The human spine is made up of 24 bones called vertebrae that are placed one on top of the other. Within these vertebrae is the spinal cord. Between each vertebra is an intervertebral disk that acts like miniature shock absorbers to protect the vertebrae from damage due to movement or impact caused by physical activity. The disks are made up of a tough flexible outer ring and a soft center with a jelly-like filling.
What Is Herniation?
A disk is herniated when the soft jelly in the center pushes against the outer ring due to wear and tear or because of injury. The pressure against the outer ring of the disk can often cause pain. If the pressure continues for any length of time, the jelly-like filling may cause the outer ring to bulge out. This may place pressure on the nerves that are nearby and on the spinal cord. This results in even more pain and mobility problems. Additionally, if the inner filling of the disk leaks out, it can cause irritation to the nerves it comes into contact with. This results in even more pain, numbness and a condition called sciatica where there is weakness in one or both of the legs.
A herniated disk can occur anywhere on the spine, but it is most common in the lower back. It is estimated that between 60 to 80% of the adult population will experience lower back and/or leg pain at some point in their lives. Some of these cases may be caused by a herniated disk.
Also Read: What causes low back pain in women?
When Is Surgery Required?
While a herniated disk can cause severe pain, in many cases non-surgical treatments will bring the problem under control. If medication and physical therapy do not help in alleviating the condition, surgery is usually the next step. It is usually advised if:
- The pain is so extreme that normal activities and movement are affected
- The herniation causes numbness or weakness
- Bladder and bowel control is a problem
- Even standing up or walking a few steps is a problem
If surgery is advised there are different procedures that may be adopted, depending on the specifics of each case.
Diskectomy
In this procedure, the damaged disk is removed to relieve the pressure on the nerves. This could be done by a traditional surgical method using an incision on the back or by microdiscectomy where a much smaller incision is made and a small tube is inserted that has a miniature camera and special tool to enable the surgeon to see the damaged disk and remove it.
Lumbar Laminotomy
In some cases, a piece of bone called the lamina will have to be removed to have access to the disk. Removing the lamina may also reduce leg pain and sciatica. Here also there are 2 options – laminotomy to remove some of the lamina and laminectomy to remove most or even all of it. Removing the lamina can be either part of the diskectomy or performed as a separate procedure. A surgeon will decide on the right course of action.
Spinal Fusion
Once a diskectomy or laminotomy is done, the surgeon may choose to fuse together the 2 vertebrae on either side of the damaged disk. This will make the spine more stable and prevent the recurrence of pain.
Artificial Disk Surgery
In some cases, the surgeon may find that the best course of action is to replace the damaged disk with an artificial one that is made of either metal or plastic. This will keep the spine stable and allow for free body movement.
There are many health and medical factors that influence the choice of what type of procedure should be performed. The surgeon will determine what type of surgery is right for a patient.
Recovery And Long Term Outlook
Whatever type of surgery is done, the results are usually noticeable fairly soon. There will normally be a reduction in the pain, numbness and weakness a few weeks after the surgery and the improvement will continue over the next few weeks or months – the speed of the recovery will depend on the overall health and age of the patient and other factors. Physical therapy and/or special exercises may be prescribed to speed up the recovery process. The patient is also advised of precautions to be taken until the recovery is complete. These include:
- Not bending or stretching too much as this places stress on the spine
- Not sitting in one position for long periods of time
- Not lifting heavy objects
In many cases, the patient is able to return to office and work at a desk 2 to 4 weeks after the surgery. If the occupation involves physical activity, the time before returning to work may be greater.
Once the recovery is complete, patients can usually return to their normal pre-herniation lifestyles. Of course, any activities that may have contributed to the herniation occurring in the first place must be avoided. The surgeon will provide advice on this during the post-surgical checkups.
Finding The Right Hospital
If you suspect that you have a herniated disk or have been diagnosed with having one, finding the right hospital for the treatment is vital to ensuring the best possible outcome. It must be a hospital with a full Orthopedics And Spine Department. This is where you will be examined and treated by the best specialists and if surgery is the right option for you, highly qualified and experienced spine surgeons will be available to perform the surgery, using the best surgical techniques and latest medical equipment. A physiotherapy department must also be available so that you can be sure of receiving the right care and support to make your recovery as quick and complete as possible.