What is a lumbar disc herniation?
A lumbar disc herniation is the rupture of the intervertebral disc and its exit into the spinal canal compressing the nerves.
The intervertebral disc is a cushion that we have between the vertebrae and its rupture causes its contents (the nucleus pulposus) to come out, which invades the vertebral canal and compresses the nerves. This can give rise to lumbar pain (low back pain) and/or pain along the leg (sciatica), as well as alterations in sensitivity, referred to by the patient as tingling, cramping, numbness and/or alterations in strength, especially in foot movements.
95% of lumbar disc herniations occur at the L4-L5 and L5-S1 levels, also better known as L5 S1 disc herniation and L4 L5 disc herniation. Although it can appear at any age, it is exceptional for it to appear below 20 and above 60 years of age. The ideal test for its diagnosis is Magnetic Resonance Imaging and, failing that, CT.
When is surgical treatment indicated?
Although it is always necessary to individualize each case, in general, surgical treatment for lumbar disc herniation is indicated in the following cases:
1. Pain that does not respond to medical treatment.
2. Pain that reappears when treatment is suspended.
3. Presence of neurological injury (loss of strength or sensitivity).
4. Risk of neurological injury
What does the intervention of a lumbar disc herniation consist of?
The surgical treatment of a lumbar disc herniation consists of removing the portion of the disc that compresses the nerves. Various techniques have been developed to perform the herniated disc operation, depending on the characteristics of the lesion and the patient.
Microsurgery-Discectomy: This is the “queen” technique in the treatment of lumbar disc herniation. The operation is performed under general anesthesia and through an incision in the midline of the back in the lumbar region varying the height according to the level of the hernia and length, depending on the constitution of the patient (2-4 cms. approx.). With the aid of the microscope or magnifying loupes with frontal light. A “window” is made in the ligament that joins the posterior part of the vertebrae (yellow ligament) and, if necessary, the bony ridge of the vertebral lamina is lowered a few millimeters to allow reaching the injured disc.
Subsequently, the disc fragments compressing the nerves are removed. The removal of the disc is not total, basically extracting the portion of the disc that compresses the nerve root, thus leaving the disc between the two vertebrae. The approximate duration of the procedure is less than one hour. Generally, the patient is up and about in less than 12 hours and is discharged from the hospital on the second day after the operation. Subsequently, a protocol of physical measures and postural hygiene should be followed in order to obtain the best results.
Complications of lumbar disc herniation surgery>>.
– Need for reoperation because of disc remnants, fibrosis or instability of the lumbar spine.
– Deficits due to nerve root involvement (pain, tingling), transient or persistent.
– Infection of the disc wound (0.4- 3%).
– Cerebrospinal fluid leakage.
– Mortality (0.02%).
Nucleoplasty, the treatment for small hernias.
In the case of small disc herniations or disc protrusions that compress the nerve root, especially those of foraminal location, we have the option of performing this technique.
Nucleoplasty consists of the use of intradiscal radiofrequency. It is performed in the operating room, with local anesthesia and light sedation. Guided by RX, we place through a percutaneous puncture, an electrode inside the disc. Once the ideal placement is obtained, radiofrequency is applied on the disc and the electrode is removed. With this, the volume of the disc is reduced and therefore, the nerve root is released. The procedure lasts approximately 30 minutes. The patient can be discharged a few hours later and return to a normal life.