Lumbar Disc Herniation
What is a lumbar disc herniation?
With aging and various reasons, the inner watery and soft nucleus pulposus (the soft filling in the center of the disc) begins to lose its watery structure and the height of the disc distance, which should be flexible, decreases. The disc distance cannot carry the loads and weight it is exposed to and starts to protrude with the tear that appears on the outer part of the disc. This process usually takes a long time. The surging inner part puts pressure on the neighbouring nerve roots. Lifting heavy weights or a sudden movement can usually cause a disc to rupture. The dic material can rupture due to forces it is exposed to such as a traffic accidents or falling from a height.
What are the symptoms of a lumbar disc herniation?
Symptoms of a lumbar disc herniation depends on the location of the lumbar disc herniation and the nerve root it is pressuring. We can list the most common symptoms of a lumbar disc herniation as follows:
Pain in the lower back area: Complaints of pain can become worsened with coughing, sneezing or standing for long periods of time. Muscle spasms can also occur.
Pains spreading from the lower back to legs: One of the most typical indicators of a lumbar disc herniation is pain spreading from the lower back to the legs (sciatic) The pain can spread to the sole of the foot.
Paresthaesia: In addition to the pain that occurs in the leg, there can also be complaints of numbness and matting.
Muscle weakness: Along with pain, muscle weakness in the leg, foot or thumb may also occur on the affected side due to a lumbar disc herniation.
Changes in bladder or bowel function: Bowel or bladder function can also be affected by a lumbar disc herniation in advanced stages. Due to the inability to urinate, the bladder fills up and urinary incontinence occurs. Pain tolerance can vary from person to person. Even if the person can handle the pain, it is important to consult to an expert brain surgeon if progressive muscle weakness that affects the ability to control muscles and significant numbness- matting are present.
Emergency medical help becomes necessary in situations such as pain spreading to the leg that increases enough to prevent your daily life activities, symptoms such as urinary incontinence, inability to urinate, progressive loss of sensation in the area around the inner thighs, the back of the legs and the anus, and progressive muscle weakness.
How is a lumbar disc herniation diagnosed?
For the diagnosis of lumbar disc herniation, the person's medical history is first learned by the doctor and a physical examination is performed. During a physical examination, your doctor questions the source of your complaints and discomfort. Then a number of tests and scans are performed on the person. Imaging tests help the doctor identify problem areas. High-resolution diagnostic devices such as X-rays, Magnetic Resonance Imaging and Computed Tomography are used to detect spinal cord or nerve compression caused by a hernia. High-resolution diagnostic devices that can be applied within the framework of lumbar disc herniation diagnostic methods include:
X-Ray:It is used to quickly evaluate and follow up on conditions such as bone fracture and spinal shift, in cases of lower back pain.
Magnetic Resonance Imaging (MRI): With its soft tissue separation and multi-plane imaging capabilities, MRI is the most appropriate imaging examination to evaluate the spine in most clinical situations. MRI uses different sequences to contrast between tissues, providing information about the spine, spinal cord, nerve roots and cerebrospinal fluid, as well as the surrounding tissues that enter the image field. For detailed images of organs and structures in the body, a combination of large magnets, radiofrequencies and a computer is used.
Myelogram: In order for the structure to be clearly visible on the X-ray, dye is injected into the spinal canal.
Computed Tomography Scan: (Also called CT or CAT scan) . It is an imaging scan that uses X-rays and computer technology to produce body images. A CT scan shows detailed images of any part of the body, including bones, muscles, fat, and organs.
Electromyography (EMG): EMG is a test that measures muscle response or electrical activity in response to a nerve stimulating the muscle.
How is a lumbar disc herniation treated?
When a lumbar disc herniation is diagnosed, relief can be achieved largely by bed rest, pain medication, and sometimes physical therapy in rehabilitation and physical therapy centers. In the vast majority of patients, complaints lessen with these methods. Surgical treatment is inevitable if there are complaints such as pain, loss of strength, urinary incontinence, which do not get better despite these treatments, impair quality of life, and cause loss of work and strength. No matter which method is used, the goal of surgical treatment is to relieve the nerve root that is under pressure. Currently, microsurgical and endoscopic methods are the most widely used methods. The frequency of use of the endoscopic method is increasing every day.
