Over time, almost all humans, probably due to overload in the lumbar spine by standing, chemical changes occur within the disk, leading to dehydration. Dehydration alters the properties of the hydraulic mechanism having a healthy disc. When disc damper loses its function, the distribution of the load is transferred to the vertebral joints and ligaments which can react hipertrofiándose and narrowing the channel where the nerve roots run. Besides mechanical alterations occur in mobility between the vertebrae.
The first image is a drawing in which different degenerative manifestations that produce nerve root compression are represented. The second image is an MRI of a case with degenerative problems and hernias in the last two lumbar levels.
These morphological and functional manifestations define "lumbar spine arthrosis". The discs and the joints become inflamed and irritated cause lumbar pain, better known as lumbago. Specialists explain Traumatology when nerve roots are irritated sciatic pain or sciatica occurs.
When to operate?
In most cases there is no need to follow any surgical treatment for the ailment disappears with conservative treatments. It is therefore advisable to wait some time (at least three months) before deciding surgery. However, in many patients the pain persists over time and need to operate.
The decision to go into surgery taken with "common sense" as other major life decisions: considering the pros and cons. Consider especially future expectations and quality of life. The decision was taken when the symptoms are sufficiently important and the patient knows that will not improve if you do not operate.
Objectives of surgical treatment of lumbar radiculopathy:
Surgery has two objectives:
- Decompression. To decompress the nerve roots laminectomy, facetectomías, flavectomías, foraminotomías or disk removal (diskectomy) are performed. These actions aim to liberate the roots of compressions (Figure 2).
- Fusion or arthrodesis. Frequently, unzipping also need to merge. Fusion is the preferred method for stabilizing the lumbar levels. By this method we immobilize the vertebral levels whose mobility is sick and painful. For this purpose implants placed in the vertebrae and bone graft osteoconductive substances associated with calcium.
Thanks to the technological development of the last decade, both the descompresióncomo for the merger, we have significantly reduced the surgical aggressiveness, making it less invasive surgery using special separators, which allow much smaller incisions.