Saturday, April 6, 2024

Surgery For Herniated Disc In Lower Back

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THE #1 Neurosurgeon Recommended Treatment For A Herniated Disc

Despite discectomy surgery for lumbar herniated disc generally being a highly successful procedure, certain patients are at a higher risk of recurrent herniation following spine surgery.

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  • Have you undergone any of the following non-operative treatments:
  • Have you consulted with a spine surgeon?*
  • What Causes A Herniated Disc

    Before understanding that surgery is not your only option when it comes to a ruptured disc, its important to understand the causes of the condition.

    With the natural aging process, discs dehydrate and lose resiliency, making them more susceptible to wear. The problem starts when your disc shifts and presses on a nearby nerve, causing pain, numbness, tingling sensations, and possibly weakness. Essentially, the jelly-like center of a spinal disc pushes out through a tear in the disc’s outer layer. This can happen due to age-related wear and tear or from an injury.

    Lumbar Spine Herniated Discs

    A herniated disc can occur anywhere along the spine but is most common in the lower back. In this region, pressure may begin to build on one or more of the spinal nerve roots that compose the sciatic nerve. This may lead to the brain interpreting pain anywhere from the lower back down the leg into the calf or foot.

    What Is A Lumbar Discectomy

    Lumbar discectomy is a type of surgery to fix a disc in the lower back. This surgery uses smaller cuts than an open lumbar discectomy.

    Your backbone, or spinal column, is made up of a chain of bones called the vertebrae. Your spinal cord runs through the spinal column. The bones help protect the cord from injury. Discs sit between each vertebra to provide cushioning and support. Large nerves called nerve roots lead from the spinal cord through small holes in the bones called foramen. These nerve roots send and receive signals to and from the body. The signals are sent to and from your brain through the spinal cord.

    Sometimes the outer wall of one of these discs may dry out and weaken with age or injury. When this happens, the soft, inner part of the disc bulges out. This is called a herniated or bulging disc. This bulging disc can press on the spinal cord and cause symptoms such as pain, tingling, or weakness in a nearby part of the body.

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    Common Cervical Herniated Disk Symptoms

    The cervical region of your spine is the second most common area of the spine to develop a herniated disk. The symptoms associated with a cervical herniated disc develop from compression of either an individual nerve root or the spinal cord and include:

    • Pain or tingling in the neck and possibly down into the shoulders, arms and even hands and fingers
    • Numbness and weakness in the aforementioned areas
    • More extreme cases can experience a loss of fine motor skills in the hands and fingers, difficulty walking, or a sensation of heaviness and immobility in the legs
    • Bowel or bladder control problems

    What Nonsurgical Treatments Are Used For A Herniated Disc

    Microdiscectomy

    Treatments other than surgery can often help you feel better, be more active, and avoid surgery. Many people are able to manage their symptoms with things like:

    • Changing the way they do their activities. This means trying other ways of doing your activities that don’t cause pain or make other symptoms worse. For example, if sitting makes symptoms worse, try standing up to do your tasks. Or you can switch between sitting and standing.
    • Taking medicines to manage pain. Acetaminophen and nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen may help your pain. Be safe with medicines. Read and follow all instructions on the label.
    • Exercise. Aerobic exercise can help your symptoms. Take a short walk on a level surface every 2 to 3 hours. Walk only distances you can manage without pain, especially leg pain.
    • Physical therapy. It helps you learn stretching and strength exercises that may reduce pain and other symptoms. The goal of this treatment is to make your daily tasks and activities easier.
    • Steroid injections. These are shots that might be recommended for some people if other nonsurgical treatments haven’t worked. The shots may ease leg pain by reducing inflammation in the nerve root. These shots may work for some people, but not for everyone. And when they work, they only help relieve symptoms for a short time.

    If one of these things doesn’t work, you can try something else or combine some of them.

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    What Is The Best Slipped Disk Treatment

    You may need more advanced treatments if your symptoms aren’t getting better. Your healthcare provider might recommend:

    • Medication: Your provider may prescribe an anti-inflammatory pain reliever or muscle relaxant.
    • Physical therapy: A physical therapist teaches you an exercise program to help relieve pressure on your nerves. Exercise loosens tight muscles and improves circulation.
    • Spinal injections: Called an epidural or nerve block, a spinal injection is a shot of steroid medication directly into your spine. The medication reduces swelling and inflammation of the nerve from the disk herniation. This will allow your body to heal and return to activity faster.
    • Surgery: In rare cases, a large herniated disk might injure nerves to the bladder or bowel. That may require emergency surgery. For nonemergency cases, surgery is an option when other treatments fail. There are various ways to perform spinal decompression surgery, but the goal is to relieve pressure on the nerve.

    When Is Surgery Required For A Herniated Disc

    Surgery is most often done when patients present with progressive weakness, numbness, tingling, and/or bowel and bladder changes and then is confirmed by MRI to see where the herniation is located. If you have absent reflexes this is also a sign that you may need surgery.

    The surgeon will carefully test your reflexes, strength, numbness and tingling and review your imaging.

