Dimensions of the lumbar spine for surgery

What size of the spinal hernia is subject to surgical treatment?

People with back problems are interested in the question of what size of the spinal hernia surgery is required.

In recent years, people are increasingly faced with diseases of the spine.

The reason for this is a sedentary, sedentary lifestyle, a long ride in the car, no physical exertion, problems with posture from childhood, scoliosis.

Hernia of the spine is a disease in which the nerve endings are infringed by displacement of the vertebral disc, which leads to a strong pain syndrome.

Is spinal hernia dangerous? Yes, in the absence of competent treatment in the future, even paralysis of the extremities or the lower part of the body is possible.

To prevent this, in the presence of absolute indications for the patient, an operation must be made to remove the intervertebral hernia.

When does surgery become necessary?

There are various methods of conservative treatment that help to effectively cope with the symptoms of this disease and prevent relapse of the disease.

As a rule, 95% of patients can be cured without resorting to surgery. Choosing between these two methods of treatment, doctors estimate such an important factor as the size of the hernia.

In order to do this, various types of surveys are used:

• MRI;
• X-ray;
• CT scan.

Based on the results of such a survey, the doctor will decide on the optimal method of treatment for the patient.

The size of the hernia, which is the determining factor in deciding on the operation, depends on the department of the spine in which it is localized.

It is believed that protrusions in the lumbar and thoracic parts up to 12 mm are subject to conservative treatment, and the patient has a chance to avoid surgery. And for a cervical hernia, the size of 7 mm is already critical, in which case the likelihood that an operative method of treatment will be applied is high.

Operative intervention is also addressed when long-term treatment with various methods does not bring relief to the person and the pain syndrome does not decrease.

In general, the patient should try as long as possible without surgery and use all possible methods and techniques in order to be cured in a non-surgical way.

The patient should understand that the operation can remove the existing hernia, but do not affect the cause of its appearance.

There is a high probability that after a while the protrusion will appear on the other part of the spine.

This operation has a rather high level of complications (approximately 80% of cases). Another feature of this operation is that after it the patient has a long rehabilitation period, which can last for several years.

Lumbar spout protrusion size

The most common is a hernia in the lumbar spine. Usually it manifests itself:

1. severe pain in the legs;
2. numbness of limbs;
3. problems in the genitourinary system;
4. disturbances in the work of the intestine.

With a hernia of the lumbar spine, no more than 3 mm in size, is meant an outpatient or home treatment, therapeutic gymnastics.

It includes a set of special exercises aimed at strengthening the muscular corset.

With their help, you can tone the weakened muscles and, conversely, relax the clamped muscles.

A protrusion of 6-7 mm is considered to be a moderate and involves more complex outpatient treatment. But surgical intervention in this case is not required.

If the protrusion reaches a size of 12 mm or more, surgery is usually required. Especially if there is an infringement of the nerve roots, called the ponytail.

When squeezing it, the patient may develop paralysis of the lower part of the body.

In this case, the operation to remove the hernia of the spine is the only chance for the patient to maintain or restore his motor activity.

Cervical hernia dimensions

Cervical hernia is less common than a lumbar hernia. Its symptoms may include:

• headache;
• memory problems;
• blood pressure jumps;
• dizziness;
• pain in the extremities.

In the presence of a hernia in the cervical region, the patient's blood supply to the brain is impaired, which in the future can cause a stroke. Therefore, if there are suspicions about the presence of protrusions in the cervical department, it is necessary to visit specialists and start treatment as early as possible.

At a size of 2 mm, the neck protrusion provides treatment combining medication, massage and a set of special exercises.

If its size is 3-4 mm, then treatment should be started as early as possible in order to prevent further increase. The maximum protrusion size at which conservative treatment is allowed is 5-6 mm.

If its size exceeds 6 mm, then the patient needs to have surgery.

Hernia hernia dimensions

In the presence of protrusions in the thoracic spine of the patient, pain in the chest, between the shoulder blades, in some cases, can develop scoliosis.

