Introduction
The lumbar spine (lumbar spine) is relatively often affected by herniated disks, because in our modern society there are long periods of sitting. It is important to distinguish a real herniated disc of the lumbar spine, i.e. prolapse, from other complaints such as the symptoms of lumbago. While an actual herniated disc in the lumbar spine may require an operation to prevent further damage, back pain without a specific prolapse can usually be managed well in other ways.
As with all herniated disks, it is therefore important in the lumbar spine area to distinguish well when one should really undergo surgery and when conservative measures are sufficient. One should not be too hasty. In particular, the more minor herniated discs can be treated very well conservatively in the multitude.
Indication for surgery
Even though the decision for or against an operation depends on the individual ideas of the patient, there are still some points to consider. If an operation is scheduled, it is particularly important to first make a very careful diagnosis in order to exclude other causes. Good imaging of the affected region should also be available.
Only with the help of a precise assessment of the herniated disc by means of MRI of the lumbar spine or CT it is possible to decide whether and how to operate. If possible, an MRI of the lumbar spine should rather be performed to avoid the radiation exposure of a CT. If these images show a herniated disc, the indication for surgery depends mainly on the symptoms.
For example, MRI or CT images of healthy people often show conspicuous findings, but these do not cause any symptoms. Therefore, the extent of the actual impairment is the most important factor for an operation. Especially the subjective extent of complaints is the most important evaluation criterion for an operation of a herniated disc of the lumbar spine.
In addition to pain, the main focus is on disorders of the affected nerves. These can manifest themselves for example as numbness or tingling in the legs or feet. Other sensory disorders, such as impaired tactile or touch sensation, are also possible.
In some cases, these findings can be objectively recorded with the aid of electrophysiological methods with which the nerve conductivity can be measured. In addition to the nerves that conduct sensation in the legs, the nerve fibres responsible for the bladder and rectum can also be affected. If functional disorders occur in these areas or in sexual function, surgery should always be performed.
In addition to the sensitive areas, paralysis of the motor parts of the nerves can also occur in the leg area. Pronounced paralysis (pareses) is also an indication for surgery. Pain can usually be treated well, but if this is not possible, surgery may be considered.
In most cases the pain is relieved immediately after the operation. If none of the above-mentioned points apply, i.e. the bladder and rectum are not affected, no severe paralysis or severe pain occurs, treatment can usually be conservative. Regardless of the symptoms, surgery may be necessary if the pain or other problems are caused by a purely mechanical impairment. Even then, it is often not possible to alleviate the symptoms conservatively as long as the cause remains. So if there is no improvement after about two months of conservative therapy, this may speak for surgery.
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