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Written by: 01 Medical Clinic
2020-08-17 07:00
Last update date: 2020-08-17 07:00If you want to understand the surgical treatment of disc herniation, you must understand the relationship between disc herniation and sciatica. You might as well regard the former as the cause of the disease, and the latter as the manifestation of the disease. Generally speaking, most sciatica is caused by a herniated disc and squeezed into the sciatic nerve. The patient has a chance to feel pain in the buttocks spreading to the back of the thighs and calves. In severe cases, it may even affect the mobility. Even if the treatment is successful, it is difficult to recover completely.
Most patients can effectively relieve arthralgia through conservative treatment, but about 5% of patients have to surgically remove part of the herniated disc. In addition to traditional surgical methods, minimally invasive surgery is also quite popular. In contrast, the wound of the latter is relatively small and the amount of bleeding is relatively low. However, the doctor still has to recommend the appropriate surgical method according to the individual patient's condition to bring the best results and shorten the recovery time.
Written by: Dr. Huang Songting, Specialist in Orthopedics at St. Paul's Hospital
To diagnose a herniated disc, we must understand its cause. If it is a patient between 20 and 40 years of age who continues to work for a long time and tears the ligament of the nodule intervertebral disc, there is a chance that a herniated disc may begin to occur. Some patients can clearly remember when to start sciatica, such as a fitness exercise , After carrying heavy objects or traffic accidents, the nucleus pulposus of the intervertebral disc may be herniated due to trauma. As for patients aged 40 to 70, due to the aging of the body, most of them are accompanied by narrowing of the lumbar spinal canal. The cause is the hardening of the yellow ligament, which leads to the narrowing of the nerve channel and compression of the nerve line, resulting in sciatica.
The picture shows the spine model, the red part represents the herniated disc
Minor illness can still trouble patients
It must be known that sciatica can be large or small. Some patients have too much pain in their feet, which not only makes them fidgeting, but also to accommodate when turning around during sleep, otherwise they will suffer from numbness. But what is special is that from the MRI examination, some patients' disc herniation is not necessarily serious, but the symptoms still make them greatly troubled. The reason may be related to the herniated nucleus pulposus, which makes the cells secrete inflammatory factors. For nerve palsy caused by inflammation, patients can take a new generation of anti-inflammatory analgesics and nerve analgesics to suppress and relieve the pain. Eight to ninety percent of the patients can get better after four to six weeks of medication and physical therapy. However, if the situation is not ideal after receiving conservative treatment, surgery should be considered.
Many middle-aged and elderly people have urinary problems such as frequent urination, difficulty urinating or frequent urinary urgency, but if it is accompanied by low back pain and foot pain, be careful that it may be related to the herniated disc. In fact, the condition is not mild at this time, but surgery can still alleviate the problem. If it is delayed, more serious symptoms will appear at any time, such as weakness in the feet, muscle atrophy, difficulty in standing, etc., and even worse, incontinence may occur, which greatly increases the difficulty of treatment, and it is even difficult to reverse the condition.
Sciatica has a chance to affect mobility. Even affect standing
Minimally invasive surgery is faster and less painful
Regardless of surgical or minimally invasive surgery, the purpose is to remove the herniated part of the intervertebral disc, so as to reduce the degree of nerve compression. Traditional surgical operation requires a 7 to 10 cm stoma in the longitudinal direction of the back; if there are two intervertebral discs, the stoma can even reach 15 cm. Due to the larger wound, the patient may bleed more and increase postoperative pain. However, with the advancement of anesthesia technology and the assistance of analgesics, the above situation has been greatly improved, and the patient can be discharged from the hospital in about 3 to 5 days.
As for the minimally invasive surgery, it is only necessary to make a 1.5 to 2 cm stoma on the back, and use an endoscope and microscope to remove the protrusion of the intervertebral disc through the enlarged internal image. Generally speaking, a 2 cm stoma can handle two intervertebral herniation, and because the wound is small and the pain is low, the patient can get out of bed on the day of the operation and can be discharged in about 1 to 2 days.
Minimally invasive surgery is particularly suitable for patients with a high risk of bleeding or a slim body. However, not every patient is suitable for minimally invasive surgery. Traditional surgical surgery still has its advantages. For example, patients have more segments of herniated disc (more than two segments), and the time required for surgical surgery is more than minimally invasive surgery Short; and more than one stoma is required to treat more segments of the intervertebral disc with minimally invasive surgery. Sometimes the risk of anesthesia is increased due to the longer operation time. In fact, many studies have found that the two surgical methods have no difference in the long-term recovery of nerves. Therefore, doctors and patients should choose the most appropriate surgical method, with the shortest time and the least painful method, rather than blindly seeking new.
Advances in medical technology greatly reduce the risk of neurological damage
Some patients worry about whether the surgery around the spine will damage the spinal nerves, leading to hemiplegia and even paralysis. Indeed, the risk of anesthesia during surgery decades ago was relatively high, and without the aid of a microscope, the risk of nerve damage caused by surgery may be as high as 2%. Therefore, patients usually consider surgery when their symptoms have deteriorated to such an extent that there is no other alternative. But nowadays, the medical science has shown that the probability of nerve damage due to intervertebral disc herniation surgery is as low as one in a thousand. Therefore, most patients should not worry too much and delay seeking treatment.
However, the completion of the operation is not a one-time operation. About 5-10% of patients will relapse about 5-8 years after the operation. The cause may be aging or the position of the previously healthy intervertebral disc is gradually narrowing. However, these patients may not need to undergo surgery. If treated early, conservative treatment is enough to alleviate symptoms. In fact, whether patients undergoing conservative treatment or surgery, they must avoid re-injury and overwork, and pay attention to the correct posture in daily life. For example, when carrying heavy objects, do not bend over and move objects directly; if the sofa at home has insufficient support, Or sitting on the side of a bed without a back can easily cause lumbar strain. One thing to note is that smoking can damage the nerves, so the survivors of this disc herniation must quit smoking.
01Medical Clinic