The protrusion on this part of the spine is 1-5 mm small, 5-6 mm - medium, 9-12 mm - large, more than 12 mm - the vertebra falls out.

Immediate surgical intervention is indicated in the presence of a hernia size of 12 mm or more in the event that there are signs of infringement of the spinal cord.

Now there are many clinics offering a variety of methods for this. Among them:

To achieve a positive effect in the treatment of the intervertebral hernia, the main thing is to start treatment immediately after its detection, without postponing for later. Therapeutic gymnastics should be done all the time to prevent the emergence of new foci and strengthen the muscle tone in the back.

It must be remembered that if you do not perform a set of back exercises after the operation and recovery period, your chances of relapse are very high.

A source: https://OrtoCure.ru/pozvonochnik/gryzha/razmery-dlya-operatsii.html

Intervertebral hernia: at what size is the operation shown

With constant aching or "shooting" pain in the back, waist, neck, which do not pass a long enough time, you should pay serious attention to your health. Perhaps, such pains speak about the presence of an intervertebral hernia.

This is an unpleasant, dangerous disease that requires prompt treatment, otherwise the disease can progress and cause serious damage to a person's health and well-being.

Intervertebral hernia occurs when the pulpous nucleus of the intervertebral disc is displaced with a rupture of the fibrous ring.

Where there is a vertebral hernia

The intervertebral hernia can be localized in different parts of the spine. The most common is a hernia in the lumbosacral spine.

In this case, pain can be given in the back, lower back, hips, legs, feet, buttocks.

There may be disruption of the bowel, bladder, men may have problems with potency.

Less common is intervertebral hernia in the cervical region.

There may be headaches, pain in the arms and shoulders, frequent dizziness, memory functions are disrupted.

With the intervertebral hernia of the thoracic region, the pain is also in the thoracic region, in the interlateral region, scoliosis may appear.

Intervertebral hernia appears, as a rule, from an uncomfortable workplace and an incorrect position during the performance of professional duties of drivers, surgeons, welders, etc.

Often the affections of the intervertebral disc arise from the regular lifting of weights.

Hazards of the intervertebral hernia are also exposed to those who suffer a spinal injury due to unsuccessful falls, various fractures.

Methods of treatment based on the size of the vertebral hernia

Treatment of a hernia should be started as soon as it is detected. The more you start the intervertebral hernia, the more time and effort it takes to relieve pain. If the intervertebral hernia is suspected, the doctor prescribes CT or MRI.

In general, experts recommend that as a method of diagnosis of intervertebral hernia use magnetic resonance tomography - it is the most safe for health and provides the most accurate data on the localization of hernia and its size.

Intervertebral hernia is treated in various ways: conservative and surgical. The method of treatment is determined by the size of the hernia of the spine.

A medium-sized protrusion, for example, an intervertebral hernia 5 mm, is also treated by a non-surgical method. With a large amount of herniated spine 8 mm treatment is prescribed including surgical.

However, surgical intervention in this case is not the final stage of treatment of the hernia of the spine. After the operation, the patient is prescribed medication, massage, physiotherapeutic procedures, recommend sanatorium treatment.

We will tell more in detail about treatment of a hernia, proceeding from the sizes of displacement. The dimensions of the intervertebral hernia of the lumbar and thoracic spine are divided as follows: a small protrusion from 1 to 5 mm.

The average protrusion is from 6 mm of the protrusion of the intervertebral disc, and the larger protrusion is greater than 9 mm. Dimensions of the hernia of the cervical spine: small - 1-2 mm, large protrusion - 5-6 mm.

Thus, the need for surgical intervention is most often determined by the size of the vertebral hernia.

Dimensions of the lumbar intervertebral hernia

Intervertebral lumbar hernia in 3 mm requires ambulatory treatment, home treatment, involving spinal traction, therapeutic gymnastics.

The vertebral hernia of the lumbar region of 6 mm is considered average, therefore it implies more serious ambulatory therapy with the use of additional methods.

