The intervertebral discs ("discs") lie between the body of the vertebrae. Degenerative changes of the intervertebral disc, colloquially called "discopathy", are a common cause of back pain. When nerve root compression occurs in the course of "discopathy", symptoms such as sensory disturbances and pain radiating to the upper or lower limb, decreased muscle strength (paresis) or urinary incontinence may appear. The indication for surgical treatment is pain resulting from advanced structural changes leading to pressure on the nerve structures, which cannot be removed by conservative treatment. Surgical treatment methods include a number of techniques and procedures, the ultimate choice of which is with the neurosurgeon. The overall aim of the operation is to decompress the nerve structures by removing the conflict with the nucleus pulposus emerging from the degenerated intervertebral disc.
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Intervertebral disc degeneration stages
The intervertebral disc consists of a centrally located nucleus pulposus and a circumferentially lying fibrous ring. The nucleus pulposus slides within the fibrous ring in response to movements in the spine, e.g. during a forward bend, the nucleus pulposus moves backward towards the spinal canal where the spinal cord and the nerve roots that emerge from it lie. Increased load on the lumbar spine (prolonged bad sitting position, heavy physical work) leads to a gradual weakening of the structure of the intervertebral disc. Over time, the nucleus pulposus begins to penetrate more and more into the fibrous ring gaps. There is a risk of the pulmonary nucleus protruding beyond the circumference of the intervertebral disc and putting pressure on the nerve roots, the meningeal sac or the spinal cord.
Depending on the severity of "discopathy", there are changes of the type:
Herniation - displacement of the pulp pulp within the damaged fibrous ring, the nucleus pulposus does not extend beyond the circumference of the fibrous ring,
Hernia - the nucleus pulposus protrudes beyond the fibrous ring, but its continuity remains intact,
Sequestration - the nucleus pulposus is fragmented and separated from the intervertebral disc.
Symptoms of pressure on the nervous structures
Symptoms of compression of the nucleus pulposus on the spinal roots are pain of a radiating nature in the area consistent with the innervation. In the course of a hernia of the intervertebral disc within the cervical spine, the pain may radiate to the shoulder, elbow and fingers (shoulder tear). "Discopathy" at the level of the lumbar spine can manifest as pain radiating to the thigh, knee and toes (sciatica). The pain may be accompanied by paresis of the muscles supplied by the nerve, depending on the pressure level, e.g.
L5 - weakness of the muscles of the anterior shin group, inability to stand on the heel, foot drop while walking,
S1 - paresis of the muscles of the posterior group of the lower leg, inability to walk on the toes.
The symptoms described above may affect one or both of the legs. Heavy pressure on a few nerve roots can weaken the muscles of the urethral sphincters, resulting in urinary incontinence.
Surgical treatment indications
Surgical treatment is performed in the states of irreducible hernia or nucleus sequestration. Surgical decompression of nerve structures is indicated in the following cases:
persistent pain despite the implementation of rehabilitation treatment, the use of anti-inflammatory and analgesic drugs and injecting the spine with a steroid,
conditions indicating advanced compression of the nerve roots - muscle paresis or urinary incontinence,
In the qualification process for the procedure, the analysis of magnetic resonance images of the spine is also performed in correlation with the observed clinical symptoms.
Surgical treatment methods
Surgical treatment consists of a set of procedures that can be modified or combined depending on the patient's anatomical conditions and the neurosurgeon's expertise in particular techniques. Examples of surgical treatment for herniated release of an intervertebral disc are:
Endoscopic discectomy,
Microdiscectomy with possible laminophoraminotomy,
Removal of the hernia of the intervertebral disc from the anterior approach and insertion of the implant between the vertebral bodies (cervical spine),
Cloward surgery (removal of a hernia with spondylodesis using a bone taken from the iliac plate),
Placement of a removable intervertebral disc prosthesis.
Important information
| Duration of the procedure (depending on the method) | |
| Tests required for surgery | morphology, coagulation, electrolytes, blood group |
| Anesthesia | |
| Hospital stay | |
| A period of significant dysfunction | |
| A period of limited dysfunction | |
| Removal of stitches - first visit | |
| Change of dressings | |
| Contraindications to the procedure |
Frequently asked questions about hernia surgery of the intervertebral disc:
Performing the surgery is recommended when:
the pain persists despite the implementation of rehabilitation treatment, the use of anti-inflammatory and analgesic drugs and injecting the spine with a steroid,
there is muscle paresis or urinary incontinence - these are conditions indicating advanced compression of the nerve roots, requiring urgent surgical intervention.
The aim of the surgery is to decompress the compressed nerve structures by removing the nucleus pulposus that has slipped out of the degenerated intervertebral disc. The choice of surgical access and the procedure technique is up to the neurosurgeon who qualifies the patient for surgery.
