Sunday, April 14, 2024

Herniated Disc Lower Back Surgery

When Should I See A Doctor

Right L4-5 Microdiscectomy on Right L4-5 Herniated Disc

Initially, you can treat herniated disk pain at home. But you should see your doctor if:

  • Pain interferes with daily life, like going to work.
  • Symptoms arent better after four to six weeks.
  • Symptoms get worse.
  • You develop loss of bladder or bowel control.
  • You notice tingling, numbness or loss of strength in your arms, hands, legs or feet.
  • You have trouble standing or walking.

A Patient’s Guide To Lumbar Herniated Disc

Lower back problems can occur for many different reasons. The terms ruptureddisc and slipped disc seem to be used more commonly in the last few decades.People often assume that everyone who has back pain has a ruptured disc. However,a true herniated nucleus pulposus is not very common. Most problems that cause pain in the back are not due toa herniated disc.

For a more in-depth discussion of the parts of the spine and how they work,along with a general overview of back and neck problems, you might want to reviewthe document, entitled:

Let’s look at what a herniated disc really is, how it causes problems, and how the condition is diagnosed and treated by a back specialist.

The Nature Of Your Symptoms

One person can have a disc thats significantly herniated and experience little or no discomfort, yet another individual can have a disc thats similarly damaged and causing debilitating pain. For this reason, how youre experiencing pain from a herniated disc is one of the factors that will determine if surgery should be discussed. Possible symptoms associated with a herniated or bulging disc include:

Pain felt in the lower back or neckthe two most common areas where disc herniation occurs Pain accompanied by general weakness Discomfort that extends to nearby areas

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Does Laser Spine Surgery Work For A Herniated Disc

While there are plenty of spinal issues for which laser spine surgery might not work, such as degenerative spine diseases, a herniated disc is a problem that laser spine surgery can easily solve. There is no need to undergo intensive traditional spine surgery if you are suffering from a herniated disc, as laser surgery can get the job done equally well with minimal amounts of pain involved.

Nerve Conduction Studies And Electromyogram

Herniated Disc / Bulging Disc / Protruding Disc  Michigan Spine &  Pain

These studies use electrical impulses that measure how much your nerves might be affected by compression from a herniated disc. NCS and EMG are not routine tests to diagnose herniated disc, and are only used if you have symptoms of nerve trouble like numbness and radiating pain. These studies are typically only used if MRIs and a physical exam are inconclusive and your doctor thinks other conditions are a possibility.

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If You Have Been Using Epidural Steroid Injections And Painkillers To Manage Your Back Pain More Likely Yes You Will Need That Surgery

We have a very extensive article on epidural steroid injection. In this article, we compare various treatments to epidural steroid injections and we demonstrate the research which suggests that while some people will benefit from epidural steroid injection, others will not. There is also evidence suggesting prolonged use of these injections may actually accelerate the need for surgery.

A July 2020 study published in the Global Spine Journal from researchers at the Cleveland Clinic, and the University of Texas Southwestern Medical Center compared conservative treatments in patients with lumbar intervertebral disc herniations who were successfully managed nonoperatively versus patients who failed conservative therapies and elected to undergo surgery .

  • The study examined the clinical records of more than one-quarter million with lumbar intervertebral disc herniations. Of these, 269 713 were successfully managed with nonoperative treatments, while 8228 failed maximal nonoperative therapy and underwent a lumbar microdiscectomy.
  • Maximal nonoperative therapy failures occurred more frequently in males , and patients with a history of lumbar epidural steroid injections or preoperative opioid use .

In other words, men, getting epidural steroid injections or using painkillers will eventually need surgery. These two pain treatments do not stop progression to surgery.

What Is A Herniated Disc In The Lower Back

  • Alternative treatments for a herniated disc acupuncture
  • A herniated disc in the lower back occurs when one of the discs in the lumbar region of the spine ruptures, causing inner disc fluid to be pushed out into the spinal column. This can cause localized disc pain as well as traveling symptoms into the lower body if disc material puts pressure on nearby nerves.

    A herniated disc is a very common condition affecting people of all ages. Herniated discs often develop in athletes earlier in life, but are more frequently seen in older patients as the spinal anatomy naturally begins to deteriorate. In some instances, a ruptured disc requires little to no treatment some individuals might not even know theres a problem while others can experience chronic, frustrating lower back pain and difficulty moving. Effective treatment of this condition depends on identifying the source of the pain and developing a comprehensive treatment plan that is tailored to your needs.

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    Why Might I Need A Lumbar Discectomy

    You may need this surgery if you have a herniated disc in your lower back that is causing symptoms. The symptoms may include weakness, pain, or tingling in the back area and in one of your legs.

    Lumbar discectomy cant be used to treat all cases of back pain. And not everyone with a herniated disc needs a lumbar discectomy. Your healthcare provider might advise the surgery if youve tried other treatments but still have severe symptoms. Other treatments to try first include physical therapy and anti-inflammatory medicines.

    Talk with your provider about the risks and benefits of minimally invasive surgery compared to open surgery. Minimally invasive surgery may lead to less pain and faster recovery. But not all surgery centers can use this method.

