Lumbar Disc Herniation Surgery

Lumbar hernia surgery is performed in patients who have severe back and leg pain due to herniated disc disease and sometimes who develop paralysis. Such patients; They do not benefit from conservative treatments such as medication, physical therapy, prolotherapy, epidural steroid injections. Depending on the surgeon's preference, different lumbar hernia surgery techniques can be used according to the patient's current need. These are three types of surgical intervention.

1. Lumbar hernia surgery performed with classical open surgery

2. Microsurgical lumbar hernia surgery (Microdiscectomy)

3.Endoscopic lumbar hernia surgery

When Is Lumbar Hernia Surgery Recommended?

The most curious issue by patients is the question of when should I have surgery. If leg pain due to lumbar hernia is severe, if the pain does not disappear with conservative treatments; For example, if the patient is unable to sleep due to pain, has difficulty in going to work, or is difficult to do daily activities, surgery may be recommended to the patient. If paralysis of the legs and feet has developed and urinary incontinence has started, the situation is even more serious and an indication that emergency surgery is required. A neurosurgeon should be consulted as soon as possible.

Classic Open Lumbar Hernia Surgery

A microscope is not used in this surgical technique. 4 cm at the waist. and an incision is made on it. The waist muscles are stripped. Then, the spine and some of the ligaments are removed. Lumbar hernia is removed by excluding the nerve root. The difference from microsurgery is that a microscope is not used and a large incision is made. It is a technique that is not preferred much today.

Microsurgical Lumbar Hernia Surgery (Microdiscectomy)

The main feature of lumbar hernia surgeries performed with microsurgery is that they are performed using a microscope. Why do we use microscopes? You can see the tissues 40 times larger in operations. This makes the surgeon better distinguish the tissues and minimizes the possibility of damage to the nerve. This procedure is also called microdiscectomy.

The surgery is performed under general anesthesia. The way the patient lies on the operating table is in the prone position. The waist is slightly bent. 1.5-3 cm to the area that fits the targeted area in the surgery. A skin incision is made in between. The back muscles are stripped from the spine bones. With a laminectomy, some spinal bone is removed and an area where the surgeon can work is opened. Microscope is brought to the surgical field. After the connective tissue we call yellow flavum is removed, the nerve root is pulled aside towards the midline with the retractor. The part that puts pressure on the nerve is found and removed with surgical tools. It is sufficient to reduce the pressure on the nerve.

In the video below, you can watch the lumbar hernia surgery performed with microsurgical technique.

http://www.youtube.com/watch?v=qhyuvTIGeko

Full Endoscopic Lumbar Hernia Surgery

Lumbar hernia surgery performed using endoscopic devices is called " full endoscopic lumbar hernia surgery ". It is referred to as "Full Endoscopic Spine Surgery" in English. It is the most current lumbar hernia surgery technique.

Minimally invasive spine procedures have evolved rapidly over the past decade. Efforts to reduce muscle crush injuries during prolonged operative periods, avoiding significant soft tissue injuries, and efforts to minimize bone resection are surgical principles used to reduce postoperative pain and disability to patients. Full endoscopic lumbar hernia surgery enables the spine surgeon to reach the spine pathology using these principles. Endoscopic techniques have evolved and innovated for over 30 years. Currently, endoscopic techniques are used for pathologies in the cervical, thoracic and lumbar spine. There is a great deal of literature supporting its advantages in terms of less morbidity and fewer complications. The endoscopic spine technique has also started to be used in cases of degenerative spinal stenosis , spondylolisthesis , scoliosis , previous fusion surgery, tumor and infection. As technological advances continue to simplify the surgical technique and expand the indications for use; Endoscopic spine surgery will provide surgeons with a hands-on approach to the treatment of spinal diseases and will further raise the standard of care in the treatment of patients.

Performing the surgical procedure requires special equipment and surgical experience. The hand tools used are smaller than those used in microsurgery. The advantage over microsurgical technique is that the same procedure can be easily performed without damaging the muscles and bone tissues.

According to the surgeon's preference; It can be easily applied under general or local anesthesia. The surgeon can perform this operation on a compatible patient, preferably without putting the patient to sleep. 0.5 - 1 cm to the waist area. A small incision is sufficient. We have the opportunity to reach the spine from the middle of the waist (interlaminar) or from the lateral side of the waist (transforaminal). You can imagine this method as follows. A pen-sized tool is sent through your waist. In such a small working area, this procedure can be performed with surgical instruments. Thus, the process is carried out without damaging the tissues. After the operation, the patient can be sent home 3-4 hours later.

