The human spine is quite flexible, it has a high strength, since one of its functions acts to protect the spinal cord along the vertebral canal. However, due to excessive load, a bad fall or because of age-related changes it can develop a herniated disc (often lumbar).
He is represented by the small size of the cartilaginous disc that lies between adjacent vertebrae and provides cushioning and support the spine.
The intervertebral disc is constructed of an outer shell and inner substance. In the case of forced loss of content due to certain circumstances, it presses on the nerve roots or spinal tissue. In this case, the person feels expressed painful sensation, the possible loss of sensation in certain areas of the body, up to disability.
Surgical pathology solution performs discectomy – surgery complete or partial removal of the intervertebral disc. When excision is achieved by the reduction (or complete elimination) of pressure on nanocores. In certain embodiments, the discectomy is performed in combination with laminectomy, which is a deletion of part of the vertebra.
Initially, this operation was carried out in 1922 by Adana on the cervical spine in a herniated disc. So far, the described method of surgical intervention is considered the most acceptable in the treatment of the prolapsed disc.
In the most part resorted to conservative method of treatment, comprising:
- the appointment of anti-inflammatory medication;
- epidural introduction of medications into the area of inflammatory changes narokoroko;
- special figurante to reduce the pressure of the blade on nanocores.
In some embodiments, the transformed disk as a result of this treatment is deployed or takes a position which does not interact with necroeconomy. In this case, the clinic hernia quenched, and the patient comes relief.
Surgical treatment is necessary when there is the following syndrome:
- pain and numbness in certain areas of the body that do not undergo a prolonged period;
- in the muscles there is a pathological weakness;
- depending on the place of compression narokoroko develop problems from the systems( for example in the lower back – abnormal urination and defecation);
- expressed pain defies even the relief of potent medicines;
- on Grajewo the protrusion of deposited calcification;
- there is an increase in the size of the formation.
In spite of sufficient simplicity of surgical intervention, and of the latter there are some limitations:
- reduced bravesbaltimore;
- diabetes mellitus;
- cardiac failure;
- infectious and other sporitelny process in the body;
- diseases of the respiratory system.
The preparatory period
We first performed a rigorous medical history, a mandatory examination of the patient with understanding the nature of pain (duration, location, etc.).
Additionally performed MRI to determine the exact location of the prolapsed disk. In the last decade is the procedure for discography, which involves the insertion in the intervertebral disc contrast agents with subsequent exposure. In addition also carried out a standard set of laboratory blood tests and ECG.
Three options – three approaches
The operational manipulation itself is performed in three variants:
- Classic. Applies General anesthesia. This operation is performed in the region of the lumbar and made through the rear access. In a certain area is performed an incision of the skin (up to 100 mm). The surgeon pushes the muscle mass spetsinstrumenta, then icsacompliant disk, if necessary, conducts a cauterization of the nerve roots, and at the end of the operation produces a layer-by-layer suture wounds. The entire operating period lasts approximately two hours.
- Microdiscectomy (microsurgical discectomy). It involves a small incision of about three inches.Manipulation is carried out using the operating microscope. Originally apart of the muscle, and then discharged in the direction of nanocores, and then deleted the tissue of the intervertebral disc.
- Endoscopic (minimally invasive) discectomy. The least traumatic method. Incision is made 1.5-2 cm, then posredstvom endoscope deleted the disk. The surgery is performed with epidural or local anesthesia.
Adjacent vertebrae after surgical intervention are fused. In some cases, you may need transplantirovannam bone mass to maintain the spinal column. Then, in wound field inserts the drainage tube is extracted after a certain time.
Advantages and disadvantages
The negative side is the possibility of the formation of certain complications:
- recurrent prolapse internal part of the disc in the case of an incomplete excision;
- the development of the inflammatory process in the spinal tissue;
- numbness of the skin or of its individual parts because of the damage necroeconomy;
- the development of thrombosis in the veins of the legs;
- enuresis and disorders of defecation (incontinence).
Rarely in the case of destruction of the dorsal roots or spinal tissue may develop paralysis.
On the positive side should be attributed fairly rapid and lasting effect. After excision of the hernial diverticulum already after a short period the patient can come to normal life. Expressed regress of pain, goes numb, normal General and neurological symptoms disappear.
The recovery period
After surgery a period of rehabilitation in which the patient should be in a horizontal position on the back, at least 24 hours. Sitting is allowed only after 30 days. The stitches are removed after two weeks.
After some time introduced moderate fiznagruzki, but prohibited from lifting more than 3-4 kg For 60 days is shown wearing a special medical corset which holds the spine.
In the presence of pain in postoperational period shown analgesic drugs.