However, when asked if surgery is necessary to treat a lumbar intervertebral hernia between 6-7 mm, doctors respond that surgery is not required.

But with the intervertebral hernia of the lumbar part 12 mm in size, surgical intervention is required if symptoms of compression of the spinal cord appear and when the elements of the "horse tail" appear.

Cervical hernia dimensions

Intervertebral hernia up to 2 mm in the cervical spine is considered small, for its treatment provided for manual, medicamental, physiotherapy methods.

Hernia of the cervical spine 3 mm in size, like the intervertebral hernia in 4 mm, requires urgent ambulatory treatment to avoid further trauma of the site. Intervertebral hernia in this area of ​​5-6 mm still allows ambulatory treatment.

But with the detection of the intervertebral hernia of the cervical spine larger than 6 mm requires urgent surgery.

Regardless of what size and in what department the intervertebral hernia is found, the sooner the treatment begins, the better.

If the hernia of the spine is found in time, there is every chance to get rid of the disease or at least to remove the symptoms, ensuring the proper level of quality of life. In addition to ambulatory treatment, it is effective to use folk remedies for the treatment of a hernia.

But only as a supplement, not replacing them with conservative treatment (medical method, manual and physiotherapy).

A source: http://www.sportobzor.ru/zabolevaniya-oporno-dvigatelnogo-apparata/mezhpozvonkovaya-gryzha-pri-kakih-razmerah-pokazana-operaciya.html

When a hernia requires surgery

The precursors of the intervertebral hernia - osteochondrosis in the advanced stage or trauma of the spine.

Depending on the part of the spine in which the hernial protrusion is localized, such symptoms: headaches, numbness of upper or lower extremities, impairment of mobility in the area of ​​the affected disk. In some cases paresis of limbs arises.

Treating a herniated intervertebral disk is perhaps conservative (the use of medications, physiotherapy, massage and exercise therapy) or an operative route.

Indications for surgery for the removal of a hernia: a prolonged pain syndrome, not amenable to conservative therapy, a large hernial protrusion that compresses the nerve endings and

Dimensions of hernial protrusion

Hernias can be localized in the thoracic, cervical or lumbar spine.

Regardless of the location of the protrusion, doctors initially resort to sparing methods of therapy, and only when conservative methods are tried, the neurologist will recommend an operation to remove hernia.

It is advisable to perform the operation if the use of traditional methods of treatment for 2 months does not give positive results and the pain continues to torment the patient.

In addition to the ineffectiveness of conservative therapy, the indication for surgery is the large size of the hernial protrusion.

With a hernia of the thoracic or lumbar spine, surgery is necessary if the size of the protrusion exceeds 9 mm.

Indication for immediate surgical intervention is the syndrome of the horse tail, which is characterized by severe pain, change in tactile sensations, violation of reflex functions.

With hernial protrusion in the cervical region, the indication for the operation is a protrusion, the size of which exceeds 6 mm.

Hernia of the intervertebral disc of the cervical spine is considered small in sizes up to 2 mm, medium - up to 4 mm, large - up to 6 mm, but even at this size one can manage a conservative therapy.

With a hernia over 6 mm doing the operation. Surgery is also mandatory for stenosis of the spine, even if the size of the protrusion is small or medium.

Preoperative Diagnosis

As already mentioned, an operation on the spine follows with intense pain, which is removed by conventional therapeutic methods is impossible, with large sizes of hernial protrusion, with a violation of sensitivity and motor activity extremities.

Before making a decision to conduct an operation, the doctor carefully examines the part of the spinal column in which the disc ruptured with the exit of the pulpous nucleus.

To determine the location and size of the hernia, magnetic resonance imaging is required.

This method for studying the intervertebral disc is accurate and informative, but at the same time it is complex.

This method allows you to determine the size and location of hernial protrusion and identify associated pathological processes.

Another study, which is used for protrusion of the disc, is a CT scan. However, this technique is not as effective as MRI (there are errors), and less safe for the patient's body.

