The latest technological advances have also been reflected in medicine. This is based on technical advances that allow us to obtain a view of the surgical field through small incisions, in radiodiagnostic systems and intraoperative navigation techniques. Thanks to them, it is possible to perform operations with minimally invasive techniques. Dr. Pedro Mata Gonzalez, a neurosurgeon expert in this type of intervention, explains the advantages of these techniques that “allow us to achieve the surgical objectives with minimal aggression for the patient, obtaining recoveries in times that were unthinkable until recently and with minimal risk for the patient”.
What techniques are used to treat such a common injury as Lumbar Disc Herniation?
Microsurgery and Endoscopic Surgery are the techniques of choice for the surgical treatment of disc herniation. These consist in the rupture of the disc between the vertebrae, which when coming out compresses the nerves or the spinal cord. Through a minimal incision and thanks to a working cannula with an endoscopic camera or with the help of the surgical microscope we can extract the fragments of the disc that are compressing the nerves.
What are the advantages for the patient?
These procedures last less than an hour, the anatomical alteration is minimal, and the patient can be discharged after 24 hours. Thanks to them we obtain a magnified view of the surgical field, the nerves and the hernia without the need to expose large areas and without large scars.
In which cases should a herniated disc be operated on?
It is always necessary to individualize each case. Surgical treatment is indicated when there is neurological damage, with loss of strength or alterations in sensitivity, or pain that does not subside with medical treatment or in patients who, due to the size of the hernia, imply a significant risk.
Can these procedures be applied to other hernias such as cervical hernias?
Cervical herniated discs are also treated by microsurgical procedures and the latest technical developments have achieved disc prostheses that allow movement of the spine similar to the natural disc. Although these prostheses are indicated only in a specific group of lesions.
Can minimally invasive surgery also be used in canal stenosis?
Yes, with the passage of time and the aging of the spine, a narrowing of the spine can occur, resulting in oppression of the nerves, producing pain and tingling and gradually reducing the mobility and movement capacity of patients. There are different minimally invasive techniques, depending on the degree of involvement.
What do these interventions consist of?
Percutaneous interspinous devices: in mild and moderate cases, or in patients with diseases that complicate a major surgery, we can use procedures under local anesthesia that consist of placing percutaneously through a 1 cm hole, a device to reduce the thickness of the yellow ligament and increase the diameter of the exit holes of the nerves.
Microsurgical recalibration: this procedure is performed under general anesthesia. It consists of increasing the diameters of the lumbar canal, both the central and lateral exit orifices. It is performed with the use of a surgical microscope or magnifying lenses with frontal light. The objective is to obtain space for the nerves at the expense of reaming the walls of the ducts while respecting the intervertebral joints and therefore the stability of the spine.
Lumbar arthrodesis-Posterior fixation using minimally invasive techniques: in some patients it is necessary not only to decompress the nerves but also to stabilize the spine because it is initially unstable or because decompressive surgery can destabilize it. In a large number of cases we can do this with minimally invasive procedures, minimally altering the back musculature and obtaining the objective of fixing the spine with recovery times that were unthinkable until recently. Depending on the case, semi-rigid or dynamic rigid systems may be used.