Why does hernia occur?
In reality, it is the price of human survival. The basic structure that ensures the integrity of the body and its movement in a certain configuration is the vertebrae, among which there are discs in the cartilage structure that act as shock absorbers in automobiles, that is, they meet the incoming loads. While discs are present between the spine and vertebrae in all living things, herniated discs are only seen in humans. Because the biggest load on the body is gravity. In humans, these disks are loaded on average five million times a year. As a result of the body structure of fish and awns taking the loads on the vertebrae, disc structures do not deteriorate at all. When we look at other land-dwelling creatures, we see that there is always horizontal movement and their bodies develop accordingly. Thus, there is no load on the spine and lumbar hernia is not seen in animals.
Why does man have to pay such a price?
Standing and seeing the face directly, the dominance of the environment brought the dominance of nature over time. At this point, although the main factor is thought to be the mind, the importance of physical characteristics in dominance is easier to understand when considering the early periods when the mind was not used in a very developed way.
Why does lumbar hernia occur?
There are five vertebrae in the lumbar region and the coccyx that connects them with the hip. The cartilage structure, which is located between the vertebrae and called the disc due to its shape, consists of two different parts. On the outside, there is a hard and solid layer called the “annulus fibrosus”, which is intertwined with the surface of the spines. On the inside, there is the “nucleus pulposus”, which is soft with more water content and allows movements. The deterioration of this elastic structure, that is, the “explosion of shock absorbers”, removes the resistance against the incoming loads. First of all, the disc is easily crushed and protrudes to the sides, pressing on the nerves just behind it. This condition, which is often called “the onset of herniated disc”, benefits from medication and rest therapy. However, if there is a sudden overload or excessive loads are continuous, the outer hard part, namely the annulus, will rupture and cause the soft part to fall into the channel where the nerves are located. Surgical treatment comes to the fore in this case, which has various names such as rupture, rupture, sequestration, fragment, extruded disc.
In whom is lumbar hernia more common?
Intervertebral discs, whose nutrition is impaired from the age of 18 due to the absence of vessels, begin to degenerate, that is, to deteriorate, from the age of 30 as a result of the loads. After the age of 50, 80% of them lose their normal consistency. Because of these anatomical and physiological features, lumbar hernias are very rare under the age of 18, and they occur more frequently after the age of 50.
How does a hernia appear?
Low back and especially leg pain are the most common findings of lumbar hernia. Again, approximately 5% loss of strength, 1% urinary and stool incontinence occurs. However, all these may occur due to non-spineal causes such as kidney stones, fibroids in women, hip and knee problems. More importantly; It is a simple lumbar hernia, it is said that it is the beginning of lumbar hernia, and infections such as spinal tumor and spinal tuberculosis, which are given painkillers and/or physical therapy, are encountered at no less than rates. Again, congenital or advanced narrowing of the spinal canal containing nerve structures, shifts between the vertebrae, spinal fractures, especially due to osteoporosis, cause similar complaints and most of them require surgical treatment.
So what do we do in this situation?
Considering that 80% of people have had low back pain at least once in their life and that about 90% of them do not require any special treatment, it is correct to consult a specialist for pain that does not improve with a few days of rest. At this point, it is wrong to lie on the floor on the board, as the human spine contains various curves. Orthopedic mattresses that are not too soft and do not collapse are ideal. Again, it is wrong to lie down for 20 days, 1 month, and a maximum of 5 days of rest is sufficient. If the pain still persists at the end of this period or if the pain starts again with the transition to a normal life despite the relief of the pain, it is absolutely necessary to consult a specialist.
What is the place of treatments such as waist pulling, various natural remedies, electromagnetic power?
