What Should Be Known About Herniated Disc Surgery?
There are 5 vertebrae in the lumbar region. Between these vertebrae are structures called discs. The structure of a healthy lower back consists of the vertebrae, the joints connecting the vertebrae, ligament structures, discs, the spinal sac, and the anatomical unity of the muscles. Any wear or deterioration occurring in these structures causes lower back pain in the person. The source of this severe pain radiating from the lower back to the legs is generally a herniated disc. A herniated disc occurs when the gel-like fluid of the discs is lost over time and, as a result, the disc protruding through the torn outer layer puts pressure on the nerves.
Lower back pain is a common problem in our country as it is in the world. Generally, the problem of a herniated disc can be resolved by resting in bed and / or with medication. Depending on the condition of the pain, physical therapy may also be applied. The course of the treatment to be applied is determined according to the patient's history, examination, and the data obtained from imaging tests.
The most common symptom of a herniated disc is severe and long-lasting pain. These pains also bring limitation of movement. If the patient's pain does not go away with rest, medication, or physical therapy; in this case, herniated disc surgery is required. In such a case, the pain reaches a level that prevents the person from sitting down, standing up, sleeping, and performing daily tasks, and herniated disc surgery becomes a necessity. In such patients, the final stage is the patient's inability to control bowel and bladder function. The condition is too serious to be postponed and the patient must be taken into surgery urgently. In summary; surgery is an extremely correct and effective solution for patients whose quality of life has decreased due to a herniated disc.
Some patients consult a doctor because of loss of strength in their legs and feet. The earlier a patient in such a condition undergoes surgery, the higher the chance that their feet and legs will regain strength. Herniated disc surgery is performed in order to remove the herniated disc fragment that puts pressure on the root of the sciatic nerve extending to the leg along a line and therefore causes pain.
In this way, the pressure on the compressed nerve root is relieved and the pain also disappears. When applied to the right patients, it is an operation with a success rate higher than 90%.
Herniated disc surgery is performed under general anesthesia, but in some patients spinal or epidural anesthesia, in which only the lumbar region and the lower parts are numbed, may also be performed.
Postponing herniated disc surgery may lead to permanent nerve damage. For this reason, whether such a condition exists, that is, the condition of the nerves, should be examined with imaging tests before surgery.
The examinations provide the surgeon with very serious information about the patient’s current condition. Thus, both the surgeon and the patient can foresee what they will encounter during and after the surgery and to what extent improvement can be achieved with the surgery. The risk of nerve damage occurring during the surgery is low.
Herniated disc surgery can be performed in three types: open discectomy, microdiscectomy, or full closed (endoscopic) discectomy.
Open discectomy is performed under general anesthesia while the patient lies in the prone position. The procedure is performed through a 2 - 4 cm incision made in the skin. A small window is opened in the bone tissue at the back of the spine and the ligament tissue underneath is reached. This ligament tissue is either removed or entered through it, and the herniated fragment putting pressure on the nerve is seen and removed.
Microdiscectomy is performed with microsurgery, and the surgical field is magnified 30 - 40 times. Thus, the surgeon can work on fine details and, since a detailed image can be obtained; the surgery can be completed without damaging the adjacent tissues and nerves. With the application of experienced surgeons, the risks of herniated disc surgery, which are already low, have decreased even further with this method. Moreover, since there is less tissue damage, the recovery process after surgery is faster and less painful.
In full closed (endoscopic) discectomy, the lumbar region is entered from the back or the posterolateral side. In endoscopic procedures, a much smaller skin incision (about 0.6 cm) is made than in other types of surgery. Significant advances have been made especially in recent years in endoscopic surgeries.
Depending on the type of surgery, patients are either discharged the same day or stay in the hospital for one night.
The points to be considered after herniated disc surgery are as follows;
- It is not recommended for the patient to go up and down stairs during the first three days after returning home after herniated disc surgery. Patients who must do so should go up by bringing one foot next to the other.
- There is no harm in patients sitting during the initial period of recovery; however, lumbar support is absolutely necessary.
- Patients should lie on a bed suitable for lower back health immediately after surgery and even throughout the rest of their lives. Sleeping on an armchair or sofa is absolutely not recommended for such patients.
- Walking outdoors can be started within one week.
- Patients working at desk jobs can return to work after 15 days, while patients working in heavier jobs can return after 1 or 2 months.
- Some sports should be avoided after surgery. The recommended sports are walking and swimming.
- Because of the weight and pressure it causes, excess weight increases the risk of a herniated disc. Patients who have undergone this surgery are not advised to gain weight. For overweight patients, reaching their ideal weight is preferred if possible.
- Exercises recommended by the doctor should be started 2 months after surgery. During these exercises, slight pain may be felt at first; however, over time it will be possible to perform the movements without pain.