    Surgery For Degenerative Disc Disease

    Low Back Pain: Lumbar Laminectomy Surgery

    If back or neck pain caused by degenerative disc disease doesnt respond to medication or therapeutic injections, NYU Langone doctors may recommend a surgical procedure. Surgeons may remove some or all of a damaged disc, take pressure off a pinched nerve, or eliminate movement between the bones of the spine.

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    When To Call A Doctor

    911 or other emergency services immediately if:

    • An injury causes numbness or weakness in one or both legs.
    • You have a new loss of bowel or bladder control.
    • You have leg pain along with persistent weakness, tingling, or numbness in any part of the leg from the buttock to the ankle or foot.
    • You have low back pain along with vomiting, fever, or both.
    • Leg pain or intermittent weakness, tingling, or numbness lasts longer than 1 week despite home treatment.
    • You have back pain that either won’t go away or builds in intensity over a few weeks.
    • You have a back injury, and your symptoms don’t improve in 2 to 3 days.
    • You have back pain along with pain during urination or blood in the urine.
    • You have back pain that is worse when you are resting than when you are active.
    • You notice a gradual increase in problems with bowel or bladder control.

    Surgery Can Help But There Is No Guarantee That Symptoms Will Disappear

    The different surgical procedures described here have been looked at in a number of studies, and some have been compared with one another. Most of the studies involved surgery on people who had pain for weeks despite receiving other treatment. One of the larger studies mostly included people with severe sciatica . The outcome: If someone is a suitable candidate for surgery, it can relieve pain and other symptoms such as limited mobility over the long term. The pain in the participants who had surgery went away quickly after the procedure. But it took a few weeks before there was an improvement in mobility. There is no guarantee that surgery will relieve all of the symptoms.

    Research has shown that rehabilitation immediately after slipped disc surgery can shorten the recovery time and improve mobility.

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    How Is A Herniated Disk Diagnosed

    Your healthcare provider will do a thorough exam. During the physical, your provider will assess your pain, muscle reflexes, sensation and muscle strength. Your provider may also order tests such as:

    • Magnetic resonance imaging : The most common and accurate imaging test for a suspected herniated disk is an MRI.
    • X-rays: Getting X-rays helps rule out other causes of back or neck pain.
    • Computed tomography : A CT scan show the bones of your spine. Herniated disks can move into the space around your spinal cord and nerves and press on them.
    • Myelogram: A myelogram involves an injection of dye into your spine using X-ray guidance for a CT scan. The dye can reveal a narrowing of the spinal canal and location of your herniated disk.
    • Electromyogram : This test involves placing small needles into various muscles and evaluate the function of your nerves. An EMG helps determine which nerve a herniated disk affects.

    What Are The Risks What Is My Outlook

    How Microdiscectomy Surgery Is Performed

    Herniated disk surgery is generallyà safe. Risks are rare, but can include:

    • Damage to nerves or blood vessels
    • Problems with the new disk
    • Leaks of spinal cord fluid

    There’s a small chance surgery won’t improve your symptoms. Or, your pain might get better for a while and then come back in the future.

    Surgery can give most people with a herniated disk relief from pain and other symptoms. Yet it doesn’t work for everyone. In about 5% of cases, the disk will herniate again.

    Although surgery offers faster relief than other treatments, it isn’t always the best choice. Talk to your doctor carefully about the risks and the benefits of surgery before you decide on a treatment.

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    What Can I Expect During Recovery

    Herniated disk surgery is often very effective, and it works faster than other treatments. You should start to see an improvement in symptoms like pain, weakness, and numbness within a few weeks after surgery.

    Physical therapy or rehab can help you recover quicker. You can go to a rehab center, or do exercises at home. Walking can also help you regain movement in your spine.

    In the first few weeks after your surgery, be careful not to:

    • Lift heavy objects
    • Sit for long periods of time
    • Bend or stretch too much

    Your doctor will let you know when you can drive, go back to work, and do other things you usually do. You should be able to go back to a desk job in 2 to 4 weeks. If you have to lift heavy objects or work big machines at your job, you might have to wait 6 to 8 weeks.

    How Do I Know If I Need Emergency Surgery

    Very rarely, a large disc herniation may press on the nerves which control the bladder and bowel, causing loss of bladder or bowel control. This is usually accompanied by numbness and tingling in the groin or genital area and is one of the few indications that you need surgery immediately for a herniated lumbar disc. Call your doctor at once if this happens.

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    What Can I Expect After Surgery

    Greater than 90% of patients experience relief of leg pain after surgery. Relief of central low back pain, not typically caused by a simple disc herniation alone, is less reliable from a microscopic discectomy procedure.

    Most patients will not have complications after discectomy, but it is possible you may have some bleeding, infection, tears of the protective lining of the spinal nerve roots or injury to the nerve. It is also possible that the disc will rupture again and cause symptoms. This occurs in about 5% of patients. Ask your doctor for recommendations on postsurgical activity restrictions. Usually you can get out of bed and walk around immediately after recovering from anesthesia. Most patients go home within 24 hours after surgery, often later the same day.