If after treatment with traditional methods of pain the patient does not stop, organ dysfunction occurs small pelvis, and conducted studies showed a large hernia - requires operational intervention. There are several methods to remove the pathological neoplasm.

Methods of surgical intervention

Before performing the operation, the patient should carefully and deliberately approach the choice of the method of removal of hernial protrusion. Excision of pathological neoplasm is performed in several ways, and all of them have their pros and cons.

The choice of method depends on the diagnosis, the medical history and preferences of the patient. Not the last role is played by the financial condition of the patient.

But most often the pains force the patient to agree with the doctor, since the patient's only desire is to get rid of the problem as soon as possible.

There are several ways to perform surgery for disc protrusion and hernial protrusion. It:

• Discectomy;
• microdiscectomy;
• Laminectomy;
• endoscopy;
• nucleoplasty.

Each of these methods relieves the patient of pathology. The pain subsides, and it seems to the person that tomorrow he can start active work.

But after surgery, rehabilitation is necessary.

In addition, you need to remember that the removal of the hernia does not promise a 100% result, sometimes pain returns, and a relapse occurs.

Discectomy

This method is already outdated, it is necessary to do such an operation in extreme cases. The intervention is under general anesthesia - the surgeon makes a 10 cm incision and dissects the affected disc.

This is an inexpensive option to remove a hernia, which requires antibiotic therapy and long-term rehabilitation. After the intervention, the operated person stays in the hospital for two weeks.

A full rehabilitation takes place in three months.

Plus this method - the minimum percentage of relapses (3%).

Microdiscectomy

This is a microsurgical intervention. Through a small incision (up to 4 cm), the surgeon uses a powerful microscope to hernia protrusion and releases the squeezed nerve root. After excision of the neoplasm, laser treatment is performed to regenerate the damaged disc tissues.

After microsurgical excision was performed, the patient is allowed to sit down, and rehabilitation in this case will take no more than a month.

To active activity with physical exertion the patient is allowed to proceed after three months wearing a special supporting corset.

The disadvantages of this method are relapses up to 15% for the first postoperative year.

Endoscopy

This microsurgical intervention is performed using endoscopic instruments under epidural anesthesia. The surgeon monitors his own actions through the monitor, since the instruments are equipped with a microscopic camera.

The incision is minimal (not more than 2 cm). This is a minimally invasive operation, in which muscles and ligaments remain intact. Already in 1-2 days after hernia, the patient is released home, rehabilitation in this case lasts less than a month.

This method has few shortcomings, so it is often used in surgery.

Cons: the percentage of relapses is 10%, not all types of hernias are to be removed by endoscopy, and this is an expensive operation.

Nucleoplasty

Such a minimally invasive intervention is performed under local anesthesia. Look it this way - in a few places of the damaged disk with a special needle make small holes.

Through the aperture of the needle, laser or radio-frequency radiation is transmitted, the gelatinous substance is heated inside the disc, under the influence of which it disintegrates, the pressure on the nerve roots subsides, and the pain disappears syndrome.

The operation is performed for not more than an hour, a few hours after it the patient is released home, the full rehabilitation lasts for a month.

Laminectomy

The operation of the case under general anesthesia - the surgeon makes a cut to 10 cm, through it the part of the vertebra is removed, to which the hernia is pressed by the nervous process.

After the operation, rehabilitation is carried out in the hospital for several days, the pain syndrome recedes immediately.

Of the risks, the risk of infection and damage to nerve endings are highlighted.

After the operation, the rehabilitation period is important, but this is not the time to lie on the couch. During this period, it is necessary to practice physical therapy, it will help to strengthen the muscular frame and reduce the risk of relapse.

A source: https://sustavlechit.ru/oslozhneniya/gryzha-operatsiya.html

Conservative and operative treatment of a hernia of a backbone

Our spinal column is the result of billions of years of evolution.

This is a complex design that provides a support function and considerable mobility.

