Herniated Lumbar Disc (Lumbar Disc Herniation)
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What is a Herniated Disc? What are the Treatment Methods?
The spine consists of a series of interconnected bone structures called vertebrae. The disc is a solid connective tissue that connects the vertebrae and functions as an intervertebral cushion. Discs consist of a solid outer layer called the annulus fibrosus and a gel-shaped nucleus pulposus in the middle. As the person ages, the gel structure in the middle loses its water content and begins to fulfill its function less as a pillow. This causes the center of the disc to be displaced through a crack in the outer layer, creating a condition called disc herniation (lumbar herniation). Most herniations occur in the lumbar region of the lumbar vertebrae and in the last two discs just below the waist.
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A herniated disc can cause lower back pain, as well as pressure on the nerves coming out of the spine, causing pain, numbness and standing pain in the legs, called sciatica. It may cause weakness.
There are many other causes of waist and leg pain besides herniated disc. For this reason, differential diagnosis must be made carefully. Approximately 80-90% of patients with sudden herniated disc can recover without surgical intervention. Your doctor will usually start treatment with non-surgical methods. If you still cannot perform your daily living activities due to your pain, or if you have problems such as serious loss of strength or urinary incontinence, your physician may recommend surgical treatment. Although surgical treatment cannot fully restore the former strength of your leg, it prevents it from becoming weaker and relieves leg pain.
Non-Surgical Treatment Methods
Your physician may recommend non-surgical treatments such as short-term rest, anti-inflammatory treatment to reduce swelling, painkillers to control pain, physical therapy, may recommend exercises or epidural steroid injection treatment. If you are advised to rest, take care to take bed rest for the recommended time. Bed rest for too long will cause stiffness in your joints and weakness in your muscles, preventing you from making movements that will reduce pain. During your treatment, ask your doctor when you can start working again.
After starting treatment, your physician can provide training on how to perform daily living activities without straining your waist.
The aim of non-surgical treatment is to reduce nerve and disc damage and improve physical condition and increase general body functionality to protect the spine. This can only be achieved with an organized program that combines more than one treatment method in most patients with a herniated disc. can suggest methods. Traction (stretching) may also provide limited pain control in some patients. Sometimes, your doctor may recommend you to use steel rods or flexible waist corsets to reduce your pain, although they cannot cure your hernia. Although manipulation (waist pulling) can provide a short-term improvement in non-specific low back pain, it is generally not recommended in cases of herniated disc.
To reduce your waist or leg pain, light stretching exercises and posture changes should first be recommended. After your pain subsides, more effective exercises can be performed that will improve your flexibility, strength and endurance and help you return to your normal daily life. After starting the exercises, the type of exercise should be shaped according to the recovery status. Learning and continuing home exercises and stretching programs are important parts of the treatment.
Medication and Pain Control
Medications used to control pain are called analgesic drugs (painkillers). Although not very often, muscle relaxants may sometimes be recommended. If you have severe pain, your doctor may recommend using narcotic painkillers for a short time. Use these medications only when you need them. Otherwise, using it for a long time and in high doses will not cause you to recover faster, and may cause unwanted side effects such as constipation and drowsiness, and you may become addicted to these medications.
All medications should be used only as recommended. Inform your doctor exactly about the medications you are using and whether you benefit from the treatment given. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also painkillers and are also used to reduce swelling and inflammation that occur as a result of a herniated disc. If your doctor recommends painkillers or anti-inflammatory drugs, you should be careful about their side effects such as stomach pain or bleeding. You should be under the supervision of your doctor for problems that may arise with long-term use of painkillers or anti-inflammatory drugs. If you have severe leg pain, epidural injections or 'blocks' may be recommended. These are corticosteroid injections made into the epidural space (the space around the spinal nerves) by a doctor specially trained in this technique. The same procedure can be repeated several more times after the first injection. These treatments are usually administered as part of a comprehensive physical therapy program. The purpose of these injections is to reduce inflammation of the nerve and disc. Trigger point injections are injections of local anesthetic material, sometimes combined with corticosteroids, directly into the painful soft tissue or muscle in the waist or hip. Although they are often useful in controlling pain, trigger point injections do not have a healing effect on a herniated disc.
Surgical Treatment
The aim of surgery is to eliminate the pressure of the herniated disc on the nerve, which causes pain and weakness in the leg.
The most common The method used is discectomy or partial discectomy, in which only the herniated disc part is removed. In order to see the disc clearly, it is sometimes necessary to remove a part of the bone called lamina located behind the disc. The bone removed may be a very small piece (hemilaminatomy) or a larger piece (hemilaminectomy). Some surgeons may use an endoscope or microscope in some cases.
Discectomy can be performed under local, spinal or general anesthesia. The patient lies face down on the operating table, usually in a kneeling position. A small incision is made in the skin over the herniated disc and the muscles overlying the spine are stripped away from the bone. A small piece of bone may be removed so the surgeon can see the pinched nerve. Nerve compression is relieved by removing the herniated disc and its ruptured parts. ir. Bone protrusions called osteophytes are also cleaned to remove anything that could put pressure on the nerve. Usually there is very little bleeding.
What Can I Expect After Surgery?
If you are bothered by leg pain rather than back pain, you can get good results from surgery. Before surgery, your doctor will perform some tests to make sure your hernia is compressing the nerve and causing your pain. In physical examination; Straight leg stretch test, which indicates sciatic pain, may possibly include muscle weakness, numbness, and reflex changes. In addition, an imaging method such as magnetic resonance (MRI) and computed tomography (CT) is used to clearly see nerve compression. If all of these tests are positive and your doctor is sure that you have nerve compression,
your chance of getting rid of leg pain after surgery is approximately 90%.
Most patients do not experience any complications after discectomy. However, you may have some bleeding, infection may occur, the membrane protecting the nerve (dura mater) may rupture, or nerve damage may occur. It is also possible for the disc to rupture again and cause complaints. This condition is seen in approximately 5% of patients.
Learn about post-operative movement restrictions from your doctor. After waking up from anesthesia, it may be recommended to get out of bed and take a walk. Most patients are discharged within 24 hours after surgery, and often later on the same day.
You should avoid driving, sitting for long periods, lifting heavy loads, and bending forward in the first four weeks after going home.
Some patients , may benefit from a post-operative rehabilitation program. You can find out from your doctor whether it is appropriate to do waist strengthening exercises to prevent recurrence.
Is Emergency Surgery Required?
Sometimes, a hernia can cause significant loss of strength in the leg by compressing the nerve root leading to the leg. Emergency surgery may be required due to a herniated disc. If such a thing happens, you need to contact your doctor immediately. Very rarely, a large hernia can put pressure on the nerves that provide bladder and bowel control, causing this control to disappear. this was Rheumatoid arthritis is usually accompanied by numbness in the groin or sexual area and is one of the rare conditions that require emergency surgery due to a herniated disc. If such a thing happens, you need to contact your doctor immediately.
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