OPTIONS FOR HERNIATED LUMBAR DISC SURGERY
There are 5 vertebrae in lumbar region; and between them, there are structures called “discs”. A healthy waist is possible with normal anatomical unity of the spine, the joints connecting the vertebrae to one another, discs, thecal sac and muscles. The entire weight of the body is transferred to the legs through these structures located in the lumbar region. Problems that may occur in one or more of these structures lead to lumbar pain. This disease called lumbar disc hernia in medical terminology develops in the structures between the vertebrae, which are called ‘discs’. 80% of adults experience a serious lumbar pain attack at least once in their lives. This problem is mostly solved with bed rest and/or medication. Herniated lumbar disc is one of the most important causes of pains felt in the waist and legs. Most of herniated lumbar disc problems arise from the last two discs. A herniated disc may cause lumbar pain or leg pain by compressing the nerve roots extending from the spinal cord.
After your diagnosis is made based on your complaints, medical history, physical examination as well as the required laboratory and radiological analyses, we will basically have two options in the treatment plan. One of these is treatments including resting, pharmacotherapy, physiotherapy practices and interventional practices intended for pain treatment. The other treatment method is surgery. As a neurosurgeon, I will decide on which one of these is appropriate after the above mentioned process, and then will make recommendation to you. The main factors that influence my decisions on surgical treatment: Urinary and fecal problems, loss of strength in the legs or/and feet, and pains that excessively affect the patient’s social and business life and do not respond to resting therapy or pharmacotherapy.
Especially in recent years, our patients have encountered a confusion of terms with respect to surgical treatment. I have written this article with intent to tell you about the surgical treatment options more understandably. Surgical treatment is intended for eliminating the pressure of the herniated disc on the nerve, which causes pain and weakness in the legs. Open discectomy, microdiscectomy or full endoscopic discectomy can be offered to patients with lumbar disc hernia.
Open discectomy is performed under general anesthesia while the patient is in a prone or knee-elbow position. It is performed through a 2-4 cm skin incision. Then, the muscle tissue is stripped and a retractor is placed. A small window is made on the bone tissue behind the spine to access the connective tissue just beneath it, and then sometimes this tissue is removed and sometimes another small incision is made to see the thecal sac and the nerve root extending from it. Subsequently, the herniated part that increases the complaint of the patient by compressing on the nerve root is seen and removed. Afterwards, discectomy is performed by entering the disc area, where the herniation has occurred, and then the operation is completed after bleeding control.
Microdiscectomy (a surgical procedure performed by using a surgical microscope), involves a smaller skin incision and less amount of muscle tissue dissection. This enables the patient to experience a painless and more comfortable postoperative period. Performing the surgical operation by dissecting less amount of muscle tissue means LESS MUSCLE SPASM, i.e. LESS PAIN. The microscope used during the operation reduces the risk of complication by enabling the surgeon to have a magnified and very detailed 3-D view of the tissues.
I instruct my patients to stand up 6 hours after microdiscectomy. This early mobilization enables the patient to get through the night more comfortably and use the toilet without help. I use a digital PCA (patient-controlled analgesia) device prepared by my anesthesiologist friend for ensuring patients to get through the night without pain. This device regularly administers medications with considerably high analgesic properties to patients, and also enables them to get ADDITIONAL DOSES by pushing on its button when they feel pain. However, because of its digital features, the device adjusts the doses automatically and does not allow patients to take any additional dose after a certain dosage. In this way, patients are ensured to spend the night with maximum comfort. Patients are usually discharged 1-2 days after surgery. For the postoperative period, you can have a look at the section under the heading ‘Things You Wonder about the Postoperative Period of Cervical Herniated Disc Surgery’.
Full endoscopic herniated lumbar disc surgery is performed by accessing the lumbar region from posterior, posterior-lateral or lateral direction. All types of endoscopic procedures involve a skin incision (0.6 cm) considerably smaller than incisions used in microdiscectomy. Endoscopic procedures have become very prominent in medicine and taken an important place in neurosurgery in the last decade.
Full endoscopic herniated lumbar disc surgery is a day-case procedure that allows patients to walk 2 hours after and go home 6 hours after the operation. Early mobilization enables the patient to get through the day more comfortably and use the toilet without help. Surgical operations are performed under general or epidural anesthesia.
Full endoscopic herniated lumbar disc surgery is performed with a medial or posterior approach depending on the location of the hernia in the lumbar region, with the help of a 4 mm endoscope inserted into the herniated disc area through a 0.6 cm incision, while reviewing the surgical site on the monitor. The most important advantage of this surgical procedure is that it does not require muscle tissue dissection and bone tissue removal, which are required in microdiscectomy. This enables patient to get mobilized and resume his/her normal daily activities earlier after full endoscopic surgery, because of the less postoperative lumbar pain. For these reasons, full endoscopic herniated lumbar disc surgery is a surgical procedure that provides EXTREMELY HIGH PATIENT COMFORT.
We recommend our patients to have a 3-day moderate postoperative resting period at home. During this period, our patients can meet their all kinds of personal needs on their own. Office workers can return to their works 4 days after surgery, whereas manual workers can return after 4 weeks.
Among all these types of surgical procedures, the one appropriate for the patient is selected by the brain surgeon. Certain criteria should be met for full endoscopic herniated lumbar disc surgery. The recurrence rates after these surgical procedures usually appear to be between 5 and 12%. Please see the section ‘Things You Wonder about the Postoperative Period of Herniated Lumbar Disc Surgery’ (written by me again), for reading the recommendations and learning what will be waiting for you after herniated lumbar disc surgery.
I wish you healthy days.