What is a herniated disc, what kind of symptoms does it cause?
A herniated disc occurs when the inner part of the cartilage disc, which is located between the vertebrae and receives a type of suspension treatment, tears its hard outer capsule and comes out. and causes pain by pressing on the nerves. Sudden onset hernias are usually caused by heavy lifting, trauma, or a similar reason. A group of patients have attacks of painful lumbar stiffness that occur every few months and resolve spontaneously in a short time. Patients do not care about this as they get better every time, but eventually these patients begin to experience severe back stiffness and pain. In mild herniated discs, the patient usually feels pain in the lower back. In severe hernias, the pain usually starts in the waist and spreads to one leg. Along with the pain, numbness in the leg, loss of strength, and loss of reflexes may occur.
What non-surgical treatments are applied for herniated disc?
A mild painful lower back that develops slowly. The treatment of a herniated disc that suddenly begins with severe pain with stiffness varies somewhat. But usually rest and medication are the first treatment of choice. What is meant by rest here is active rest. It is definitely not bed rest. Approaches such as "You will lie on the hard ground on your back for 10-20 days and never get up", which were and are still recommended to the patient by some doctors, have no place in modern medicine. This does more harm than good to the patient. If the patient can get up, walk around, or sit, he or she can do these activities. But it is especially said to avoid sitting for long periods of time. Physical therapy should be the first treatment of choice in patients who do not improve with medication and active rest treatment. In general, a 15-session physical therapy program provides success in the majority of patients. In recent years, we have also been using waist ozone injection successfully. With 2-3 sessions of ozone injection per week added to physical therapy, treatment success rates increase to 80-90%. Patients who do not improve with these treatments can receive cortisone injection in the waist.
Surgery for a herniated disc should always be the last option, except for special cases...!
So, if the patient does not respond to all these treatments, should he undergo surgery? does it take? Our golden rule; “Surgery in lumbar disc herniation should always be the last option except in special cases.” But the situation in our country is not in line with this scientific reality. Because a patient who develops sudden and severe back pain is diagnosed with a herniated disc using an MRI and surgery is recommended immediately. It is thought that the rate of people having surgery for herniated disc in our country is quite high compared to other western countries. Scientifically, the first condition that requires surgery for a herniated disc is progressive loss of muscle strength. In other words, the patient's nerve is damaged as a result of the pressure of the herniated disc on the sciatic nerve roots, and as a result, weakness occurs in the foot and leg muscles. But what needs to be taken into consideration here is that this loss of power worsens in subsequent checks. In other words, mere loss of power may not require surgery. Unfortunately, even patients with a slight loss of strength may be told, "There is a risk of paralysis, you need to have surgery immediately." In these cases, the electromyography (EMG) test is very helpful in understanding the severity of muscle weakness. EMG test is a special evaluation method performed by the doctor using a special device, using tiny electric currents and thin needles inserted into the leg muscles. It provides valuable information about whether the patient's muscle weakness requires surgery. It should not be forgotten that there may be weakness in some muscles in the foot due to herniated discs, but paralysis that prevents walking cannot occur other than cauda equina syndrome, which is a very rare condition, which is the second condition that requires surgery in cases of herniated discs. This syndrome is a serious condition that occurs rarely in very large hernias, with symptoms such as weakness in all leg muscles and difficulty in urinating and continence. These patients are already emergency room patients and are operated on immediately. The third condition that requires surgery is the pain that does not go away despite all treatments. What is meant by all treatments here is that treatments such as medication, rest, physical therapy, ozone injection, cortisone injection have been tried. If the pain does not go away despite all these treatments, the patient may undergo surgery. But the decision maker here is the patient, not the doctor. If the pain does not affect the person's normal life and the patient can do his/her job, surgery is not recommended. Because the operation is There is no guarantee that the pain will go away. But if the pain negatively affects the patient's daily life and reduces the quality of life, then surgery is recommended. Here, the patient has to take the risk of the operation, otherwise he will not be able to live his life normally.
What is the success-failure rate of herniated disc operations? What kind of negativities might occur? What risks should be taken?
Studies report that the failure rate in herniated disc operations is between 10 and 40%. There is no significant difference in the failure rate between the surgical techniques used. So what does this high failure rate mean? An unsuccessful operation may mean that the pain continues as it is, or it may mean lifelong pain that is impossible to treat and more severe than before. This last situation is known as "failed back surgery syndrome" in medicine. Failed back surgery syndrome may be caused by poor surgical technique or may occur due to excessive scar tissue in the surgical area due to surgical intervention. This scar tissue can wrap around the nerves, making treatment impossible. It is not possible to predict this situation in advance, and it may also occur after surgeries performed by very experienced surgeons. When unsuccessful back surgery syndrome occurs, it becomes even more risky to correct it with a second intervention. Research shows that there is no difference in clinical well-being between those who have surgery and those who do not in the long term. For this reason, the decision to perform surgery for a herniated disc should be taken very carefully. Our advice to our patients is that they make the decision for surgery based not only on the surgeon's opinion but also on the opinion of a physical therapist.
As Hippocrates said, the principle of "primum il nocere", that is, "first do no harm", should always be our guide.
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Stay well,
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