Herniated discHerniated disc or disc hernia is a widespread disease, because about 5% of all people are affected at least once in their lives. The causes of this are aging and wear and tear of the spine, which can begin as early as age 20. Start at the age of. As the outer fibrous ring of the intervertebral disc wears down, pieces of tie can escape into the spinal canal and compress the nerves and spinal cord. One-sided physical strain and an unbalanced body posture when lifting promote such a herniated disc. Patients experience back pain and possibly numbness in the arms and legs.
Often a herniated disc recovers partially or completely on its own or with conservative therapy. Surgery is always indicated when either significant neurological deficits occur or severe pain persists for 6-12 weeks despite medication, physiotherapy and anti-inflammatory injections.
The therapy of choice is Microsurgical minimally invasive operation via a special tie-sparing approach and under the high-resolution surgical microscope or with an endoscope. The results of surgery are better with careful indication than with continued conservative therapy, as these two studies * , * show.
Typical herniated disc in the cervical spine. The escaping disc material compresses the spinal cord and nerves. Image: University Department of Neurosurgery, Inselspital Bern © CC BY-NC 4.0
Overview of different herniated discs
Neurosurgery Inselspital Bern
At the Inselspital all Spine surgery from a specialized team performed with experienced surgeons. Minimally invasive and microsurgical techniques, such as surgery under a high-resolution microscope, are part of the daily standard in neurosurgery. These techniques enable a Tie-sparing intervention and provide faster recovery of the patient.
Working at the Inselspital Specialists from all fields under one roof closely together and coordinate with each other. Through the cooperation of rheumatology, physiotherapy, neurology, neuroradiology, pain center and orthopedics, the optimal treatment strategy can be developed for the patient on an interdisciplinary basis. Complicated cases are discussed in an interdisciplinary board and often operated on jointly by neurosurgeons and orthopedists. This is how we create the conditions for the best possible treatment for each individual patient.
What is the function of the intervertebral disc??
The intervertebral disc is a cartilaginous disc between two adjacent vertebrae and serves as a shock absorber and motion hinge. Humans have 23 intervertebral discs, from the second cervical vertebra to the coccyx. Only because of the intervertebral discs can the spine move so flexibly.
An intervertebral disc consists of three parts: a gelatinous inner nucleus (nucleus pulposus), a strong outer fibrocartilage ring (annulus fibrosus) and the cartilaginous parts at the upper and lower ends, which merge into the vertebral bodies. The intervertebral disc distributes the weight that rests on the individual vertebrae evenly from the upper to the lower vertebrae.
Structure of the spine. The intervertebral disc is located between two vertebrae and serves as a shock absorber. Inside, it has a gelatinous core surrounded by a strong outer fibrous ring and cartilaginous portions at the upper and lower ends that merge into the vertebral bodies. Image: Department of Neurosurgery, Inselspital Bern © CC BY-NC 4.0
Herniated intervertebral disc – a widespread disease?
The price paid for the mobility and shock-absorbing function of the spine is its wear and tear with age. Over the years, bone thickening, ligament loosening and wear of the intervertebral disc occur. These signs of wear and tear can already occur from the age of 20. The development of bananas can begin at the age of six and is accelerated by one-sided strain, incorrect posture when lifting and other factors. Thus, several studies have also shown a genetic predisposition for more rapid degeneration of the intervertebral disc. Wear is practically unavoidable.
Changes in the spine and protrusions of the intervertebral disc can be detected in the majority of people by magnetic resonance imaging (MRI or. MRI from. Magnetic Resonance Imaging), usually do not cause any symptoms and therefore have no clinical value. However, a herniated disc affects about 5% of all people at least once in their lives. This is why it is a real widespread disease.
What happens in a herniated disc?
The most common synonyms for a herniated disc are Disc hernia, Disc herniation or Nucleus pulposus prolapse. They all describe the pathological process: due to Cracks in the outer ring of connective tie, the Anulus fibrosus, tie emerges from the inner nucleus of the disc, the nucleus pulposus, in the direction of the spinal canal or the nerve roots. If the tie is still in contact with the interior of the intervertebral disc and the annulus fibrosus only bulges forward, it is referred to as a Disc protrusion. A sequestered disc herniation is when the piece of tie is completely detached from the interior of the disc. This broken out piece of disc can have a size of a few millimeters up to 2 cm. It becomes problematic when the disc exits into the spinal canal and compresses nerve roots or the spinal cord. Depending on the size and location of the herniation, different symptoms can then occur for lumbar, thoracic or cervical disc herniations.
Lumbar disc herniation. The herniation at the level of the lumbar spine presses on the nerves of the spinal canal. Image: Department of Neurosurgery, Inselspital Bern © CC BY-NC 4.0
When should a herniated disc be operated on?
In cases where surgery is not (yet) required, we work in the conservative therapy works closely with the other disciplines of the Spine Center at the Inselspital. These are, for example, the rheumatology or the pain center. Most disc complaints disappear after a few days to weeks with rest during the acute phase, medication and physiotherapy. However, if pain does not improve significantly within 6 weeks or if severe pain or even loss of strength is present, surgical relief should be considered. An absolute Urgent emergency for immediate referral to neurosurgery is present when a complete loss of strength of a muscle or a Bladder emptying disorder occur.
Why you should be treated at the Inselspital
Neurosurgical intervention for a herniated intervertebral disc will always minimally invasive under the surgical microscope performed. There are also more invasive procedures such as the Implantation of a prosthesis or a Fusion surgery, but one should always start with the simplest and gentlest procedure first.
In the Department of Neurosurgery at the Inselspital, intervertebral disc surgery is one of the most common procedures. For more information on the exact treatment plans for the different herniated discs, see the individual subchapters.
Further reading
– Adams M, Roughley P. What is Intervertebral Disc Degeneration, and What Causes It??. Spine. 2006;31(18):2151-2161. – Dowdell J, Erwin M, Choma T, Vaccaro A, Iatridis J, Cho S. Intervertebral Disk Degeneration and Repair. Neurosurgery. 2017;80(3S):S46-S54. – Miller JAA, Schmatz C, Schultz AB. Lumbar Disc Degeneration. Spine. 1988;13(2):173-178. – Videman T, Sarna S, Battie M, Koskinen S, Gill K, Paananen H et al. The Long-Term Effects of Physical Loading and Exercise Lifestyles on Back-Related Symptoms, Disability, and Spinal Pathology Among Men. Spine. 1995;20(6):699-709.
References
Lurie J, Tosteson T, Tosteson A, Zhao W, Morgan T, Abdu W et al. Surgical Versus Nonoperative Treatment for Lumbar Disc Herniation. Spine. 2014;39(1):3-16.
Bailey C, Rasoulinejad P, Taylor D, Sequeira K, Miller T, Watson J et al. Surgery versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months. New England Journal of Medicine. 2020;382(12):1093-1102.