Back pain is the harbinger of disc problems. Initially, conservative medical therapy will be used to try to combat it. This is because the cause of low back pain is not always a herniated disc. 23 Intervertebral discs cushion the individual vertebrae of the spine against each other like shock absorbers. When standing, the entire weight of the upper body rests on the cartilage discs. This is why overweight is the most common cause of back problems. If conservative treatment is not successful, disc surgery is usually advised.
What is intervertebral disc surgery?
During disc surgery, the surgeon will eliminate the herniated disc. In this way, the pinched nerve roots are relieved again. Built like gel cushions, human intervertebral discs have a gelatinous core inside. A robust fibrous ring surrounds and strengthens the individual intervertebral disc. With increasing age, the cartilage mass loses elasticity and dries out more and more. This can lead to cracks forming. The ailing, thinning cartilage tissue is less and less able to withstand the frictional forces between the vertebrae, and the bones begin to rub against each other. In the case of a herniated disc, the firm fibrous ring surrounding the cartilage mass tears. The fixation of the inner, soft gelatinous mass is lost and it will bulge forward into the spinal canal. Then, depending on the position of this bulge, unnatural pressure is exerted on the nerve fibers, which, depending on the intensity, can lead to impressive pain and even paralysis. For neurological diagnosis, the specialist will consult images from an MRI, X-rays or [[CT]] scans until a reliable clinical picture emerges. Herniated discs can be completely painless and go undetected. They can produce severe pain or even cause paralysis. Accordingly, the scale of forms of therapy ranges from medication and physiotherapy to surgery of the herniated disc by the surgeon.
Function, effect and goals
Surgery on the intervertebral discs becomes necessary when paralysis occurs, no more painkillers are effective and the clinical picture generally worsens more and more. Urgent surgery is indicated when cauda equina syndrome occurs, which is manifested by numbness in the anal or genital area and even bladder and fecal incontinence. During the course of the disc surgery, the surgeon will eliminate the herniated disc. In this way, the pinched nerve roots are relieved again. For this purpose, the surgeon uses microsurgical discectomy, in which relief of the spinal cord nerves is generated under the operating microscope. By means of this procedure, all herniated discs can be removed and it is irrelevant in which direction the disc had slipped. The operating physician also accurately determines whether the spinal nerve was correctly relieved. The operation is performed under general anesthesia and in the prone position. In order to obtain the greatest possible spacing between the individual vertebral arches and the necessary widening of the spinal canal, the patient is in a kneeling position. The upper body lies on the operating table. Schematic anatomical representation of the vertebrae and the intervertebral disc, as well as the pinched nerve. Click to enlarge. Then the surgeon will make a small skin incision over the diseased area and gently push the back muscles aside. Microscopes and delicate special instruments are used during the surgery. With their help, the ligamentum flavum – a ligament that connects the individual vertebral bodies – is partially incised. This gives the surgeon the necessary unobstructed view into the spinal canal. Only in rare cases does some of the vertebral bone have to be removed. Now the bulging tissue of the affected intervertebral disc can be separated. Parts of the disc that had slipped into the spinal canal are also removed. The spiral nerve will be kept under constant microscopic scrutiny throughout the operation. If there are large defects in the fibrous ring, they will be sutured microsurgically. At the end of the disc surgery, the corresponding skin area will be sutured again.
Risks, side effects and dangers
As with all surgical procedures, there are risks associated with disc surgery. Rarely, there is injury to the nerve, which should be relieved.Impaired bladder and bowel functions, movement disorders of the legs and sexual dysfunction can be the consequences. Wound healing disorders and infections are also considered possible complications. The rare post-discectomy syndrome causes pulling and tingling sensations in the legs, which can occur at times despite an optimal operation. As a sensible aftercare following disc surgery, ligaments and muscles are strengthened through physiotherapy. Within rehabilitation, occupational therapists, nutritionists and psychotherapists are also used as needed.
