Operation of a herniated disc in the lumbar spine
introduction
The Lumbar spine (Lumbar spine) is relatively often affected by herniated discs because of the long sitting times in today's society.
It is important to have a real one Herniated disc of the lumbar spine, so Prolapse, from other complaints such as the symptoms of a Lumbago (lumbago) to delimit.
While a real herniated disc of the lumbar spine may require an operation to prevent further damage, back pain without a specific incident can usually be managed well in other ways.
As with all So it is also in the lumbar spine area with herniated discs It is important to clearly distinguish when you should really have an operation and when the conservative measures are sufficient. You shouldn't be too hasty. The majority of the lighter herniated discs, in particular, can be treated very conservatively.
Indication for an operation
Even if the decision for or against an operation depends on the patient's individual ideas, there are still a few points that can be used as a guide.
If an operation is in the offing, it is particularly important to start with a very careful one Diagnosis to operate to rule out other causes.
Also should be a good imaging the affected region. Only with the help of an accurate assessment of the herniated disc using MRI of the lumbar spine or CT it is possible to decide whether and how to operate.
If possible, it should be one MRI of the lumbar spine performed in order to avoid the radiation exposure of a CT.
If a herniated disc can be seen from these images, the indication for an operation also depends mainly depends on the symptoms.
For example, there are often abnormal findings in MRI or CT images in healthy people, but these do not cause any symptoms.
That is why above all the extent of the actual impairment crucial for an operation. In particular, the subjective extent of complaints is the most important evaluation criterion for an operation of a herniated disc of the lumbar spine.
Besides the Pain stand above all Disorders of the affected nerves in the foreground. This can be done for example Numbness or tingling of the legs or feet express.
Other disorders of sensation, for example disturbed tactile or touch sensation are possible.
In some cases, these findings can be made using electrophysiological methodswith which the Nerve conductivity can be measured, recorded objectively.
In addition to the nerves that guide the sensation of the legs, the nerve fibers that are responsible for the bladder and the rectum are responsible.
If there are functional disorders in these areas or in the sexual function, an operation should always be carried out.
Besides the sensitive areas can of course also have one in the area of the legs Paralysis of the motor parts of the nerves arise. Also pronounced Paralysis (Paresis) are an indication for surgery.
Pain can usually be treated well, but if this is not possible, surgery can also be considered for this reason. Usually the pain relief already occurs right after the operation on.
If none of the above points apply, i.e. the bladder and rectum are not affected, no severe paralysis or severe pain occurs, this is usually the case conservative be treated.
Regardless of the symptoms, surgery may be necessary if the pain or other problems are purely through one mechanical impairment arise. Even then, it is often not possible to alleviate the symptoms conservatively as long as the cause persists.
If there is no improvement after about two months of conservative therapy, this can speak for an operation.
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A herniated disc is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.
Therefore, treating a herniated disc requires a lot of experience.
The aim of any treatment is treatment without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.
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Duration of the operation
The surgery itself usually takes about 30-60 minutes. Depending on the individual condition is then a Hospital stay of a few days necessary.
Only about two weeks after the operation, the physiotherapy began.
First of all, you shouldn't sit too much. Therefore, a precise plan is usually drawn up as to how long you can sit every day.
After about 4 weeks you can usually go again without restrictions sit and start light exercise. Back-friendly sports such as swim or to jog are mostly after about 6 weeks again possible without major restrictions.
Activities that put more strain on the back can usually only be resumed after about 12 weeks.
Surgical method
There are a number of surgical procedures available to operate on a herniated disc in the lumbar spine area.
Which method is used exactly then depends on a number of factors.
Besides the exact location and type of incident the individual ones also play anatomical conditions and of course the patient's wishes also play a role.
The preferences and experiences of the surgeon or the clinic usually mean that not all methods are used everywhere.
However, the differences between the individual methods in terms of the quality of the results are usually not great.
The Standard procedure usually consists of operating on the herniated disc from the back of the body.
Then the incident is exposed and then removed. If necessary also will other soft tissue or bone tissue removed that on the Nerve root presses.
Symptoms can only be alleviated when this is completely exposed.
Depending on the location of the incident, side access can also be selected. Now the operation is often called either minimally invasive or as microsurgical procedure offered, but studies have so far not shown any clear advantages for either method.
All operations are done under X-ray control.
At the open microsurgical method access is via a small skin incision, through which the nerve root is then exposed.
With the endoscopic minimally invasive surgical method a rigid tube with optics is used, which is usually inserted from the side. This tube can then be operated on using fine instruments, similar to the usual appendix operations. This procedure requires a slightly smaller skin incision. The minimally invasive procedure is intended to promote the formation of Reduced scar tissue in the area of the skin wound become.
Both methods can be used in addition to normal methods laser are used. These can be used to cut as well as to evaporate fine fiber fractions if they are too small for normal removal.
In all procedures it is important enough cartilage to remove. If too much cartilage remains in the area of the intervertebral disc, it can slip and lead to another herniated disc.
Sick leave after an operation
The length of sick leave depends on the person individual living conditions and above all from the professional activity from.
In this way, lighter and short work phases can of course be resumed earlier than heavy physical work.
As a rule, one should be on sick leave of about 6-12 weeks calculate.
Depending on the profession, it may also be necessary or possible, initially as part of a Reintegration only partially to go back to work to allow slow acclimatization.
In some cases it is a Rehabilitation after a herniated disc necessary, which extends the time of sick leave accordingly.
Risks of surgery for a herniated disc of the lumbar spine
Disc operations of the lumbar spine are - contrary to the general opinion of the layperson - as low risk Interventions. However, as with any surgery, there is a risk of complication how Wound infections, healing disorders, bleeding or general surgical risks.
Also one Nerve damage cannot be ruled out during an operation in nerve-rich regions.
Then there is the risk from the anesthesia and general stress on the body from hospitalization.
In addition, one should be aware that the operated spine is not a new replacement. As a rule, the pain disappears after the operation, but it can always be the case that the symptoms do not subside.
Also through Scarring after the operation can it to Pain or restriction of movement come.
In the case of a herniated disc in the lumbar spine, the nerves of the L4 / 5 and L5 / S1 nerve roots are particularly at risk.
The consequences of damage to the nerve root can be found at:
- Herniated disc L4 / 5
and - Herniated disc L5 / S1
Rehabilitation after an operation
As with most orthopedic diseases, rehabilitation is also important after a herniated disc in order to maintain the success of the treatment in the long term. However, this usually begins after a herniated disc not right after the operation.
Rather, the spine becomes in the first two weeks especially relieved. Therefore you should lie as much as possible during this time, because then the The least amount of force acting on the spine is.
That too Go may be resumed very quickly after the operation.
Sit but should be avoided as far as possible, so there are usually precise plans from when you can spend a certain amount of time sitting again. You usually start with around 10 minutes per day and then slowly increase this time.
During this time you can too passive exercises to activate the muscles and Lymphatic drainage are used.
In the 4th to 6th week after the operation you can then increase physiotherapy to be started. Also back-friendly sports, especially light ones swim, can be started.
From the 7th week the load can then be increased further. Here, too, you should make sure that sports or physiotherapy do not cause pain should.
After about 12 weeks, full resilience is usually achieved again. Around to avoid further herniated discs, but you should continue afterwards Exercises to strengthen the back muscles carry out.
The exact healing process differs from person to person, so all plans and times are given always only guidelinesthat can differ individually.
