Herniated disc / lumbar disc herniaA herniated disc (lumbar disc hernia) is often accompanied by the acute onset of back pain, leg pain and numbness. Under certain circumstances it can even lead to paralysis. Timely diagnosis and treatment adapted to the extent of the symptoms are important prerequisites for preventing permanent nerve damage.
Between the vertebral bodies lie intervertebral discs – the intervertebral discs. These consist of cartilage tie. Acting as a kind of shock absorber. Since the spine is very mobile, the intervertebral discs must be able to withstand the tensile, compressive and shear forces that occur in the process. This is the task of a unique fibrous ring that surrounds the disc nucleus.
Thus the intervertebral discs function like a water cushion. As a buffer between the bony vertebrae, they reliably cushion all conceivable loads and distribute them evenly. The intervertebral discs of the lumbar spine bear the highest load in this case.
What is the cause of a herniated disc?
The trigger for a disc hernia is often heavy lifting or a jerky movement. The lowest two motion segments of the spine are most commonly affected. Lumbar disc hernia is a typical disease of middle age. Over a long period of time, heavy physical work, sports and poor posture put additional strain on the intervertebral discs.
In the outer fibrous ring of the intervertebral disc, this can cause small tears to form. Through these cracks, part of the gelatinous core is forced into the spinal canal. Adolescents seldom have disc hernias, since they have no or only few changes in the fibrous ring. In older patients, on the other hand, the gelatinous core usually no longer emerges through the small fibrous tears. This is because the disc loses fluid and elasticity with age and thus exerts less prere on the fibrous ring.
How does a herniated disc become noticeable??
The complaints caused by a herniated disc are often very different. The localization of the herniated disc in the spinal canal determines the extent of the discomfort. Often shows localized back pain that usually increases with certain movements. When disc tie presses on the root of an outgoing nerve, pain, numbness and/or even paralysis may occur in the leg, foot or toes. However, the symptoms are mild in most cases.
Paralysis is uncommon and is an indication that the disc hernia is either very inconveniently located or very large. In a so-called mass herniation, the spinal canal is almost completely filled in. A mixture of paralysis, numbness and pain then occurs as a symptom. Sometimes loss of control of bladder and rectal function also occurs. Mass incidents with these severe dysfunctions represent an acute neurosurgical emergency.
Herniated disc in lateral view
How is a lumbar disc hernia diagnosed??
The localization of a disc hernia can be estimated very precisely by means of an exact neurological examination. However, if a disc hernia is suspected, an imaging procedure is nevertheless necessary. This is because the symptoms caused by a herniated disc often vary greatly in their severity.
In a normal X-ray image, a herniated disc can not be seen exactly. Nowadays, it is therefore diagnosed by magnetic resonance imaging (MRI) of the lumbar spine. It allows a detailed view of the intervertebral disc. of the adjacent neural structures (nerve roots).
What are the treatment options for lumbar disc herniation?
The prognosis for lumbar disc hernia is good. It is known that disc herniations can become smaller over time and in some cases even disappear completely. Ca. 80 to 90 % of all disc hernias are therefore treated conservatively, d. h. without surgery. Physiotherapy and physical applications alleviate the pain. Patients also learn exercises that they can perform independently at home.
The pain and any accompanying inflammation of the nerve root irritated by the disc herniation can be treated with appropriate medication. In addition, targeted infiltrations under fluoroscopic control are used, z. B. directly into the nerve root or the spinal canal. These injections contain painkillers and a drug that fights the inflammation of the nerve root on site. Here's how it can effectively control and relieve pain.
Herniated disc in axial view KSW
Surgery
Surgery is needed only if there is more severe paralysis. Then time is a decisive factor for the prognosis. The longer the prere on the nerve root lasts, the less likely it is that the root will recover and the paralysis will subside. In such a neurological emergency operated on immediately be.
Surgery is also indicated if pain cannot be controlled by conservative treatment measures or does not decrease to a tolerable level within 6 to 8 weeks. However, each treatment must be planned individually. be explained to you in detail.
The decision to operate must be well weighed. There is no guarantee of freedom from pain after the operation. In most cases, significant relief of pain can be achieved and the ability to work can be maintained.
The operation is performed under general anesthesia. In disc surgery, only the portion of the disc nucleus that has leaked into the spinal canal is removed. The remaining, intact intervertebral disc is not affected by it.
At the KSW Neurosurgery Clinic, the procedure is performed microsurgically via a minimally invasive approach under a surgical microscope. Depending on the location of the herniated disc, endoscopic techniques may also be considered.
The operation with microscope takes approx. 40 to 70 minutes. The operation is performed over an approx. 3 cm long skin incision. Due to the use of minimally invasive techniques, the physical impairment of the patient during the operation is minimal. As a rule, a hospital stay of 3 to 5 nights is required.
Minimally invasive disc surgery is considered a low-risk procedure. As with any surgical procedure, complications cannot be completely ruled out.
Your doctor will inform you in detail before the operation about any complications that may occur, such as secondary bleeding, wound infections or swelling.
Serious complications such as. B. Nerve injuries, injuries to large organs, etc. These complications hardly ever occur – nevertheless, you must also be informed about them before the operation. All this will be explained to you during the explanatory consultation.
Already on the day of the operation it is allowed to stand up carefully. You will be supported by the nursing staff. In the following days, you should soon be able to move freely on your own. To reduce pain after surgery, you will receive pain-relieving medication tailored to your needs.
When you leave the hospital, the pain should be reduced to such an extent that you can cope with everyday life on your own or with only a little support. For further treatment, in addition to painkillers, you will be given tablets to relax the muscles and reduce swelling, which you should continue to take for about 2 weeks as instructed, gradually reducing the amount. In this case the family doctor resp. the family doctor the first point of contact.
Some patients suffer from pain for longer, and the healing process is delayed. This is not uncommon. In such cases it may be necessary to take painkillers for a longer period of time.
Strenuous physical activities and lifting heavy loads should be avoided for several weeks after the operation. Strengthening the weakened back muscles is the most important prerequisite for healing and the success of the treatment.
Therefore, targeted back gymnastics and physiotherapy are started early on. It will take approx. 2 weeks until the spine can be fully loaded again. 6 months. Incorrect loads due to incorrect lifting should be strictly avoided until then.