the back needs support in the form of a corset.
• It is forbidden to lift weights. Restriction - weight more than 2 kilograms, while the load should be evenly distributed over both arms
• The spine should not be strained for more than half an hour. Breaks are required, with the transition to a horizontal position

The late rehabilitation period is reduced to performing a complex of physiotherapy exercises, undergoing physiotherapy and on trips to sanatorium-resort treatment.

Corset after removal of the intervertebral hernia

The product must be rigid and immobilizing so that it is able to stabilize the spine and enable it to fully recover after removing the hernia. It should not be worn longer than 6 hours, if necessary, lie down, the hard bandage is removed.

Find out more: what corset is used for herniated discs?

Before making a purchase, you need to get the most accurate recommendations from your doctor regarding the choice of the product.

The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist

Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.