Endoscopic surgery of herniated discs for efficient back pain relief

10. 6. 2018

Vžhżez plotānky 4A chronic back pain radiating into a limb is mostly caused by a herniation (prolapse) of an intervertebral disc, which presses the root of the adjacent spinal nerve and is also the most prevalent reason for a surgery. By contrast to a conventional spinal surgery, an innovative medical approach involves advanced mini-invasive and endoscopic procedures. Such procedures are carried out with close monitoring by an endoscopic camera, without general anaesthesia and necessity of hospitalization, and the treatment of a damaged disc takes no more than 90 minutes.

How does a herniated disc occur?
The spine consists of 33 vertebrae and is divided into five main regions – cervical, thoracic and lumbar spine, sacrum (hiatus sacralis) and coccyx. In the event of hernia of a disc in the lumbar region, the main “protagonists” are five lumbar vertebrae numbered L1 to L5.
A disc is a cartilaginous plate lying between individual vertebrae and is to serve as a “cushion” absorbing shocks between them. It consists of the outer solid ring and inner gel-like center. When a disc becomes worn, e.g. due to the age (degenerative changes of the spine), an injury or excessive strain when lifting heavy weights, the outer ring may become ruptured and the gel-like center is “pushed out” into the spinal area. It results in oppression of the spinal nerve, which causes pain.

Can I find out myself that I have a herniated disc?
A herniated disc is diagnosed by a physician – specialist based on the results of MRI or CT. However, you can identify the signs of prolapse yourself, moreover if your pain lasts over a long period (pain lasting more than three months is classified as chronic). In the affected part of the back, especially in the lower back, you can feel a dull, stabbing or burning pain which very often shoots into a lower limb (or into a hand as well if a herniated disc is located in a higher spine region). Typical signs are stiffness, muscle cramps, numbness in various parts of a leg (fingers, toes), and often immobility of the leg. These signals, which are caused by the oppression or irritation of a nerve root by a herniated disc, rank in the group of “root pain” which is a sign of the root or radicular syndrome, and constitute a reason to see a specialist without undue delay.

What is the difference between a conventional surgery and an endoscopic procedure?
The patient of the Clinic of Mini-invasive and Endoscopic Back Treatment undergoes an initial examination and precise back diagnostics to confirm the source of pain. Subsequently the physician sets out a treatment plan with the most appropriate and effective therapy. In many cases, the diagnostic procedure itself is sufficient to relieve the pain, as a medicine is applied in the place of pain with millimeter accuracy during the procedure. If the effect is not sufficient, the patient undergoes further procedures that may involve advanced endoscopic procedures including a disc surgery. All the procedures are carried out as mini-invasive ones. This is the basic difference from a conventional surgery of spine, during which the skin is incised, back muscles and tissues are pushed aside, and the prolapsed part is removed under a microscope. An endoscopic surgery does not require such an open access.

How is an endoscopic procedure performed?
The surgical instruments are introduced into the spinal space through the entry opening sized approximately 1 cm, and the procedure itself is performed with the aid of an endoscopic camera which shows the space throughout the surgery. The herniated part of the disc is removed with special forceps, and the disc undergoes thermal radiofrequency treatment at the end of the procedure in order to prevent repeated prolapses. With the aid of a special endoscope (epiduroscope) introduced through the sacrum, the epidural space is examined for any other pathologic changes that could cause pain – such as enlarged ligament that may press the spinal root. This ligament (i.e. epidural fibrosis) is broken up by a laser fiber. An anti-inflammatory medicine may also be administered. The procedure takes no more than 90 minutes and is performed in local anaesthesia (analgosedation). After approximately two hours of bed rest, the patient returns home.

The surgery has been done. What is next?
Before discharge, the patient undergoes an examination during which the physician explains to the patient all the regimen and movement recommendations that should be observed, especially in the first two weeks after the procedure: how to reduce burden, how to walk and sit in an appropriate manner, what to avoid e.g. when driving a car or during exercises and sports. However, this is not the end, because this is followed by further telephone and online check-ups taking place in regular intervals as well as the final physical examination carried out after three months from the surgery. All this time, the patient is in the care of the physician, consults the physician about his/her health, pain intensity and feelings, and may contact the physician at any time either directly or through a special hotline.

Is the surgery always successful?
Mini-invasive methods of treatment are based on scientifically verified procedures of “evidence-based medicine” and follow the recommendations of international organizations for spine treatment. However, it is necessary to bear in mind that this type of treatment is not necessarily suitable for every patient and, just like with other surgeries and other diagnoses, the patient might not get rid of the pain completely or to an extent he/she expected. Each patient also perceives the intensity of his/her pain differently. However, the advantages of mini-invasive and endoscopic procedures are provable – in addition to a number of clinical benefits, such as a lower risk of damage of muscle and bone structures, slighter bleeding, lower formation of ligament adhesions after the surgery or occurrence of infections, it is clearly a faster recovery and return to daily activities, which are important factors for a person suffering from pain over a long period. Ordinary activities are usually resumed by the patient after 6 weeks from the surgery.

Lower back pain or when “back goes out”
This type of pain technically known as ischias or lumbago cannot be omitted either. It is a severe acute pain in lower back, or rather blockage of the lumbar spine. In most cases it occurs as a result of lifting a heavy object or inappropriate body rotation, sometimes as a result of cold or an improper sleeping position. Lumbago involves damage of muscles, joints and ligaments in the lumbar spine region and is mostly treated by rest, pain relieving medicines and rehabilitation.  In severe cases, the pain is caused by the pressure of the prolapsed disc on the roots of the sciatic nerve (i.e. in the place where it connects to the spine) and is accompanied by shooting into a leg. If the condition is left untreated, it may result in permanent impairment and damage of nerves.

That is why, just like with any diagnosis, and all the more when back and spine are concerned, the sooner we seek medical help, the sooner we prevent problems and pain in a later period, e.g. also in the relapse of the condition!

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