¿What is a lumbar disc herniation?
A lumbar herniated disc is the ruptured intervertebral disc and vertebral canal out, compressing nerves.
The intervertebral disc is a pad that we have between the vertebrae and breaking produces comes out the contents ( nucleus pulposus ), which invades the spinal canal and compresses the nerves. This can lead to both back pain ( back pain ) and / or pain radiating down the leg ( sciatica ) as well as changes in sensation, referred by the patient as tingling, numbness, stiffness and / or power changes, especially in the movements of the foot.
The 95 % of lumbar disc herniations occur at levels L4- L5 and L5 -S1, they are also the best known as herniated disc L5 S1 and hernia L4 L5 disc. Although it can occur at any age, it is exceptional to do it for under 20 and above 60 years. The ideal test for diagnosis is the Magnetic Resonance and failing CT.
¿When surgical treatment is indicated
While you should always individualize each case, in general, the surgical treatment for lumbar disc herniation is indicated in the following cases:
1 Pain does not respond to medical treatment
2 That reappear after discontinuation of treatment pain
3 Presence of neurological injury (loss of strength or sensitivity)
4 Risk of neurological injury
¿, which consists in the intervention of a lumbar disc herniation
Surgical treatment of lumbar disc herniation is remove the portion of the disc compressing nerves. To make the operation of herniated various techniques have been developed according to the characteristics of the lesion and patient.
Microsurgery - Discectomy: Is the art“Queen” 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 by varying the height according to the level of the hernia and length, according to the constitution of the patient (2-4 cms. approx.). Using a microscope or magnifying loupes with front light. & Rdquo window, a practiced“ligament which connects the back of the vertebrae ( yellow ligament ) and, where it is necessary, a few millimeters the bony rim of the vertebral lamina is lowered to allow to reach the damaged disc.
Subsequently, the disc fragments that compress the nerves are removed. The extraction of the disk is not full, basically removing the portion of the disc compressing the nerve root, so running disc between the two vertebrae. The approximate duration of the intervention is less than one hour. Generally, the patient gets up in less than 12 hours and is discharged on the second day of the intervention. Should continue later with a protocol of physical and postural hygiene measures in order to get the best results.
Complications of lumbar disc herniation operation
- Need to re- intervene because remnants of the disk, fibrosis or instability of the lumbar spine
- Deficit by affectation of persistent nerve root (pain, tingling), transient or
- Infection of the wound disc ( 0,4- 3% )
- Departure of cerebrospinal fluid
- Mortality ( 0.02 %)
The nucleoplasty, treatment for hernias small
For small-sized herniated discs or disc protrusions that compress the nerve root, especially those of foraminal location, we have the option to perform this technique.
Nucleoplasty, involves the use of intradiscal radiofrequency. It is performed in operating room under local anesthesia and light sedation. Guided by RX, put through a percutaneous puncture, an electrode inside the disk. Once the perfect placement of the RF drive is applied and the electrode is removed. This is achieved by reducing the volume of the disk and thereby release the nerve root. The procedure lasts approximately 30 minutes. The patient can be discharged within a few hours and join a normal life.