AND TREATMENT OF lumbar hernia
Herniated disc disease occurs as a result of tearing the sheath of the structure called the disc, which is located between the spinal bones and which acts as a shock absorber, and the rubbery cartilage structure inside it overflows through this tear and compresses the nerves going to the legs.
WHAT ARE THE SYMPTOMS?
Lumbar hernia patients are mainly; They apply with complaints of low back and/or leg pain, numbness in the feet, felting, difficulty in walking, loss of strength in the legs or feet.
Often, the connective tissue of the sheath surrounding the disc is torn as a result of a forceful movement at the waist. In the first stage, the patient only feels low back pain. After a while, the rubbery tissue inside the disc from the ruptured area overflows into the canal where the nerves are located, and the pain spreads to the legs as a result of compression of the nerves. This is the answer to the question, “If I have a herniated disc, why don’t I have any pain in my back, why only my leg hurts?” The pinched nerve feels pain along the line it extends. Likewise, leg and foot numbness causes complaints of felting, burning and tingling. In advanced stages, weakness may occur in the feet. In more advanced cases, cauda equina syndrome may be encountered, which is a very serious picture and is very rare. All of these may occur gradually, or they may reach the final stage within hours.
HOW IS THE DISEASE DIAGNOSED?
In the diagnosis of the disease; The most important criteria are the patient’s statements and neurological examination. In addition to the examination findings, direct x-ray, MRI (Magnetic Resonance Imaging), CT (Computed Tomography) are often used. Electrophysiological examination of the nerves, which we call EMG, may be required. The picture that emerges as a result of all examinations and findings helps to reveal whether the person has a herniated disc.
WHAT ARE THE RISK FACTORS FOR THE FORMATION OF HERNIA?
Among the diseases that cause loss of workforce in working life, herniated disc is seen at a rate of 25%. The loss of work force of these patients sometimes extends up to 6 months. In some occupational groups, the rate of disease is higher: Occupations that carry heavy loads and put a load on the body, those who drive for a long time, occupations that require constant sitting or standing at a desk, being overweight. At some point in their life, 85% of the population has low back pain. Whether these people are treated or not, 85-90% of them get over this pain spontaneously with rest. For this reason, it is useful to know that 85% of those who go to non-medical places and have their waist manipulated by uneducated people will go away on their own with rest! Do not forget that there is a medical solution to your back and leg pain. Therefore, when you have these complaints, consult your doctor first. There is no difference in the incidence of the disease between men and women. However, during pregnancy, especially as a result of excessive weight gain, the pressure on the lumbar spine increases and the risk increases. The disease is seen at a higher rate in obese people and it is more difficult to treat. Smoking has a negative effect on back health. Herniated disc disease is less common in people who exercise regularly, especially in people with developed waist and abdominal muscles.
Removing these risks should be with education from childhood and should start in the family. How to lift a load, how to pick something up from the ground, how to get out of bed, habit of doing regular waist exercise program, not gaining weight, the importance of walking… It is possible to significantly reduce today’s surgery and treatment costs by giving this education starting from kindergarten. It should not be forgotten that these trainings and gaining these habits are completely free, but the treatment of diseases is very costly.
TREATMENT
Treatment is conservative, except for primarily emergency surgical indications. Patients who do not respond to conservative treatment (ie, medication, rest, physical therapy, etc.) for three weeks should be re-evaluated.
The most important criterion in surgical practice is progressive loss of strength.
Surgery is also applied for severe pain that does not even respond to narcotic drugs.
Conditions requiring emergency surgery are rapid progressive loss of strength and cauda syndrome.
Radiological examinations are methods that support the diagnosis. It is a completely wrong practice to operate on a patient just because there is a hernia in MRI. For example, if we randomly select 100 people over the age of 40 passing by on the street and have lumbar MRI performed, at least 40% of them report hernia or wear (blackening) in the disc. Are we going to operate on these people now? Of course no! Do not forget that there are many people in the society who have a significant hernia or black disc in MRI and live without any high-level problems.
The goal is to treat the patient, never the MRI.
It is very, very wrong to say to a patient with a herniated disc that you will lose your sexual power, you will become paralyzed, you cannot hold your urine and your large toilet, and to operate for this!!!
ARE HERNIA OPERATIONS RISKY?
Today, thanks to the developing microsurgery techniques, herniated disc surgeries can be easily performed by neurosurgeons. Herniated disc surgeries do not carry any more risk than other surgeries. Moreover, the fact that the surgical field can be seen down to the smallest detail with the help of a microscope provides great comfort in herniated disc surgeries. The best known surgical technique today is microsurgery.
The number of patients who can be treated with laser, nucleotomy, and various treatments applied inside the disc is very small (like 1 in a thousand). It may be beneficial in patients who have not responded to highly selected medications, rest, and physical therapy methods.
Herniated disc surgery with endoscope has not been proven to be superior to microsurgery!
WILL A FOREIGN OBJECT BE INSTALLED IN MY WAIST IN THE SURGERY OF WAIST hernia?
There is no need to insert screws, prostheses, wedges, cages, separators, platinum … etc. in the waist in almost any of the normal herniated disc diseases. “Let’s empty the hernia in your waist and put things like wedges, cages, prostheses, etc., so that it doesn’t collapse and recur.” Statements in the form of are absolutely false and do not have any evidence-based scientific support. If you are going to have a simple lumbar hernia surgery, talk to your doctor in detail and get information on how to do it!!
These instruments are mostly used in advanced waist slips, fractures, tumors and scoliosis and they are not used alone!!
Statements such as “You have lumbar hernia, you do not lose strength, but it may be in the future, so let’s do a protective lumbar hernia surgery” are definitely not true. There is no such thing as conservative surgery in herniated disc!
Does hernia recur?
It is one of the most frequently asked questions by our patients. The recurrence rate of lumbar hernia is not at the rate that our patients generally fear. The recurrence rate of lumbar hernia from the same place after surgery is around 3-10% in 10 years. These rates are higher in those who work hard, those who are obese, those who work hard while sitting or standing for a long time, those who do not do sports and do not use their waist correctly. But that doesn’t necessarily mean it will recur. This rate will be even lower if postoperative recommendations are taken into account.
LAST WORD
Let’s teach our children the importance of using the waist and neck correctly, not gaining weight, and the importance of walking, let’s include it in education programs in schools, let’s make this a country policy so that future generations will be healthier.
Let’s not forget that preventive measures are free, but treatments are very expensive and troublesome for both the patient and the government.
Stay healthy,
