Prof. Dr. Erkan Kaptanoğlu


Back Hernia (thoracic disc hernia)

It is a condition characterized by the rupture of the cartilage between the bones in the spine which in turn causes pressure on the nerves within the spinal cord due to the leaking of jelly material inside the cartilage. Although it is rarer than lumbar and neck hernias, since the spinal canal in the back is narrower, nerve and spinal cord pressure is more common, which can cause significant complaints in patients.

Findings and diagnosis

In a back hernia, back pain can be observed in almost every patient. According to the location of the hernia, weakness and paralysis of the abdominal muscles and legs can be observed. Loss of sensation, numbness and tingling sensation can be observed in the torso and legs. Enuresis and encopresis can be seen.

After the doctor’s examination, it is usually necessary to view the hernia with magnetic resonance (MRI) imaging technique. Computed tomography (CT) imaging may be required to show the relationship of hernia to the bones. X-rays give valuable information about the spine.

Treatment of back hernia

Back hernia treatment is planned as a result of a comprehensive evaluation and diagnosis. Bed rest, drug treatments, corset treatments, physiotherapy methods, injections and algological methods and surgical methods are used.

Physical therapy and Osteopathic therapy

In osteopathic treatment, it is aimed to correct the limitations of movement in the tissues, regulate circulation and eliminate obstacles to fluid flow and create an environment in which the body can heal itself. It is aimed to loosen the surrounding tissues, increase circulation, open joint blockages and thus reduce hernia.

Exercise programs include strengthening the back muscles are implemented to reduce stiffness and improve the range of movement. The goal is to reduce pressure on the discs and nerves. In physical therapy, hot/cold therapies are implemented together with electrical stimulation and ultrasound.

Algological treatment

Injections and radiofrequency applications are known to partially relieve the pain in back hernia. Since hernia can put pressure on the spinal cord and cause paralysis, surgical evaluation is usually performed first.

Surgical treatment

Thoracic hernia surgery is a complex one. In order to make surgical planning, clinical and radiological evaluation of the patient is carried out in detail. Then the surgical method is decided. Since there is the spinal cord in the back spine, surgical planning is carried out by circling the spinal cord during surgery. One of the many surgical techniques is selected.

When deciding on surgery, the location and calcification of the hernia is important factor. It is necessary to approach the spine from the front (from the chest) to remove such calcified hernias, especially if they are located right in front of the spinal cord. For this purpose, the rib cage can be opened by classical methods or the thoracoscopic method can be used.

Thoracoscopic surgery

Video-assisted thoracoscopic surgery (VATS) is a surgery performed using highly advanced optical cameras and video screens, going through the rib cage to reach the thoracic spine from the front or sides of the torso. Thoracic surgeons have used this technique for years to treat lung and other thoracic diseases. Highly successful results are obtained in back hernia with this method. The advantages of the minimally invasive thoracoscopic approach to the back spine include less tissue dissection, less blood loss, less scar tissue, shorter hospitalization, faster functional recovery, a better quality of life, less rib cage pain and good cosmetic results.

Posterolateral approaches

Back hernias which are soft and especially located laterally can be successfully removed by removing the bones from the back on the side of the hernia around the spinal cord using microsurgery approaches.

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