When first examining methods for surgical intervention let's have a look at traditional open back surgery to correct herniated disc problems.
Spinal Discectomy: The goal of a discectomy is the removal of the problematic herniated disc or disc material from the spinal canal. When a disc herniated occurs a fragment of the normal disc is dislodged. Symptoms of a herniated disc are most often caused by this fragment pressing up against and applying pressure to either the nerves that surround your spinal cord or the spinal cord itself.
This open discectomy surgery is performed under general anesthesia and depending on the severity of the herniation will take about an hour to complete. The patient will lay face down with the back pointing upwards during the discectomy.
An incision about 3 cm long will be made over the center of your back and through this incision the surgeon will remove the fragment of herniated disc. Carefully dissecting the muscles away from the bone of your spine, the surgeon will then proceed to remove a small amount of the bone and ligament from the back of your spine. This part of the surgical procedure is referred to as a laminotomy. When the surgeon is confident that there are no more disc fragments and there is nothing left to be ?cleaned up? the incision is closed and a bandage is applied.
It is not unusual for the patients? symptoms to take several weeks to dissipate but often when patients awake after surgery their leg pain is gone. After the surgery most patients will spend the night in the hospital and be discharged the following day. The pain around the incision is controlled with oral medication. Although not needed in all situations, to help control some of the pain a lumbar corset brace is often worn.
The success rate of an open discectomy is about 85-90%. Risks of this surgery include spinal fluid leaks, bleeding and infection. Usually these will require a longer hospitalization but they are all treatable.
Now that we have looked at what is involved with a traditional open spinal discectomy, let's explore a different avenue and become informed on minimally invasive surgery.
Percutaneous arthroscopic laser discectomy: This surgical process is preformed to remove herniated disc or bulging disc material that is applying pressure to a nerve root or to the spinal cord.
When the patients history, physical examination and imaging, such as a CT scan or MRI indicate that a disc is herniated or there are signs of a bulging disc and the material inside the disc has not ruptured into the spinal canal a percutaneous arthroscopic laser discectomy can be performed.
If the patient has significant bony anomalies or is suffering from foraminal stenosis they are not a good candidate for a percutaneous arthroscopic discectomy. This patient would benefit from a foraminotomy procedure.
During a traditional percutaneous arthroscopic laser discectomy the surgeon will be guided using x-ray monitoring and fiber optics. The results of these two factors are displayed on a monitor that is similar to a TV screen. Through the use of this screen the surgeon can see what is compressing the nerve during the procedure and then remove is with the laser. This ensures a much high success rate.
Once a local anesthetic is administered, a small incision will be made where a round depuy tube is inserted into this incision. The goal of this tube is to allow for the percutaneous arthroscopic discectomy with minimal damage to surrounding muscles by pushing them out of the way and not cutting or tearing them.
Inserted into this working tube is the laser, camera, suction, irrigation and other surgical instruments and once everything is in place, the surgeon will use a laser to vaporize the disc material. Once the material is vaporized the pressure that was being put on the spinal cord or nerve will no longer be present. Patients will often feel immediate relief during the percutaneous arthroscopic laser discectomy procedure as the pressure is minimized. The tube is slowly removed after the completion of the procedure allowing the muscles to move back into place.
A percutaneous arthroscopic laser discectomy procedure take half an hour to forty five minutes and the patient is released after 1-2 hours of monitoring. Patients are encouraged to take a long walk that afternoon or evening. The patient will return to their surgeon the following day for a post-op visit to get clearance to go home.
Treatment For Herniated Discs
When looking for relief of your symptoms associated with a herniated disc, before surgery is even remotely considered many avenues of conservative treatments are first to be explored. Through the use of conservative treatment methods the body and herniated disc pain are given a chance to heal over an amount of time. Some of the treatments you may expect to find include:
Rest: Even though it seems like a few days of bed rest may provide some relief, any more then this is not a good idea. Inactivity will make your symptoms worse over time as your back muscles begin to degenerate.
Anti-inflammatory medications: This type of medication will reduce inflammation leading to less pain. Nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen and acetaminophen products such as Tylenol can help to relieve your pain. Although these provide pain relief, there is a limit to how much pain can be controlled.
Hot and cold packs: Cold packs help to reduce inflammation and relieve some of the discomfort. In a clean towel, wrap an ice pack or a bag of frozen peas and apply to the affected areas for fifteen to twenty minutes four times per day. After 48 hours have passed, apply heat to the affected areas. Warm packs or a heating pad on the lowest setting should help to alleviate some of the pain. Try to alternate warm and cold packs if you continue to have pain.
Physical Therapy: Physical therapy can play an important part in your recovery from a herniated disk. When your condition improves your physical therapist can work with you to help design a rehabilitation program that will help you prevent the same injury in the future.
Steroid Injections: An injection medication to the affected area may be helpful in some instances. If taken in doses that exceed your natural levels, inflammation is suppressed relieving painful symptoms caused by the pressure of the inflammation. Because of the serious side effects that steroid injections can cause, the number of injections you can receive in a year is usually limited to no more than three.
Physical therapy is usually started once the pain has begun to lessen. Through physical therapy you can begin to strengthen your back muscles and joints. As you strengthen your back muscles you improve the chances of you not re-injuring your back.
Although there may be some residual pain over the next few months the acute pain from your herniated disc should go away within a few weeks. If you have a history of disc problems, strengthening and stretching exercises should be recommended throughout you life to help keep your backaches under control. Strong back muscles are also essential to protecting your spine when lifting.
Good practices to remember when thinking about preventative measures include:
Use proper lifting techniques and maintain a healthy posture.
Avoid standing in one place for longer periods of time.
Stretch often when sitting or standing in the same place for long periods of time.
Use ergonomically correct seating that provides healthy back support.
Sleep on a firm mattress.
Instead of sleeping on your stomach, sleep on your side.
When driving for long periods of time (or sitting in a vehicle as a passenger) stop and rest often. Use this time to stretch your back muscles.
After your injury, to avoid aggravating it further which could lead to permanent damage, make sure you do not return to activity too quickly.
Maintaining good core strength and strong, flexible muscles will decrease the risk of herniated disc.
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