Each segment includes a certain number of vertebrae (therefore each has its own size), and between them - intervertebral disks, which in the spine act as joints.

Intervertebral disc

In order to understand the possible causes of disk structure violations, it is necessary to understand how it is arranged.

In the very center of the disk there is a so-called gelatinous nucleus, and on its periphery there is a fibrous ring, the density of which considerably exceeds the density of the nucleus, since the central part of the disk consists of more than 80% of the water. With age, this percentage decreases, resulting in the development of degenerative processes in the spine.

Different segments of the spine experience a different load. The most "amazed" in this regard is the cervical and lumbar spine. It is in these segments with the greatest frequency of degenerative processes and, as a consequence, hernia of the intervertebral disc.

What is a hernia?

Hernia is the result of degenerative spine disease - osteochondrosis. This is the displacement of the deformed disk and its exit beyond the vertebrae.

There are 2 variants of a hernia:

1. Protrusion - when the pulpous core partially extends beyond the fibrous ring.
2. Prolaps is an almost complete protrusion of the cartilaginous part of the disk beyond the vertebrae.

Depending on the stage of the hernia, there are two clinical variants:

• Pressure of the disc on the nerve root (2% of cases).
• Finding a part of the disk next to the spine, without any impact on it (98% of cases).

In rare cases, disc sequestration is possible - free finding of the cartilaginous part in the lumen of the spinal canal. This occurs as a result of complete rupture of the fibers of the fibrous ring.

In the overwhelming majority of cases, the hernia emerges laterally, that is, sideways. But also the posterior hernia is possible - protrusion of the disc into the lumen of the spinal canal.

Their course is extremely unfavorable.

There are also asymptomatic (latent) hernias, in which the gelatinous nucleus penetrates into the nearby vertebra - the hernia of Schmorl.

Risk factors

The appearance of intervertebral hernias, as a rule, are preceded by one or another reason. The most significant of them are:

• Genetic predisposition.
• Age of the patient (older than 40-45 years).
• Constant mechanical load in an upright position (orthostasis).
• Change in metabolic processes (impairment of blood supply, reduction of fluid content in the gelatinous nucleus, etc.).
• Injuries.
• Sedentary lifestyle.

Some of these reasons can not be corrected (heredity, age, metabolic features), but some of them are influenced by our influence: nutrition, way of life, traumatism. The result of our impact can positively influence the course of the disease or even completely prevent its occurrence, the main thing is to start prevention in time.

Herniated lumbar spine

The lumbar segment of the vertebral column is very vulnerable in vertical loads, tilting forward and especially when lifting the gravity. It is here that the greatest stress of the entire support apparatus is concentrated. As a result, it is the lumbar hernia that occurs most often.

95% of intervertebral lumbar hernias are at the level of l5-s1 and l4-l5, hernia is located between the fifth (last) lumbar vertebra and the first sacral or between the 4 and 5 lumbar vertebrae. About 4% falls to the level of l3-l4 and 1% to other locations.

Clinical picture

As a rule, the disease begins acutely. Its appearance is provoked by lifting of gravity, sudden movement or trauma.

The first manifestation is a strong radicular (neurogenic origin) pain in the lumbosacral region. It can irradiate (give off) the posterior surface of the buttocks, thighs and lower legs, i.e.,

along the sciatic nerve. There is a significant increase in pain when straining or any attempt to move.

When examining a specialist is characterized by the identification of specific symptoms: a symptom of tension (Lasega and Neri).

Perhaps the appearance of intermittent claudication, i.e., the appearance of weakness and pain when moving on the side of the lesion.

This symptom arises from the presence of circulatory problems, namely, with venous outflow.

At the same time, an important distinctive feature is that the blood flow in the lower limbs is not disturbed.

The patient takes for himself a forced position - a pose in which he is most comfortable and which delivers a minimum of unpleasant sensations. For hernia of the lumbosacral spine this is lying or sitting with bent legs.

Localization in the region of l5-s1 or l4-l5 is characterized by recurring (repeated) course, especially at the initial stages of the disease, when the operation is not yet shown.

