In a herniated disc, the intervertebral discs in the spine lose their protective shape. The damaged outer fibrous ring (annulus fibrosus) can no longer hold the disc’s nucleus in its central position. Due to the pressure, the nucleus protrudes outward into the spinal canal. There, it presses on sensitive nerve roots and causes severe pain.
Common causes of a herniated disc include advancing age and excessive strain on the back. Being overweight also increases the risk of a herniated disc.
Herniated discs most commonly occur in the lumbar spine. The cervical spine, on the other hand, is affected less frequently. The nucleus can protrude into the spinal canal and irritate sensitive nerve roots.
Herniated discs and their various forms © Henrie | AdobeStock
The symptoms associated with a herniated disc are varied. Depending on the location of the herniation, sudden, stabbing back pain of varying intensity may occur. The discomfort is often particularly debilitating in the lower back.
Many patients also report sensory disturbances in the legs or arms. These manifest as a tingling sensation and intensify when coughing or sneezing. As the condition progresses, this sensory disturbance can spread to the genital area and the anus. Patients may then lose control of bodily functions. In rare cases, paralysis or severe neurological deficits may even occur.
The type of treatment for a herniated disc depends on the severity and location of the damage. Treatment for a herniated disc can be conservative, minimally invasive, or open surgery.
Conservative treatment aims to relieve pain through physical therapy and medication.
Minimally invasive techniques are particularly helpful, especially in cases of a herniated disc compressing a nerve in the lumbar spine.
If conservative measures are no longer sufficient, doctors recommend surgery. In most cases at this stage of the condition, the underlying cause is painful nerve compression caused by the herniated intervertebral disc. This can only be resolved through surgery.
The use of an intervertebral disc prosthesis in cases of disc degeneration can help preserve the spine’s range of motion.
In cases of recent and uncomplicated herniated discs, it is possible to perform the surgery using a minimally invasive approach.
Medical professionals refer to the so-called “keyhole technique” as a minimally invasive surgical technique. In this procedure, the surgeon makes a small incision in the skin and guides the instruments through a special access channel to the affected intervertebral disc, resulting in minimal tissue damage.
Unlike traditional surgical techniques, minimally invasive techniques offer several advantages. They can usually be performed on an outpatient basis under local anesthesia, thereby avoiding prolonged hospital stays and general anesthesia.
However, in the case of a herniated disc, minimally invasive surgery can only be used for relatively simple and recent injuries.
Today, several minimally invasive surgical techniques are available for treating a herniated disc. These include:
Minimally Invasive Disc Surgery Using Chemonucleolysis
Chemonucleolysis refers to the
liquefaction and subsequent
aspiration of the inner gelatinous ring of the intervertebral disc. In this procedure, the
disc nucleus is liquefied using an enzyme and then aspirated.
The surgeon inserts a cannula between the two vertebrae at the level of the affected intervertebral disc. Through this cannula, the surgeon introduces an enzyme into the space. The enzyme liquefies the gelatinous ring. The mass is then aspirated through the cannula.
Chemonucleolysis is used relatively rarely as a minimally invasive method in intervertebral disc surgery.
If sequestra (detached disc tissue) have already formed, the procedure can no longer be performed. The enzyme must not come into contact with the surrounding tissue of the intervertebral disc.
Minimally Invasive Disc Surgery Using Laser Ablation
Another method of minimally invasive surgery for a herniated disc is laser ablation of the disc. This method of minimally invasive disc surgery can also only be used for fresh and uncomplicated herniated discs.
Using a medical yttrium-aluminate-garnet laser, the surgeon reduces the volume of the intervertebral disc. He guides the laser through a cannula between the affected vertebrae to the intervertebral disc.
The laser irradiation vaporizes the excess annulus fibrosus. The procedure is often performed under X-ray guidance to ensure the exact location of the affected intervertebral disc.
A surgeon performs minimally invasive disc surgery © romaset | AdobeStock
Minimally Invasive Intervertebral Disc Surgery Using Percutaneous Nucleotomy
In the percutaneous nucleotomy method, the surgeon inserts an instrument between the affected vertebral bodies into the intervertebral disc space. The procedure is usually performed laterally to spare surrounding structures.
Unlike chemonucleus and laser ablation, the herniated disc is removed mechanically in this procedure. The gelatinous nucleus is then suctioned out.
Percutaneous nucleotomy is used for uncomplicated herniated discs.
The choice of the appropriate surgical procedure depends heavily on the surgeon’s experience and the exact location of the herniated disc.
Endoscopic disc surgery is considered particularly minimally invasive, as only very small skin incisions are required. This results in less pain, rehabilitation is usually faster, and patients can return to their daily lives sooner. Thanks to the fine instruments used, there is less damage to the muscles, and pressure on the nerves is permanently relieved.
Minimally invasive surgeries for a herniated disc are considered low-risk procedures. Even before the surgery, the patient is given an antibiotic to prevent wound infections. Other potential issues that may arise include bleeding or swelling.
After minimally invasive disc surgery, patients should take it easy physically for 2 to 4 weeks. In some cases, doctors recommend wearing a back brace. In most cases, however, the surgery proceeds without complications, and the risk of bleeding or infection is low.
Minimally invasive disc surgeries are usually performed on an outpatient basis. This means that the patient can go home the same day. However, the patient remains
under observation for
a few hours after the procedure.
Just a few hours after the procedure, patients can get back up with assistance. Patients should move around in bed after waking up. Once the anesthesia has worn off, patients can get out of bed by rolling from a prone position with assistance. They should continue using this method of getting up for the next few months. The postoperative phase requires patience but is crucial for long-term stabilization.
A few weeks after the procedure, mild back pain is normal, and doctors recommend taking pain medication. About two weeks after the procedure, targeted physical therapy begins to improve mobility and strengthen the back muscles. Patients should avoid sitting and bending over whenever possible. In these positions, the pressure on the intervertebral disc is greatest. It is better to eat meals while lying down or standing.
The patient begins intensive conservative therapy (physical therapy) about four weeks after the minimally invasive disc surgery.
Patients should also attend follow-up appointments with their doctor. During these visits, the doctor assesses the progress of healing.
Careful follow-up care ensures better blood flow to the intervertebral disc and supports the healing process.
1. When is disc surgery necessary?
Surgery is generally recommended only when conservative treatments such as physical therapy, medication, or injections no longer provide sufficient relief. In cases of acute neurological deficits or severe back pain caused by a herniated disc, surgery is often unavoidable.
2. What is meant by minimally invasive disc surgery?
In minimally invasive disc surgery, also known as the “keyhole technique,” the surgeon works through very small incisions in the skin. This spares muscles and tissues, reduces scarring, and shortens the rehabilitation period.
3. What procedures are used in endoscopic disc surgery?
Common procedures include chemonucleolysis, laser ablation, and percutaneous nucleotomy. All methods aim to reduce pressure on the nerves and alleviate symptoms—with as little tissue damage as possible.
4. What are the advantages of endoscopic disc surgery?
Endoscopic surgery is considered particularly gentle. Patients benefit from less pain, a faster recovery, shorter hospital stays, and an early return to daily life.
5. What does rehabilitation after disc surgery involve?
After minimally invasive disc surgery, patients can usually go home the same day. Mild back pain is normal during the first few weeks. Rehabilitation begins after about four weeks with targeted physical therapy to strengthen the back muscles and prevent the recurrence of symptoms.