    Once home, you should avoid driving, prolonged sitting, excessive lifting and bending forward for the first four weeks. Some patients will benefit from a supervised rehabilitation program after surgery. You should ask your doctor if you can exercise to strengthen your back to prevent recurrence.

    What Is A Herniated Disk Anyway

    Can A Herniated Disc Heal? | WITHOUT surgery?!?

    One of the more painful conditions of the spine, a herniated disk, refers to a phenomenon where some of the soft tissues inside a spinal disk leak through a tear in the fibrous lining of the disk. Then it can put pressure on the nerves inside the spinal cord or nerve roots nearby, which results in back pain and mobility issues in your limbs on various levels.

    Herniated disks can occur for various reasons general wear and tear with old age, accidents, maladjusted heady exercise and resulting injury, etc. You can see it mostly in older people because of the natural degradation of bones.

    How can you know you have it and need herniated disk treatment? Simple, just check if you have been experiencing some of these issues for a while:

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    Who Is Eligible For Microdiscectomy

    Most patients with herniated discs that do not respond to a trial of medication and physical therapy over time, are eligible for a microdiscectomy. While the condition is usually seen in individuals aged 30 to 50, it does occur outside this age range.

    Herniated discs are rare in children and young adults, who are more frequently able to recover without surgical intervention. Microdiscectomy may be appropriate for adults in their 80s or 90s, though they should be cautioned that there is an increased chance of medical or surgical complications in this population.

    Surgeries For A Herniated Disk

    Surgery should take the pressure off the nerves that are bothered by your herniated disk. There are a few different surgeries that can do this and relieve your pain.

    Diskectomy. During this surgery, your surgeon removes your damaged disk to relieve pressure on your nerves. They can perform the surgery in a couple of ways:

    • An open diskectomy is done with a cut in your back or neck.
    • Microdiscectomy is done through a much smaller cut. Your surgeon inserts a thin tube with a camera on one end to see and remove the damaged disk.

    Lumbar laminotomy. Sometimes your surgeon will also need to remove a small piece of bone called the lamina from the vertebra. The lamina forms a cover that protects your spinal cord. Removing part or all of it helps the surgeon get to your herniated disk. It also can relieve pressure on your nerves and stop leg pain and sciatica.

    • Laminotomy removes some of the lamina.
    • Laminectomy removes most or all of the lamina.

    The lamina can be removed at the same time as the diskectomy. Or, you might have it taken out in a separate surgery.

    Spinal fusion. After a diskectomy or laminotomy, your surgeon may fuse together the two vertebrae on either side of the disk to make your spine more stable. This is called spinal fusion. Fusing the two disks will stop the bones from moving and prevent you from having any more pain.

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    How Long Will I Be Out Of Work After Herniated Disc Surgery

    Procedures for Treating Herniated Discs

    If you have a herniated disc that does not respond to conservative treatment, you may need surgery. If this is the case, there are two possible routes: traditional open back surgery, and laser surgery. Since herniated discs tend to cause compression by pressing on the nearby spinal cord and nerves, surgery is aimed at relieving that pressure by removing a small part of the disc.

    Open back surgery is quite invasive, which accounts for the long recovery time. The procedure entails:

    • Using a scalpel to cut skin, muscle, and other tissue away from the affected vertebrae
    • Performing a laminectomy to gain access to the disc and spinal cord – in this procedure, a small part of the vertebral bone is cut away
    • Performing a discectomy, in which the herniation is manually removed from the area

    While effective, traditional herniated disc surgery results in a large scar and a long, slow recovery. The patient must be put under general anesthesia.

    In contrast, laser back surgery can now treat herniated discs by:

    • Inserting a small needle into the center of the disc
    • Using special tools and an endoscopic camera to perform the procedure
    • Using a radiofrequency probe and/or laser to dissolve a small portion of the disc’s center, causing it to reabsorb the herniation

    Minimally invasive herniated disc surgery can be performed under local anesthesia, in an outpatient setting. Since only one or two small incisions are made, scarring is minimal.

    Returning to Work

    How Does A Surgeon Perform A Microdiscectomy

    Reasons for Revision Spine Surgery

    Microdiscectomy surgery may be approached using one of three minimally invasive techniques to gain access to the herniated disc and nerve: a midline, tubular or endoscopic microdiscectomy.

    Historically, a traditional discectomy required a large incision and involved removal of the entire disc. Today, with the availability of advanced techniques and equipment, almost all spine surgeons perform microdiscectomies. The procedure usually results in rapid, and sometimes immediate, pain relief.

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    Surgical Treatments For A Herniated Disc

    For a herniated disc, doctors prefer non-surgical treatments over surgery whenever possible. If surgery is necessary, they will opt for the most minimally invasive option with the highest chance of success, given your condition. Your doctor may recommend surgery if you have:

    • Difficulty standing or walking.
    • Insufficient pain and symptom relief from non-surgical treatments.
    • Pain that persists for six weeks or more.
    • Symptoms have a significantly negative effect on your mental health.

    Here are some common surgical options for treating a herniated disc.

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