Advantages of endoscopic lumbar hernia surgery compared to microsurgical lumbar hernia surgery:

• It can be performed with local anesthesia and mild sedation. So the patient is not put to sleep. This eliminates the risks that general anesthesia may bring to the patient.

• Making a small incision of 1 cm means that there is very little cosmetic scar on the patient.

• Little damage to the tissues in the operation area. It reduces the scar tissue that may occur on the nerve. Even in case of recurrence of herniated disc, it ensures that the operation can be performed easily and possible complications are minimized.

• The patient can quickly return to his normal activities.

• The patient can be discharged on the same day.

• It greatly reduces the risk of infection. There is very little bleeding.

• Multiple hernias can be intervened through the same hole.

In the video below, you can watch the operation of a case performed with the interlaminar technique, as a full endoscopic procedure.

http://www.youtube.com/watch?v=0kAo5Ud2Zzo

The Questions Patients Are Curious About About Lumbar Hernia Surgery

• Will the lumbar hernia recur, that is, it recur?

There is a recurrence rate of 5%. This ratio is based on the patient's compliance with the doctor's recommendations.

in case it drops even more. It is imperative not to do heavy work after the operation.

• Are fully closed endoscopic lumbar hernia surgeries repeated more frequently?

There is a possibility of recurrence at the same rate as lumbar hernia surgeries performed with microsurgery. So this rate is again 5%.

• Will the lumbar hernia surgeries performed with microsurgery repeat?

Yes it can. This rate is 5%.

• Is paralyzed in lumbar hernia surgery?

Technological imaging devices such as microscopes and endoscopes that we currently use help surgeons a lot because they enlarge the surgical area. That's why; The probability of developing a stroke is low in an operation performed by an experienced surgeon.

• Is lumbar hernia surgery a failed surgery?

No way. As long as you are careful after a good surgery and listen to your doctor's recommendations, you will not have any complaints for many years.

• Will my pain and numbness continue after lumbar hernia surgery?

Although the pressure on the nerve is removed after surgery, the nerve continues to give a pain signal. This is called neuropathic pain. Postoperative pain and numbness may persist for 1-3 months. Patients should not worry about this. Medications to reduce this pain will be given by your doctor.

• How do I know if my lumbar hernia has recurred?

With the removal of pressure on the nerve after lumbar hernia surgery, the pain decreases dramatically in terms of score compared to pre-surgery. If; If the pain reappears as severe as before the surgery, your lumbar hernia may have recurred. In such a case, it would be beneficial to have your doctor examined again.

• Before the lumbar hernia surgery, he was paralyzed, what now?

After the surgery, if your doctor deems appropriate, you may need physical therapy. Exercises recommended by your doctor and physical therapy must be done. The recovery process of the paralysis may be immediate in some patients after the surgery, or it may take a period of 6 months in some patients. Therefore, patients who develop paralysis are recommended not to delay surgery too much.

Rules to Follow After Lumbar Hernia Surgery

• After lumbar hernia surgery, pain may be felt in the wound area, but the general severe leg pain and low back pain are much less than before the operation.

• Sitting for a long time is inconvenient at first. Weight should not be lifted, excessively leaning forward and stretching the spine should be avoided for the first 1 month postoperatively.

• Your waist wound area should be kept clean and dry. If there is redness, swelling, warmth and discharge in the wound area, call your doctor.

• After 3 days, you can take a warm shower with waterproof dressings such as Tegaderm.

• Use your pain relievers according to the prescription given by your doctor.

• In the early days, short walks can be made at home.

• It is okay to go up and down the stairs.

• For the toilet, use European style toilets.

• It is appropriate to start sexual activity after waist surgery 2 weeks after surgery. Nevertheless, it is useful to be careful. Waist movements can increase your pain. It would be appropriate to have a passive relationship.

• Driving is allowed 2 months after lumbar surgery. In particular, place a brace behind your waist when driving and traveling.

• After a few weeks, cycling or swimming may be allowed.

• Generally, desk workers can start their light work after 2 weeks. Those who work in heavier jobs and have professions that require heavy physical load can start work after 4-6 weeks.

• If you are overweight according to your body mass index, try to lose weight by dieting.

Dr. Tamer Tekin