Diagnosis
The basis of the diagnosis is, as with many diseases with nerve involvement, the physical examination. Here muscle strength and sensitivity in different nerve supply areas are tested. However, the final diagnosis in case of suspected herniated disc is based on imaging techniques, i.e. MRI, CT or X-ray.
X-rays show the cervical spine in two planes. From the front (also called AP for anterior-posterior) and from the side. Here the intervertebral discs can be assessed and various degenerative diseases of the spine can be excluded.
However, the diagnosis of choice is the MRI, which allows a more precise assessment and an examination without radiation exposure. In order to display the spinal cord and the spinal canal, a so-called myelography can also be performed. Here, a contrast medium is injected into the spinal canal, which allows the spinal cord to be very clearly defined in subsequent imaging.
Since MRI, i.e. magnetic resonance imaging, is based on the use of magnetic waves and not X-rays, it is the gentlest diagnostic measure, albeit the most expensive and complex. In contrast to X-rays, MRI not only provides good images of high-density body parts such as bones, but also of ligaments and other soft tissue organs in particular. This allows a precise indication of the type, direction and progress of a herniated disc. A disadvantage of the MRI image is the long time the patient stays in the imaging device, which is a particular burden for patients with claustrophobia, i.e. fear of closed rooms. This fear can, if the severity of the anxiety disorder is not too fulminant, be dampened with sedatives for the duration of the diagnosis or other methods such as open MRI are used.
Therapy
The majority of patients with herniated discs are treated conservatively, i.e. without surgery. A distinction is made between self-limiting (i.e. stopping at a certain extent) and progressive courses. Especially in self-limiting courses without signs of paralysis, conservative therapy is usually the method of choice.
Thus, a reduction of pain is first achieved by sparing and drug therapy, which allows a subsequent strengthening of the trunk muscles by a physiotherapist. and medication for a herniated disc Heat therapy, massages and electrotherapy can also bring about a reduction of symptoms, but the effect on the progress of the disease is not scientifically proven. The duration of conservative therapy is usually 6 to 8 weeks, if after this period no improvement of symptoms has occurred, surgical therapy may be necessary.
Periradicular therapy (PRT) is a radiological pain therapy used in patients with chronic pain due to degenerative spinal diseases. The nerve root is localized by previous imaging using MRI or CT, which is then treated by targeted injection of a mixture of a local anesthetic and a steroid such as cortisone. The local anaesthetic has an analgesic effect, the steroid relieves the inflammation and has a desensitising effect.
Before the PRT needle is inserted, the skin is anaesthetized with a local anaesthetic and after the insertion of the PRT needle, a new image is taken to determine whether the needle is in the correct area. Surgical therapy is indicated for herniated discs with severe complications such as paralysis symptoms or for herniated discs for which conservative therapy has failed to improve symptoms. Approximately 140.
000 herniated disc operations are performed annually. Many of these operations are not absolutely necessary, but about 10% of the operated patients would suffer permanent late damage if they decided against surgery. There are two different basic forms of disc surgery.
In spondylodesis, i.e. the stiffening of the spine, the two vertebral bodies that lie against the degenerated intervertebral disc are fixed together by a screw. In this form of surgery, part of the mobility of the spine is lost. The other possibility is the insertion of an artificial disc, also called disc prosthesis.
Here the mobility of the spinal column is preserved as far as possible. In the case of herniated discs in the cervical spine, spondylodesis is the more frequently used form of surgical technique, since the loss of mobility in the cervical area is not as severe as in the lumbar area. The operation is usually performed under general anesthesia.
Where in the past an incision of up to 30 centimetres in length had to be made, today it is sometimes possible to proceed with minimally invasive procedures (so-called “keyhole surgery”). The duration of the operation is 30-60 minutes, but every patient should be admitted to the hospital and examined the day before the operation and possibly stay in the clinic for monitoring one day after the operation. The risks of the operation depend on the type of procedure, although the risks are significantly lower with the minimally invasive surgical procedure than with open surgery.
With both procedures, post-operative bleeding, wound infections, swelling and excessive scarring can occur. These complications can be accompanied by pain. Rarely, the so-called “post discectomy syndrome” can occur, in which the symptoms first improve after the disc surgery, but then after some time they become more severe again.
The risk of the post-discectomy syndrome is even lower in operations on the cervical spine, and is most likely to be triggered by operations near the sciatic nerve on the buttocks. Apart from the risks of the operation, the general risks of general anaesthesia naturally apply. For example, subsequent nausea and fatigue often occur.
Serious side effects such as an anaphylactic reaction to the anaesthetic occur at 1 in 20,000 general anaesthesia sessions. About 1 in 100,000 patients die under general anaesthesia. As already described, the duration of treatment for herniated discs depends on the type of treatment.
The conservative, i.e. non-surgical, treatment takes about 6-8 weeks. The surgical therapy takes about 3 days including preparation, surgery and aftercare. Afterwards, of course, there must be a period of physical rest in order not to disturb the healing of the wound.
