Disc herniation surgery
If the conservative therapy for a herniated disc does not lead to a reduction of pain or if the herniated disc has caused neurological disorders and impairments, then surgery can be performed. The indication for surgery for a herniated disc is now more than ever carefully considered. The operation is performed under general or local anaesthesia and can be offered in different variations depending on the surgeon and the clinic.
The minimally invasive technique allows the operation of the herniated disc without large skin incisions. However, it is not possible for every type of herniated disc and it must be decided by the surgeon whether minimally invasive surgery can be used. There are several minimally invasive methods available.
In the microsurgical variant, the patient usually lies on his stomach – in the case of a herniated disc in the cervical spine on his back – and an approx. 2 cm skin incision is made through which the surgeon can operate on the affected disc with the smallest instruments. In the endoscopic variant, a small tube is pushed through a skin incision of about 1cm to the disc.
The tube (endoscope) can be inserted from the side or the back. Through the endoscope, very small instruments and a camera are inserted, through which the surgeon can remove the prolapsed disc. In both of these variants, a laser can also be used instead of scalpels.
Here, herniated discs are not cut away, but vaporized. In addition, even the smallest parts of the intervertebral disc, which otherwise cannot be reached, can be removed in this way. Furthermore, there is also an electrotherapy.
Here, the intervertebral disc is operated on at temperatures of over 90 degrees Celsius. More complicated herniated discs often have to be operated on in the conventional open surgical variant. In this case, a longer skin incision is made from the back and the surgeon cuts through the posterior ligaments of the spine to expose the spinal canal.
It may also be necessary to remove parts of the spinal arch. The operation of a herniated disc is not risk-free and should therefore not be performed without an appropriate indication. In principle, any general anesthesia is a risk.
However, due to the development of minimally invasive procedures, which can also be performed under local anesthesia, this is an avoidable risk. After the operation, post-operative bleeding, bruising and swelling can occur at the surgical site and the wound can become infected. It is also important to note that pain, tingling, numbness and other neurological deficits may persist or even reappear after the operation, as nerves that have been exposed during the operation may be irritated or injured.
The technical term for these symptoms after the operation of the herniated disc is called post-nucleotomy syndrome. In addition to the nerves, there is a risk that vessels or other organs (intestine, bladder, etc.) may be injured during the operation.
Since the use of minimally invasive surgical options, a large proportion of complications can be prevented, since the smaller surgical access means that there is significantly less injury to other tissues. The minimally invasive procedures most commonly used today to operate on a herniated disc usually take about 30 – 60 minutes. This time, however, depends on which variant the surgeon uses, how the herniated disc is located and which access route is chosen.
Furthermore, for example, severe overweight or the age of the patient are also factors that influence the duration of the operation. In procedures involving several intervertebral discs, the operation can take up to 120 minutes, since several access routes must be created and the operation time adds up accordingly. In conventional open surgery, the surgery time for a herniated disc is between 60 and 120 minutes, depending on the localization (cervical, thoracic, lumbar) and access route.
If, in addition to the removal of the herniated disc, a spinal fusion (spondylodesis) of the spine has to be performed or a disc prosthesis has to be inserted, the operation can take up to several hours. In addition to the pure operation time, the time for anesthesia before and after the operation must also be taken into account. Anesthesia or narcosis must be administered before the operation.
After the operation it takes time to wake up in the recovery room or to remove the local anesthesia. Pregnant women are exposed to an increased risk of suffering a herniated disc. The most common area where a herniated disc occurs during pregnancy is in the lumbar vertebrae.
The reason for its development is mainly based on the weight of the growing baby. In many cases the back muscles are not sufficiently developed to withstand this counterweight. Thus, the expectant mother develops an incorrect posture, which can lead to a herniated disc.
The woman’s hormonal changes during pregnancy also favour such an event. The intervertebral discs absorb more water and thus become more unstable and more susceptible to a prolapse. If a herniated disc occurs during pregnancy, conservative treatment is the first priority.
Before pain-relieving medication is used, an attempt is made to help the expectant mother by other means. Exercise, massages, physiotherapy or acupuncture can help to alleviate the symptoms. Even stress reduction and relaxation of the pregnant woman can relieve cramps and bring about an improvement of the symptoms.
If none of this helps, pain-reducing medication is used. Here, it is essential to pay attention to the protection of the unborn child. The doctor will only prescribe painkillers that do not enter the child’s bloodstream via the placenta during pregnancy and could therefore harm the child.
Paracetamol is the painkiller of choice during pregnancy. (See paracetamol in pregnancy)The best way to prevent a slipped disc is exercise. This can prevent the wear and tear process of the spinal column by better supplying the intervertebral disc with nutrients through movement and thereby strengthening it.
However, caution is advised when choosing a sport – because not every movement is beneficial for the back. For people with back problems, however, there is a wide range of choices that are without worries. Swimming, walking and cycling are particularly suitable for back-friendly training of the abdominal and back muscles.
In these sports, both the muscles of the abdomen and the back are equally stressed, so that a strong backbone is formed. Even jogging is allowed after a slipped disc is after one. In this case it is advisable to make sure that you are jogging on an oncoming surface.
It is best to jog on a soft surface such as forest soil and not on hard surfaces such as asphalt to protect the spine from compression. For the sake of the spine, experts advise against sports that place a heavy strain on the spine (e.g. weight lifting) or involve rotational movements (e.g. tennis).