Diagnostics

To suspect a hernia in the lumbar department only at the clinic does not pose much difficulty for an experienced neurologist.

However, the diagnosis with a dot can be made with X-ray images with mandatory involvement of vertebrae from l4 to s1, CT or MRI results.

Highly informative is ultrasound.

It is the size of the compressive part of the disc is one of the defining indications for the operation.

Indications for surgical treatment

Operation with lumbosacral protrusion is a very traumatic intervention that requires a long rehabilitation. As a consequence, the list of indications for the operation is very limited:

1. Ineffectiveness of prolonged and persistent conservative treatment (within 2-3 months).
2. Detection of CT images in the formation of large sizes of the region l4-l5 or l5-s1 compressing the nervous spine and causing severe radicular pain, not stopping with anti-inflammatory preparations.
3. The presence of extraneous formation, exceeding the size, cm and squeezing the spinal cord.
4. Presence of the syndrome of compression of the horse tail (paralysis of the lower extremities).

Herniated cervical spine

Hernias of this localization are much less common than in the region with l4 to s1.

In the cervical segment, the main load falls on the lower part. Therefore, hernias often arise between c5-c6 and c6-c7.

The most common cause of protrusion in the cervical region is a "blunt" injury (rapid flexion and extension of the head), not infrequent during an accident.

Clinical picture

The disease begins with acute pain in the cervical region with irradiation in the arm and shoulder on the side of the lesion. The pain increases with the bends and turns of the neck.

There may be symptoms of spinal cord injury (with posterior hernia).

In the late stages of the disease is characterized by the presence of muscle weakness and atrophy (a decrease in muscle size) of the shoulder girdle.

Unlike hernia in the area with l4 to s1, the intensity of pain and their irradiation in the cervical region is much lower.

The size of the hernial protrusion in this case is unimportant: from, up to 5 mm. Sometimes they are not even detected in instrumental studies because of their small size.

Prevention

Hernias of the lumbar and cervical spine significantly reduce the quality of life. It is important to start therapy on time in advance by consulting with an experienced neurologist.

But it is better to take timely preventive measures, which includes:

• Doing an active lifestyle.
• Do not lift the gravity, do not work for a long time in the slope.
• Strengthening of the muscular apparatus of the back.

The earlier to engage in prevention, the lower the percentage of development of degenerative diseases of the spine.

A source: http://MedOtvet.com/drugie-zabolevaniya-pozvonochnika/konservativnoe-i-operativnoe-lechenie-gryzhi-pozvonochnika.html

Surgery for the removal of the intervertebral hernia: methods and conduct, indications, rehabilitation after

The intervertebral hernia is a pathology in which the pulpous nucleus of the intervertebral disk extends through the cracks in its fibrous ring.

The protrusion occurs, as a rule, in the posterior and lateral sides, which leads to compression of the nerve roots or spinal cord with development of persistent neurologic symptoms: pain, movement disorders, sensitivity, problems with bowel movements and urination.

Intervertebral hernia occurs in the vast majority of cases in the lumbar spine,less often - in the cervical and extremely rarely - in the thoracic.

Intervertebral hernia - a fairly common phenomenon, often occurring in general asymptomatic. There are also many methods of non-surgical treatment of herniated discs (which, of course, does not relieve the hernia, but quite effectively and permanently removes symptoms).

It is believed that only 10% of cases of intervertebral hernias are suggested for surgery.Operations on the spine are always a great risk and little guarantee.

The spine is a complex structure, each morphological component in it is very important, and removing the disc naturally disrupts the biomechanics and the basic functions of the spine.

Therefore, in the case of this pathology, the operation is offered only when no other methods manage to eliminate the symptoms that torment the patient. And there is still no consensus among doctors about the indications for such an operation.

In what cases is it proposed to remove the intervertebral hernia surgically?

At present, it is considered that the size of the hernia does not influence the choice of the method of treatment, this is only an additional factor in decision on the operation (the larger the hernia size in the presence of symptoms, the more surgeons are inclined to operational treatment).

