There are 5 vertebrae in the lumbar region and structures called discs between them. A healthy waist; The spine is possible with the normal anatomical union of the joints, ligaments, discs, spinal cord and muscles connecting the spine. The entire weight of the body is transferred to the legs through these structures located in the lumbar region. Problems that may occur in one or more of these structures cause low back pain. The disease, which is called lumbar disc herniation in medicine, but which patients call herniated disc in daily use, develops from structures called discs between the vertebrae. 80% of adults experience a severe episode of low back pain at least once in their lifetime. This problem is also mostly resolved with bed rest and/or medication. One of the most important causes of pain in the waist and legs; is a hernia. Most lumbar hernias are caused by the last 2 disc structures. A herniated disc can cause low back pain or press on the nerve roots coming out of the spinal cord and cause leg pain.
After listening to your complaints and disease history, performing your examination, performing the necessary laboratory and radiological examinations, and determining your diagnosis, there will basically be 2 options in front of us in the treatment plan. One of these treatments is rest, medication, physical therapy, and interventional treatments for pain relief. Another treatment method is surgery. As a neurosurgeon, I will decide which of these is appropriate after the process I have mentioned above and make a recommendation to you. The main factors in my decision for surgical treatment: Pain, urinary and stool problems, loss of strength in the legs and/or feet, which severely affect the patient’s social and work life and do not respond to rest-drug therapy.
Especially in recent years, there has been a confusion in the minds of our patients regarding surgical treatment. The purpose of writing this article is to explain the surgical treatment options in a more understandable language. The aim of surgical treatment is to remove the pressure of the herniated disc on the nerve, which causes pain and weakness in the leg. Open discectomy, microdiscectomy, or fully closed (endoscopic) discectomy may be recommended for the patient with lumbar disc herniation.
Open discectomy is performed under general anesthesia, with the patient in the prone or knee-elbow position. It is made through an incision of 2-4 cm in the skin. Then the muscle tissue is stripped and the retractor is placed. By opening a small window through the bone tissue behind the spine, the connective tissue just below is reached, and sometimes this tissue is removed and sometimes a small entrance is opened in the connective tissue, followed by the spinal cord sac and the nerve root coming out of it. Afterwards, the hernia part pressing on the nerve root, which increases the complaint, is seen and removed. Then, the discectomy is performed by entering the disc distance where the hernia occurred, and the surgery is terminated after the bleeding is controlled.
In microdiscectomy (lumbar hernia surgery using a microscope), a smaller skin incision is used and less muscle tissue is excluded. This causes the post-operative period of the patient to be more comfortable and painless. Performing surgery by excluding less muscle tissue means LESS MUSCLE SPASMI, ie LESS PAIN after surgery. The microscope used in surgery, on the other hand, reduces the possibility of complications by providing larger, 3D and very detailed recognition of the tissues.
I get my patients up 6 hours after microdiscectomy. This early mobilization allows the patient to spend the night more comfortably and to fulfill the need for the toilet himself without help. I use a digital patient-controlled pain prevention device called PCA, prepared by my anesthesiologist friends, to ensure that patients spend the night pain-free. This device regularly gives drugs with very high pain relief properties to the patient, and when the patient feels pain, they can take an ADDITIONAL dose of medication by pressing the button of the device. However, due to its digital feature, the device adjusts the dose that can be given to the patient and does not give the drug after a certain dose. Thus, it is ensured that patients spend the night in maximum comfort. Patients are usually discharged after 1-2 days of hospitalization. For the post-operative period, you can refer to the heading ‘What You Concern After Hernia Surgery’.
Fully closed lumbar hernia surgery (full endoscopic) is performed by entering from the back or side in the lumbar region. In lateral endoscopic intervention, a smaller skin incision is used than all other methods. In the last 10 years, endoscopic methods have become very up-to-date in medicine and have gained an important place in neurosurgery. Completely closed herniated disc surgery, which is performed by entering the lumbar region from the side, is performed by viewing the surgical area on the screen with the help of a 4 mm endoscope inserted into the herniated disc area through a 1 cm incision. The operations are performed under local and epidural anesthesia. For this reason, a daily hospitalization is made in the hospital, and the patients can be discharged 6 hours after the operation.
I get my patients up after 4 hours after fully closed herniated disc surgery. This early mobilization allows the patient to spend the day more comfortably and to fulfill the need for the toilet himself without help. Patients are usually discharged on the same day.
Fully closed herniated disc surgery is an operation with EXTREMELY LOW COMPLICATION RATE AND EXTREMELY HIGH PATIENT COMFORT. The patients are discharged from the hospital on the same day after the operation and can return to work after resting at home for 3 days. The decision of the patient’s suitability for fully closed lumbar hernia surgery is up to the neurosurgeon. Certain criteria must be met for fully closed herniated disc surgery.
The decision of which of all these types of surgery is suitable for the patient is up to the neurosurgeon. Certain criteria must be met for fully closed herniated disc surgery. When we look at the recurrence rates after these operations; It is usually between 5-12%.
I wish you a healthy day.
