Herniated disc is a condition where the disc material located between the bones of the spine is damaged, ruptured, fragmented and displaced into the canal and causes compression to the spinal cord and the nerve roots. As a result of this compression, pain, numbness or weakness may be encountered. Symptoms may be seen in waist or leg areas, on the right or left side or on both sides.
The disease can usually start with lower back pain, but it can start with leg-foot pain without any lower back pain. Leg pain is usually a symptom that urges the patient to go to the doctor, and numbness and weakness (paralysis) in the leg may be included in the symptoms. Occasionally, urinary or fecal incontinence may occur in advanced herniated disc cases. Lower back and leg pain is usually increased after activity or prolonged sitting and standing and coughing.
In the selection of treatment, the extent of the disease, the location and size of the hernia, the type of neurological damage and how it affects the daily life of the patient and their needs, the physician’s approach and experience are important factors.
Short-term bed rest, anti-inflammatory drugs to reduce edema and swelling at the site of the hernia, painkillers and muscle relaxants for pain relief can be tried as medical treatment. A large proportion of patients with herniated disc findings benefit from medical treatment. However, surgical treatment should be considered if pain interferes with daily activities or if there is a loss of strength after the treatment is completed.
The purpose of surgical treatment is to remove the mechanical pressure on the nerve. As a result, relaxation of the nerve, improvements in terms of pain, numbness, and weakness due to the body healing the nerve, and recovery are expected. Improvement in herniated disc operations is reflected by the amount of damage done to the nerve by cartilage and other tissues that crush the nerve and the body’s success in healing the injured nerve after being crushed and after the tissues are cleaned up. Therefore, if the nerve is under severe pressure, when making the decision to perform surgery, it may be necessary to act quickly to prevent it from being damaged further under prolonged pressure.
The most common practice among surgical techniques is “discectomy”. Here, the goal is to remove the herniated cartilage. Surgical options include microdiscectomy, endoscopic discectomy, laminectomy, and open classical surgical procedures depending on the size and location of the hernia. In the selection of treatment, the extent of the disease, how it affects the daily life of the patient and their needs, the physician’s approach and experience are important factors.
In case the hernia is large and/or ruptured, and in case of abnormalities in the peripheral bones, it is necessary to perform open surgery. Open surgery enables the surgeon to see and understand the surgery site much better. Since it will be easy to control the surrounding tissues and facet joints in open surgery, the procedures related to these sites may also be performed.
It is similar to open surgery, but it is all performed under a microscope and through a small skin incision. It is usually performed under general anesthesia. Mobilization and discharge of the patient will be quicker due to the small incision and the fact that only a small amount of muscles are severed.
Transforaminal endoscopic discectomy is a different procedure than open surgery or microsurgery. It is performed by entering through the 2-3 mm skin incision through the exit holes of the nerves. It is usually performed under local anesthesia.
In cases of a sudden loss of strength in the legs and urinary-fecal incontinence, urgent surgery may be necessary, if the hernia is exerting pressure on all of the nerve roots (cauda syndrome).
Most patients benefit quickly from herniated disc surgery. Leg pain is expected to cease after surgery. There may be pain in the surgery site. If there is loss of strength in your leg, it may not improve immediately and completely with surgical treatment. However, surgical treatment will prevent your leg from becoming weaker and will eliminate pain. It is possible that the reason behind the pain not going away completely or the weakness not improving immediately is the fact that the hernia may have crushed the nerve tissue and caused damage to it before the operation. Feeling of numbness felt on the surface of the skin of the leg is usually cured late after surgical treatment.