The main indications for the removal of the vertebral hernia are the severity of the clinical symptoms.

The operation is proposed:

• In case of violation of the function of the pelvic organs (incontinence or retention of urine and feces). These are symptoms of compression of the horse's tail of the spinal cord, the operation in this case is carried out urgently.
• Severe pain syndrome that does not liquefy within -2 months, sometimes requiring the use of narcotic analgesics.
• Pain syndrome, increasing in intensity, despite conservative treatment.
• Muscle weakness, impaired movement in one or both legs.
• Sequestered herniation of the disc (i.e., complete loss of a fragment of the disc or pulpous core). In this case, the operation is offered even with not very pronounced symptoms.

Types of operations in vertebral hernia

1. Discectomy.
2. Microdiscectomy.
3. Endoscopic discectomy.
4. Percutaneous discectomy (nucleoplasty).

Open Classical Discectomyunder general anesthesia.

The cut of the skin over the affected segment of the spinal column is not less than 7-9 cm. The muscles are widely retracted, the yellow ligament is dissected, covering the spine from the outside.

For better access, a laminectomy is performed - removal of a part of the vertebra artery.

discectomy

In addition to removing the disc, a partial excision of the processes of the vertebrae is performed. At the site of the removed disc, a fixed connective tissue connectivity of the vertebrae develops.

Sometimes, to stabilize the vertebrae in place of the remote disc, an implant (artificial titanium or bone, taken from the patient's iliac crest) is installed. With the same purpose, with the instability of the vertebral column, it is possible to connect several vertebrae with metal plates.

Open discectomy lasts about 2 hours, then the patient is forced to lie on his back during the day. Sitting is not allowed for 3 weeks.

Open discectomy is a rather traumatic operation that requires a long period of recovery and rehabilitation. Currently, it is rarely used.

However, in some cases this is the only method of treatment (in cases of hernias of large size, disc sequencing, narrowing of the canal of the spinal cord and some other complications).

It is also believed that open discectomy is the most reliable method and gives the least amount of relapses.

In addition, this method does not require expensive equipment and can be performed in any neurosurgical unit.

microdiscectomy

Microdiscectomy. This is a less traumatic operation, performed with the help of special microsurgical instruments under ultrasound or X-ray control.

The surgical incision in this case is small -3-4 cm. Carefully move the muscles, "bite" a small area of ​​the yellow ligament and then directly removes the hernia or part of the disc.

Endoscopic Discectomy. All stages and principles of the operation are the same. The difference is that an operation is carried out through an even smaller incision (-2 cm) using a special endoscopic device. The surgeon conducts all manipulations under the visual control of the monitor.

Minimally invasive discectomies have many advantages:

• The operation can be performed under epidural or even local anesthesia.
• It does not require long bed rest and long rehabilitation.
• Terms of inpatient treatment - 3-5 days. In some clinics, the operation is performed on an outpatient basis.
• Workability is restored in 2 weeks.

Percutaneous discectomy (nucleoplasty)is performed with small hernias without rupture of the fibrous ring (in 10-15% of all hernias). It is performed on an outpatient basis under local anesthesia.

Under X-ray control, a special cannula is inserted into the center of the disc, through which an electrode with laser radiation or cold plasma is fed to the nucleus.

They destroy part of the pulpous nucleus, reducing the size of the hernia and reducing the pressure inside the disc.

Preparing for an operation to remove the intervertebral hernia

To determine the diagnosis of the intervertebral hernia, determine its exact size and location, the MRI of the spine is used.

Immediately before the operation, the patient is examined:

1. General blood analysis.
2. General urine analysis
3. Coagulogram.
4. Biochemical analysis.
5. Radiography of the lungs.
6. Study for markers of infectious diseases.
7. Survey of the therapist.

Contraindicated surgery with:

• Acute infectious diseases.
• Decompensated chronic diseases.
• Pregnancy.
• Violation of the blood coagulation system.