If no serious nerve compression is present in the examinations and there is only lower back and leg pain, muscle relaxant medication, bed rest and avoiding straining movements are recommended.
In general, the following recommendations are given for lower back pain.
Weights exceeding two kilograms should not be lifted.
Movements such as leaning forward and sideways are prohibited. If something needs to be taken from the floor, it is recommended to take it by squatting.
It is important to place a pillow to fill the lumbar gap while sitting and not to sit for long periods of time. If it is necessary to sit for long periods of time due to work related reasons, you should stand up every hour and make sure to do light stretching movements.
You also need to make sure not to reach up. If you need to get something from a high place, it should be done by using a chair or a ladder.
It is important not to stay out in the cold, not standing in front of open windows or air conditioning.
It is also necessary to avoid stress in order to avoid pain.
Bed rest should be utilised during the time spent at home. Contrary to popular belief, surfaces that are too hard can be harmful. It is recommended to sleep on a quality orthopedic matress in the most comfortable position possible. Sleeping in the fetal position, which is lying on the right or left side and pulling the legs towards the body, would be a suitable position.
When the diagnosis is made, if the symptoms persist despite rest and muscle relaxants, local pain interventions or acute period physical therapy techniques can be applied. The aim of physical therapy in chronic pain is to increase core strength, flexibility and endurance to ensure participation in daily activities, in acute cases, the patient's participation in this treatment may be limited due to pain.
İf the pain continues in a way that restricts daily life activities and reduces the quality of life despite all these treatments, that means it is time for surgical treatment. Emergency surgical intervention is necessary if progressive loss of strength, urinary incontinence, inability to urinate and unbearable pains are present, despite the use of strong painkillers. Any delay can cause these complaints to become permanent.
The purpose of lumbar disc herniation surgery is to clean the lumbar disc herniation and remove the pressure on the nerve. A commonly used surgical option is a discectomy with microsurgery. In these operations, which are performed through a small skin opening using microsurgical techniques, the hospital stay period is one day. A microsurgical discectomy can be performed under general anesthesia, or it can also be performed by numbing the patient from the waist down in appropriate patients.
Full Closed lumbar disc herniation Surgery (Full Endoscopic Discectomy)
Endoscopic lumbar disc herniation surgery is performed by entering into the hernia area through a 6-7 mm incision on the back or side of the waist and removing the hernia tissue. The operation has a duration of about 10-40 minutes. Patients are discharged mostly on the same day after surgery and can return to their normal lives within 1 week. Endoscopic lumbar disc herniation surgery can be performed under general anesthesia (putting the patient to sleep), spinal anesthesia (numbing the patient below the waist), or local anesthesia (numbing only the area where the procedure will be performed). Depending on the location of the hernia; The hernia is removed by entering the area where the hernia tissue is located using a camera with a 4 mm gap in it from the back or 8-12 cm side of the waist. A skin incision of 7 mm is sufficient. Usually, the operation is performed by entering between the muscles without touching the bone tissue. In this way, muscle and bone tissue is preserved.
Advantages of endoscopic lumbar disc herniation surgery
Endoscopic lumbar disc herniation surgery provides significant advantages to the patient. The fact that the operation can also be performed under local anesthesia is a very important advantage for patients that are not fit to take anesthesia. In addition, short operation time, the fact that there is mostly no need for bone removal, and minimal tissue damage are its obvious advantages. It is a great advantage that patients can be discharged on the same day and return to daily life and social life immediately. Compared to other surgical techniques, the amount of tissue damage and bleeding is minimal. After this surgical procedure, patients can mostly return to their work lives within 1 week. While being overweight creates a significant disadvantage in patients who undergo surgery with other methods, this method does not.
What should you be careful about after the lumbar disc herniation treatment?
Patients who undergo lumbar disc herniation surgery with endoscopic method can adapt to daily life in a few days and can return to work life within 1 week. Most patients also do not need painkillers after surgery. Patients are advised not to sit for long periods of time and not to do heavy work, especially during the recovery period. If they experience any pain while they are working, they are advised not to continue their work despite the pain, and to rest.
Why should I choose Memorial Health Group for the treatment of lumbar disc herniation?
Memorial Health Group Spine Centers provide services with its experienced staff, modern technologies and multidisciplinary treatment approach. Today, all modern methods, including endoscopic discectomy, which is one of the advanced techniques, are applied in the treatment of lumbar disc herniation.