    Once these have all be reviewed the surgeon will determine whether you are an appropriate candidate or not.

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    Research: Latest Information On Conservative Care For Herniated Discs Outdated

    While many people will find great pain relief from the above conservative care measures, some will not. Some doctors feel that conservative care failures are based on outdated information about what will work, for whom it will work, and when it will work for these people indicating as we did above that there is a window of opportunity when these treatments or any treatment will be most effective in helping the patient avoid surgery.

    Lets look at the first choice of herniated disc treatment through the eyes of a Canadian research team who reviewed the current concepts and clinical guidelines for the management of low back pain to assess their quality of care.

    In this February 2017 study published in the European Pain Journal, doctors and researchers found according to high-quality guidelines:

    • All patients with acute or chronic low back pain should receive:
    • and instruction on self-management options
  • Patients with acute low back pain should be encouraged to return to activity and may benefit from:
  • Patients with lumbar disc herniation with radiculopathy may benefit from spinal manipulation.
  • This new study found some of these guidelines to still be in practice but outdated, specifically the use of paracetamol for acute low back pain and other herniated disc symptoms.

    The other problem they found was the recommended education, staying active/exercise, manual therapy, and paracetamol or NSAIDs as first-line treatments., were guidelines targeted to nonspecific low back pain.

    Beyond Laser Spine Surgery: The Bonati Difference

    Low Back Pain: Lumbar Laminectomy Surgery

    Laser spine surgery is a controversial topic among spine surgeons and is often associated with minimally invasive spinal surgery. However, there are a lot of misconceptions about both, so we would like to take a deep dive into the subject to facilitate a better understanding and help patients know what to expect. It is also important to differentiate the Bonati Spine Procedures from laser spine surgery and the so-called minimally invasive spine surgery offered by other spinal surgery centers ./p>

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    The First Week After Herniated Disc Surgery

    While at home, you will need to be cautious about your movements. Be sure to maintain proper posture when sitting and standing, and avoid heavy lifting or frequent forward bending. You must protect your back so that it can heal properly.

    You will be encouraged to slowly increase your activity level during the first week of recovery after surgery for a herniated disc. Walking is a great exercise after surgery as it helps to improve aerobic endurance and promote circulation in your body.

    During the week following surgery, you will be expected to slowly increase your activity level while providing moderate protection for your back by avoiding bending, lifting and slouched sitting. You should continue to remain out of work during the first week of your herniated disc surgery recovery time.

    Slowly increase your activity level and watch your incision for redness, swelling or discharge which may be signs of infection. By the end of the first week, you should visit your doctor who will check your incision and monitor your symptoms.

    What Should You Not Do With A Herniated Disc

    The only things you shouldnt be doing with a herniated disc are things that make the pain significantly worse.

    Contrary to popular belief, bending forward is not bad for a herniated disc. Some people actually feel better when they bend forward .

    Whats most important is to pick a movement that feels best and stick with that and allow for time to do its thing.

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    Key Points To Remember

    • A herniated disc in the lower back is a common cause of back and leg pain. For most people, symptoms get better over time, with or without treatment.
    • Many people are able to manage their symptoms with things like changes in the way they do their activities, medicines to manage pain, exercise, physical therapy, or steroid injections. If one of these things doesn’t work, you can try something else or combine some of them.
    • Surgery may relieve your pain faster than nonsurgical treatments. For symptoms that have lasted at least 6 weeks and that make it hard to do your normal activities, surgery is an option when other treatments haven’t helped.
    • Over the long term, surgery and nonsurgical treatments work about the same to reduce pain and other symptoms.
    • Back surgery has some risks, including infection, nerve damage, and the chance that the surgery won’t relieve your symptoms. And even if you get better with surgery, there is a chance that you may get new symptoms in the future.
    • If you don’t choose surgery now, you can change your mind later if your symptoms haven’t gotten better or have gotten worse even with other treatments.

    How Can I Avoid Getting A Herniated Disk

    How Microdiscectomy Surgery Is Performed

    It’s not always possible to prevent a herniated disk. But you can reduce your risk by:

    • Using proper lifting techniques. Dont bend at the waist. Bend your knees while keeping your back straight. Use your strong leg muscles to help support the load.
    • Maintaining a healthy weight. Excess weight puts pressure on the lower back.
    • Practicing good posture. Learn how to improve your posture when you walk, sit, stand and sleep. Good posture reduces strain on your spine.
    • Stretching. Its especially important to take stretching breaks if you often sit for long periods.
    • Avoiding wearing high-heeled shoes. This type of shoe throws your spine out of alignment.
    • Exercising regularly. Focus on workouts that strengthen your back and abdomen muscles to support your spine.
    • Stopping smoking. Smoking can weaken disks, making them vulnerable to rupture. Consider quitting smoking.

