In the case of a slipped disc, the intervertebral discs in the spine lose their protective shape. The defective outer fibrous ring(annulus fibrosus) can then no longer hold the core of the disc in its central position. The pressure causes the nucleus to protrude outwards into the spinal canal. There it presses on sensitive nerve roots and causes severe pain.
The causes of a slipped disc often include increasing age and overloading the back. Being overweight also increases the risk of a slipped disc.
Slipped discs occur most frequently in the lumbar spine. The cervical spine, on the other hand, is less frequently affected.
The herniated disc and its various forms © Henrie | AdobeStock
The symptoms of a herniated disc are varied. Depending on the location of the herniated disc, back pain can occur with varying degrees of sudden, stabbing pain.
Many sufferers also report a sensory disturbance in the legs or arms. This is noticeable in the form of a tingling sensation and intensifies when coughing or sneezing. As the disease progresses, this sensory disturbance can spread to the genitals and anus. Those affected are then no longer able to control bodily excretions.
The type of treatment for a herniated disc depends on the severity and location of the damage. Treatment of a herniated disc can be conservative, minimally invasive or open surgery.
Conservative treatment aims to relieve the pain through physiotherapy and medication.
If conservative measures are no longer sufficient, doctors recommend surgery. At this stage of the disease, the underlying cause is usually painful nerve compression caused by the prolapsedintervertebral disc(intervertebral disc). This can only be remedied by surgery.
The use of an intervertebral disc prosthesis in cases of disc wear can help to maintain the mobility of the spine.
In the case of fresh and uncomplicated herniated discs, it is possible to perform minimally invasive surgery.
Doctors refer to the so-called "keyhole technique" as a minimally invasive surgical technique. Surgeons repair damage using a small incision in the skin, which means that very little tissue is damaged.
In contrast to the classic surgical technique, minimally invasive surgical techniques have several advantages. They can usually be performed on an outpatient basis and with local anesthesia, thus avoiding lengthy hospital stays.
However, minimally invasive surgery can only be used for relatively simple and newly formed damage in the case of a herniated disc.
Nowadays, several minimally invasive surgical techniques are available for herniated discs. These include
Minimally invasive intervertebral disc surgery using chemonucleolysis
Chemonucleolysis is the liquefaction and subsequent aspiration of the inner gelatinous ring of the intervertebral disc.
The surgeon inserts a cannula between the two vertebrae of the affected disc. He introduces an enzyme into the space via this cannula. The enzyme liquefies the gelatinous ring. The mass is then aspirated via the cannula.
Chemonucleolysis is used relatively rarely as a minimally invasive method for disc surgery.
If sequestra (detached disc tissue) have already formed, the procedure can no longer be used. The enzyme must not be allowed to enter the area surrounding the intervertebral disc.
Minimally invasive disc surgery using laser ablation
Laser ablation of the intervertebral disc is another minimally invasive procedure for herniated disc surgery. This method of minimally invasive disc surgery can also only be used for fresh and uncomplicated herniated discs.
The surgeon uses a medical yttrium aluminate garnet laser to reduce the volume of the intervertebral disc. He guides the laser with a cannula between the affected vertebrae to the intervertebral disc.
Irradiation with the laser vaporizes the excess gelatinous ring.
A surgeon performs minimally invasive disc surgery © romaset | AdobeStock
Minimally invasive intervertebral disc surgery using percutaneous nucleotomy
With the percutaneous nucleotomy method, the surgeon inserts a needle between the affected vertebrae into the disc space.
In contrast to chemonucleosis and laser ablation, the herniated disc is removed mechanically. The gelatinous nucleus is then aspirated.
Percutaneous nucleotomy is used for uncomplicated herniated discs.
Minimally invasive surgery for a herniated disc is considered a low-risk procedure. The patient is given an antibiotic before the operation to prevent wound infections. Other possible complications include post-operative bleeding or swelling.
After minimally invasive disc surgery, patients should take it easy physically for 2 to 4 weeks. In individual cases, doctors may advise wearing a corset.
Minimally invasive disc operations are usually performed on an outpatient basis. This means that the patient can go home on the same day. However, the patient remains under observation for several hours after the operation.
Patients should move around in bed after waking up. Once the anesthetic has worn off, patients can get out of bed by rolling over their stomach with assistance. They should continue to get up in this way for the next few months.
Slight back pain is normal over the next few weeks and doctors advise taking painkillers. Patients should avoid sitting and hunching over if possible. The pressure on the intervertebral disc is greatest in this position. It is better to eat meals lying down or standing up.
Patients begin conservative therapy(physiotherapy) intensively around four weeks after minimally invasive disc surgery.
They should also attend check-ups with their doctor. The doctor will check how the healing process is progressing.