8 hours before surgery, it is forbidden to eat or drink.

Postoperative period

After an open discectomy, a strict bed rest is prescribed for at least 24 hours. A day later the drainage is removed. If necessary, anesthetics and antibiotics are prescribed.

During 3 weeks it is not allowed to sit, bend, lift weights. Walking is recommended in a special lumbar corset.

After microsurgical operations, you can get up in a few hours, after a few days the patient returns to normal physical activity.

However, lifting of weights and bending of the spine is still recommended to be limited for 4-6 weeks. For the same period it is recommended to take a break in driving a car.

Women are not recommended to become pregnant within six months after the operation.

Possible complications after surgery:

1. Bleeding.
2. Infection of the wound and cerebrospinal fluid.
3. Damage to the spinal cord, with the expiration of the cerebrospinal fluid.
4. Damage to the nerve root or spinal cord.
5. Recurrent herniation of the intervertebral disc.

Unfortunately,according to statistics, the operation is effective only in 80-85% of cases.The causes of recurrence of pain after surgery can be very different:

• Incomplete removal of a hernia with microsurgical technique.
• The emergence of a hernia in another disk due to increased load on it after the removal of the neighboring one.
• The cause of the pain was initially not in the hernia of the disc.

Do or not do surgery for a herniated disc?

When an acute pattern of compression of the nerve roots or spinal cord occurs, this question, as a rule, is not worth it. In this case, the operation should be carried out as early as possible in order to avoid irreversible changes.

Doubts may arise in patients with prolonged pain syndrome.Of course, surgery is a risk and an extreme measure. The overwhelming number of patients are afraid of surgery and try to delay it as long as possible.

If several courses of treatment have been carried out, 2 months have passed and the pain does not go away - an operation is suggested.

What is important to know when deciding whether to agree or disagree on it?

1. There are no clear uniform criteria for indications for the removal of a hernia. That is, the main criterion is the subjective perception of pain by each patient ("you can endure the pain - be patient, you can not - operate").
2. It is better to consult a few doctors, preferably from different clinical schools. Summing up their opinions, we arrive at our own solution.
3. If there are symptoms of compression of the nerve roots (muscle weakness, numbness), the decision should be taken within 6 months. It is believed that after this period the operation will not solve these problems.
4. If there is any doubt about the cost of the operation, you need to accept the fact that the costs of long-term conservative treatment can far exceed the costs of the operation.
5. It is very important to find on the Internet reviews of those people who have already transferred this operation, it is better to communicate with them in personal correspondence. Basically, the reviews of patients who have undergone the removal of the intervertebral hernia are positive. After all, in 80-90% of cases this operation is really effective.

The most good reviews about minimally invasive methods: microdiscectomy, endoscopic discectomy or laser removal of a hernia.

Such an operation on the spinal column is not very painful and not as terrible as it seemed.

The pains go away for several days, there is no need to observe bed rest, only some restrictions are required in the load on the spine.

Disability after a discectomy

There is an opinion that after an operation on the spine a person becomes disabled. This is not true. After all, the operation to remove a herniated disc in most cases fulfills its goal - to cure a person and return it to normal load.

Hospital sheet after removal of the hernia is prolonged to -2 months.With a favorable course, the patient returns to work.

If the work is connected with heavy physical labor (lifting weights, working with a shovel, monotonous flexion-extension of the back), such patients the list of incapacity for work can be extended to 4 months or through a commission VC issued a certificate for an easy work.

The patient is referred to the commission for the disability appointment only in the absence of the effect of the operation: with a continuing pain syndrome, neurological impairment of functions.

Cost of operation

A discectomy can be made free of charge by the MHI policy in any neurosurgical unit.

If desired, you can be operated in a private clinic, selecting a doctor, agreeing the method of operation.

The cost of surgery to remove herniated discs in different clinics varies from 30 to 120 thousand rubles.

A source: http://operaciya.info/orto/mezhpozvonochnaya-gryzha/