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    Transforaminal Endoscopic Lumbar Discectomy

    Some of you exploring treatment options may have been made aware of Transforaminal Endoscopic Lumbar Discectomy. This is a minimally invasive surgical technique akin to arthroscopic surgery. Instead of an incision, the surgery is performed through a needle puncture and an endoscope. Much has been made of this technique recently both good and not so good. The not-so-good surrounds the challenge of the surgeon making this a successful surgery. Two very recent studies point us in that direction of concern.

    A December 2021 paper in the International Journal of Spine Surgery writes: Open microdiscectomy is the gold standard surgical technique for radiculopathy with lumbar disc herniation. Transforaminal endoscopic lumbar discectomy has been developed as an effective and minimally invasive alternative to open surgery. As a result of these remarkable technical evolutions, the clinical outcomes of Transforaminal endoscopic lumbar discectomy have become comparable to those of conventional open surgery. However, considerable learning curves and endoscopy-related adverse events may emerge as critical problems.

    Other Techniques For Minimally

    Newer techniques may allow your surgeon to perform a procedure called microdiscectomy and endoscopic discectomy. A microdiscectomy is a minimally invasive disc surgery that uses specialized instruments and smaller incisions. During an endoscopic discectomy, your surgeon uses special instruments and a camera to remove the herniated disc through very small incisions.

    The endoscopic microdiscectomy is a procedure that accomplishes the same goal as traditional open discectomy, removing the herniated disc, but uses a smaller incision. Instead of actually looking at the herniated disc fragment and removing it, your surgeon uses a small camera to find the fragment and special instruments to remove it. The procedure may not require general anesthesia and is done through a smaller incision with less tissue dissection. Your surgeon uses X-ray and the camera to “see” where the disc herniation is, and special instruments to remove the fragment.

    Microdiscectomy and endoscopic microdiscectomy are appropriate in some specific situations, but not in all. Some patients are better served with a traditional open discectomy. While the idea of a faster recovery is nice, it is more important that the surgery is properly performed. Therefore, if open discectomy is more appropriate in your situation, then these minimally invasive procedures should not be done. Discuss with your healthcare provider if minimally invasive surgery may be appropriate for you.

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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.

    Who Is A Candidate

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

    You may be a candidate for discectomy if you have:

    • diagnostic tests that show a herniated disc
    • significant pain, weakness, or numbness in your leg or foot
    • leg pain worse than back pain
    • symptoms that have not improved with physical therapy or medication
    • leg weakness, loss of feeling in the genital area, and loss of bladder or bowel control

    Posterior lumbar discectomy may be helpful in treating leg pain caused by:

    • Bulging or herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall . Irritation and swelling occurs when this material squeezes out and painfully presses on a nerve .
    • Degenerative disc disease: As discs naturally wear out, bone spurs form and the facet joints inflame. The discs dry out and shrink, losing their flexibility and cushioning properties. The disc spaces get smaller. These changes lead to stenosis or disc herniation.

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    What Is A Successful Surgery For A Herniated Ruptured Or Bulging Disc

    For many patients who move onto surgery their definition of success may be based on the following questions and the answers they get from their surgeon:

    • What is the rate of success in herniated disc surgery?
    • How long will my recovery time be?
    • Will I be able to return to work quickly?

    Conflicting evidence suggests that these may be difficult questions to answer prior to surgery. Or that the patient and the doctor may have two different definitions of success and what should be the goals of treatment. This one concluding statement from a research study from the University of Leipzig in Germany spells out likely outcomes of herniated disc surgery.

    • In the majority of disc surgery patients, a long-term reduction in pain was observed. Cervical surgery patients seemed to profit less from surgery than the lumbar surgery patients. In the long term, a considerable number of patients still reported high levels of pain.

    In recap: The surgery was successful for some, did not work better for herniated discs in the neck than lumbar disc herniation, and for a considerable number of patients long-term high levels of pain remained after surgery.

    For working people, one study tried to give a better predictive value for returning to work. In this research in the medical journal Health Technology and Informatics, in 153 patients doctors found the most decisive risk factors in prolongation of work absence were:

    What Treatments Are Available

    Most patients with a new or recent acute disc herniation will improve without surgery. The doctor will usually try using nonsurgical treatments for the first few weeks. If the pain still keeps you from your normal lifestyle after completing treatment, your doctor might recommend surgery. Although surgery may not return leg strength to normal, it can stop your leg from getting weaker, and relieve leg pain. Surgery is usually recommended for relief of leg pain surgery is less effective in relieving back pain.

    Nonsurgical treatment: Your doctor may prescribe nonsurgical treatments including a very short period of rest, anti-inflammatory medications to reduce the swelling, analgesic drugs to control the pain, physical therapy, or epidural steroid injections. Some form of aerobic exercise is usually advised during the healing process, helping increase blood flow to the healing area. Most people can continue to work while they are being treated.

    Medication and pain management: Most pain can be treated with nonprescription medications such as aspirin, ibuprofen, naproxen or acetaminophen. If you have severe persistent pain, your doctor might prescribe narcotics or muscle relaxants for a short time. Taking these controlled substances do not actually help you recover faster, might cause unwanted side effects and can result in dependency. All medication should be taken only as directed.

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