The herniated disc is a condition where the disc material located between the bones of the spine is damaged, ruptured, fragmented and displaced into the canal and causes compression to the spinal cord and nerve roots. As a result of this compression, pain, numbness or weakness may be encountered. The findings can be seen on the waist or leg, on the right or left or on both sides.
The disease can usually start with low back pain, but it can start with leg-foot pain without any low back pain. Leg pain is usually a finding that brings the patient to the doctor, and numbness and weakness (paralysis) in the leg may be added. Occasionally, urinary incontinence or impaired defecation control may occur in advanced herniated discs. Low back, leg pain is usually increased after activity or prolonged sitting and standing and coughing.
The patient’s complaints, history of the disease and examination are very important in terms of diagnosis.
Narrowed disc spaces can be seen in x-ray films.
Computed tomography (CT) is important for detecting the degree of herniated disc and imaging of the spine bones. In addition, the calcification rate of hernia can be viewed on tomography.
Magnetic resonance imaging (MRI) will provide detailed information about the soft tissues of the spine such as disc, facet and nerve structures.
Sometimes electromyography (EMG: a test that measures nerve impulses coming to muscles) may be necessary.
Possible treatment options
In the selection of treatment, the degree of the disease, the location, and size of the hernia, the type of neurological damage and how it affects the daily life of the patient and their needs, the physician’s approach and experience are important.
Short-term bed rest, anti-inflammatory drugs to reduce edema and swelling at the hernia site, painkillers and muscle relaxants for pain relief can be tried as medical treatment. A large proportion of patients with herniated disc findings benefit from medical treatment. However, surgical treatment should be considered if pain interferes with daily activities or if there is a loss of strength after the treatment is completed.
Surgical treatment methods
The aim of surgical treatment is to remove the mechanical pressure on the nerve. As a result, relaxation of the nerve, improving pain, numbness, and weakness by the body by healing the nerve and recovery are expected. Improvement in herniated disc operations is the amount of damage done to the nerve by cartilage and other tissues that crush the nerve and the success of the body in the effort to heal the injured nerve after crushing and after cleaning of the tissues. Therefore, if the nerve is under severe pressure when making a surgical decision, it may be necessary to rush to prevent it from being damaged which stay under pressure for a long time. The most common practice among surgical techniques is “discectomy”. Here, it is the object to remove the herniated cartilage portion. Surgical options include microdiscectomy, endoscopic discectomy, laminectomy, and open classical surgical procedures depending on the size and location of the hernia. The degree of the disease, how it affects the patient’s daily life and needs, the physician’s approach and experience are important in the choice of treatment.
In case the hernia is large and/or ruptured, and in case of abnormalities in the peripheral bones, it is necessary to perform open surgical treatment. Open surgery offers the surgeon the opportunity to see and understand the surgery region much better. Since it will be easy to control the surrounding tissues and facet joints in open surgery, the procedures related to these regions can also be performed.
It is similar to open surgery, but it is all done under a microscope and through a small skin incision. It is usually performed under general anesthesia. Mobilization and discharge of the patient are faster due to the small incision and cutting the small number of muscles.
Transforaminal endoscopic discectomy is a different procedure than open surgery or microsurgery. It is performed by entering the 2-3 mm skin incision through the exit holes of the nerves. It is usually performed under local anesthesia.
When is urgent surgery needed?
In cases of a sudden loss of strength in the legs and urinary-fecal incontinence, urgent surgery may be necessary if the hernia compresses all of the nerve roots (cauda syndrome).
Expectations after surgery
Most patients benefit quickly from herniated disc surgery. Leg pain is expected to stop after surgery. There may be pain in the surgery region. If your leg has a weakness, it may not improve immediately and completely with surgical treatment. However, surgical treatment will prevent your leg from becoming weaker and will eliminate pain. It is possible that the pain does not go away completely or that the weakness does not improve immediately because the hernia may have crushed the nerve tissue and caused damage to it before the operation. Numbness in the leg skin usually recovers late after surgical treatment.