Surgical Treatment of Lumbar Hernia Who Is More Common in Lumbar Hernia?
The incidence of lumbar hernia, which is called disc herniation in the medical language, is as high as one in ten in the community. Lumbar hernia is most common between the ages of 35-50 and is seen equally in both sexes. Due to the structure of the spine, taller people have a higher risk of catching a herniated disc. Those who work in heavy jobs, housewives, desk workers who have to sit for a long time, drivers, professionals such as teachers, pharmacists, waiters who are constantly standing, those who work outdoors, managers under intense stress are the most likely to get herniated disc.
How Does Herniated Back Occur?
Lumbar hernia occurs when the elastic cartilage tissue called disc, located between the vertebrae, slides forward due to the pressure of the vertebrae and compresses the nerves coming out of the spinal cord sheath and going to various parts of the leg. Sometimes a sudden force, lifting something heavy, a reverse movement or even a cold back can cause a herniated disc. But the most important cause of herniated disc is excessive tension in the muscles after long-term stress and tension.
Pain in one or both legs, numbness in the feet, limitation of movement, difficulty in walking and sitting are the symptoms of lumbar hernia. If the hernia progresses, symptoms such as impotence, fatigue, urinary incontinence, imbalance and inability to walk may be added.
How is the Diagnosis of Lumbar Hernia?
With today’s modern diagnostic methods, computed tomography and magnetic resonance imaging, the diagnosis of herniated disc can be made easily and its degree can be determined.
How is the Treatment of Lumbar Hernia Made?
a) Initial Phase
The treatment of lumbar hernia depends on the degree of herniation, that is, the pressure exerted by the elastic material, which we call the disc, on the nerves going to the leg. If there is only low back and leg pain, if there is no numbness, loss of strength or limitation of movement, it means that herniated disc is in the initial stage. In this case, it is recommended to give the patient muscle relaxants, to rest in bed and to avoid movements that will force the back.
Recommendations to be made to the patient are as follows:
1) The patient should never lift weights exceeding one or two kilograms.
2) Leaning forward and to the sides, bending of the waist is prohibited. If something is to be taken from the ground, the patient is told to take it by crouching.
3 ) It is recommended that patients put a pillow behind their waist to eliminate the lumbar cavity while sitting and not sit for more than twenty minutes. If the patient has to sit for a long time due to his profession, it is recommended to walk every twenty minutes. Long-term drivers are advised to park their car and turn around their car several times every twenty minutes.
4) The patient is prohibited from reaching upwards. If he is going to take something from above, he is told to go to the top of a chair or ladder and get it.
5) The patient is reminded to always keep his back warm and not to stand in front of an open window or ventilation.
6) Patients with low back and leg pain should definitely avoid stress. In addition to increasing the pain, stress can also lead to the progression of herniated disc. It is recommended that the patient rest during the stay at home. Contrary to popular belief, very hard floors are more harmful. It is more suitable for the patient to lie in a quality spring mattress and in the position that is most comfortable for the patient.
b) If Hernia Progresses
If the patient’s complaints persist despite the above recommendations, rest and muscle relaxants, physical therapy should be applied. Physical therapy must be under the supervision of a specialist. There may be an increase in pain in the first few days during physical therapy, but the patient should continue fifteen to twenty sessions of physical therapy. Methods such as waist pulling, acupuncture, tying fish to the waist, hand massage, pitch burning can only benefit the herniated disc, which can be good even with rest. The aims of this type of alternative treatment methods are based on muscle relaxation, as in physical therapy. But if applied out of purpose, these methods bring more harm than good. If the patient’s pain does not go away despite all the treatments, the nucleoplasty method can be applied. Nucleoplasty is based on the principle of entering the herniated disc with a needle under computed tomography, heating the disc with radiofrequency waves, destroying the nerves in the disc, and the collapse of the hernia by opening spaces in the disc. Nucleoplasty is a method applied as a single session and without the need for hospitalization. There is no risk, but there is no guarantee that it will completely eliminate the hernia.
c) Conditions Requiring Surgery
If the patient’s pain persists despite physical therapy, or if there is a loss of strength that cannot be regressed, thinning of the leg, unbearable pain, or if a piece of the disc is found to be ruptured in tomography or MR films, the solution is surgery. is an intervention. mechanical pressure on the nerves coming from the spinal cord must be removed surgically. If surgical intervention is not performed and pressure on the nerve continues, the patient may develop problems such as urinary incontinence, loss of sexual power, and paralysis of the feet. Unfortunately, there are beliefs among the public that if I have an operation, I will be disabled, I will not be able to get out of bed for a long time, I will have to wear a corset, or my hernia will recur, I will have surgery again. But thanks to microsurgery, such fears are no longer necessary.