These methods have no effect, and manipulations, especially by applying force, may harm the patient. If there is a piece of cartilage that has fallen into the nerve canal, it will cause permanent damage to the patient with external procedures. In patients with disc overflow pressing on the nerve, pulling the waist relieves the patient. In fact, there are people who enter a dislocation bent double in pain and come out upright without pain. It is these patients who enable people who lack so much knowledge and education in our country to find customers (!) for very high money. However, in order to open the gap between the vertebrae and replace the overflowing disc and relieve the pain, many small bonds connecting the vertebrae need to be broken. As a result of this, these unfortunate patients, whose complaints decrease or go away, come to us in much worse conditions within days-months, their surgeries are even more difficult, and additional procedures are required.
How is the definitive diagnosis of lumbar hernia made?
Magnetic Resonance Imaging (MRI) gives us detailed and sufficient information about the condition of the vertebrae, disc and nerve roots and spinal cord. However, since this is done lying in a fixed position, it does not give sufficient information about the alignment of the vertebrae. For this reason, moving waist films should be taken before the surgery, tomography should be added if there is accompanying calcification in advanced ages, but most importantly, all these examinations should be new. Examinations exceeding 3 months must be repeated, if there is an added complaint or change in pain, we renew even a 1-day examination. [new page]
What is the risk of recurrence and paralysis after surgery?
First of all, herniated disc occurs most frequently between the 4th and 5th lumbar vertebrae, and between the 5th lumbar vertebra and the sacrum bone. The spinal cord terminates at the level of the 1st lumbar vertebra. The nerves that leave the spinal cord and go to the legs run along the canal, and a pair of nerve roots emerge from each gap, providing the thigh, knee and foot movements from top to bottom. For this reason, the risk of being completely paralyzed as a result of herniated disc surgery is “0”. However, there may be unilateral damage to the nerve root that fits into the disc space and weakness in knee movements, pulling the foot or pressing the ground in the server. This risk is around 1%, and it will reach 100% if the hernia pressing on the same nerve is not cleaned, that is, if the operation is avoided due to fear. The risk of recurrence is seen at a rate of 2-3%, regardless of the surgery performed. The most important reason here is that some bodies create too much healing tissue. In people where a simple skin incision leaves rough scars, the same rough healing occurs in the cleaned disc area. This healing tissue called “fibrosis” compresses the nerve and sometimes requires reoperation. Apart from this, the most important reason for reoperation is inadequate preoperative examinations. Failure to undergo surgery with old and/or inadequate examinations, the presence of a second hernia, and the initial stenosis or slippage lead to the continuation of the patient’s complaints and eventually to new surgeries.
What kind of surgery? Open, closed, microsurgery, laser, endoscopic ???
The main purpose of herniated disc surgery is to clean the cartilage tissue pressing on the nerve and to relieve the nerve. This surgery has been performed since 1934 and is commonly performed under the microscope after the introduction of the microscope into surgery. Disc surgery with “microsurgery”, which has recently been described as a different method in newspaper advertisements, is actually a method that has been used by many neurosurgeons for many years. Laser surgeries are currently applied with a different technique under the name of “nucleoplasty” and are generally applied to discs that are considered to be the beginning of hernia and can actually heal with a good medication and rest treatment. However, we prefer it especially in young patients, those with persistent pain, and those who cannot rest enough due to an active life. Endoscopy (closed) surgeries may shorten the incision to be made by 1 cm. However, in rare cases where the fragments that break off from the side walls press on the nerve, this method should be used to directly remove the cartilage piece without any bone removal procedure.
What should we do after the operation?
We wake the patient up 4-6 hours after the open surgery. We want the patient, whom we sent home the day after the surgery, to spend 3 weeks at home resting. The most important reason why he spends this time at home is to protect the patient from invisible accidents, which we see more often in our country. From the first day, we want a rest in the house so that he can do his own work easily. At the first month control, activities such as going to work, driving and having sexual intercourse are allowed, provided that they are not heavy, take a short rest during the day and gradually increase the dose. We recommend starting active sports after the 6th month.
As a result, the main philosophy should be “performing the right surgery on the right patient, at the right distance”.
