Symptoms & Treatement for Lumbar Herniated Disc
Treatment Options - Lumbar
Lumbar Laminectomy
Lumbar Microdiscectomy
Microscopic Discectomy
Spinal Fusion
Interbody Fusion
Interbody Fusion with Cages
Recovery
Lumbar Laminectomy
What is it?
Lumbar laminectomy is an operation that involves approaching the spine through an incision in the lower back to remove a portion of the bone over and/or around the nerve roots to provide them additional space.
Why is it done?
Patients who have pain caused by pinched nerves are potential candidates for this procedure.
The Operation
The operation is performed with you lying on your stomach.
Incision:
Your surgeon makes an incision in your lower back to access your spine. To have a clear view of your spine, the surgeon then retracts the muscles and ligaments.
Bone/Disc Removal:
Your surgeon removes a portion of the lamina, the bony rim around the spinal canal, if it is contributing to pressure on the dural sac or nerve roots. This part of the procedure is called a laminectomy. The term laminectomy is derived from the Latin words lamina (thin plate, sheet, or layer), and -ectomy (removal).
An opening is then cut in the ligamentum flavum – a ligament that connects vertebrae to the sacrum. A portion of the bone over the nerve root and/or disc material around the nerve root is removed to give your nerve root additional space.
Closure:
The operation is completed when your surgeon closes and dresses the incision. Your surgeon may choose to place a drain into the wound after the surgery to protect the incision.
Recovery:
Your surgeon will have a specific post-operative recovery/exercise plan to help you return to normal life as soon as possible. The amount of time that you have to stay in the hospital will depend on this treatment plan. By the end of your first day after surgery, you will normally be up and walking in the hospital.
As you read this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of spinal surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information. _________
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Lumbar Microdiscectomy
What is it?
Pain in the lower back (lumbar spine) and legs, among other symptoms, may occur when an intervertebral disc herniates – when the annulus fibrosus (tough, outer ring) of the disc tears and the nucleus pulposus (soft, jelly-like center) squeezes out, and places pressure on, or "pinches," an adjacent nerve root.
Lumbar microdiscectomy is an operation that involves using a surgical microscope and microsurgical techniques to access and treat the lumbar spine. By providing magnification and illumination, the microscope allows for a limited dissection. Only that portion of the herniated disc, which is pinching one or more nerve roots, is removed. The term discectomy is derived from the Latin words discus (flat, circular object or plate) and -ectomy (removal).
Why is it done?
Pressure placed on one or more nerve roots by a herniated disc may irritate these neural structures and cause:
Debilitating leg pain
Weakness and/or numbness in the legs and/or feet, and
Bowel/bladder incontinence.
Patients who suffer from these symptoms as a result of a pinched nerve are potential candidates for this operation.
The Operation
An understanding of what a lumbar microdiscectomy involves will help you to approach your operation and recovery with confidence.
Incision:
The operation is performed with you lying on your stomach. Because the operation is viewed through a microscope, this approach only requires a small incision. Your surgeon makes an incision in your lower back. Through this incision, microsurgical instruments are then inserted.
Removal:
Once your pinched nerve is located, the extent of the pressure on the nerve can be determined. Using microsurgical techniques, your surgeon removes the herniated portion of the disc as well as any disc fragments that have broken off from the disc. The amount of effort required to complete the microdiscectomy depends, in part, on the size of the disc herniation, the number of fragments present, and the difficulty presented in finding and removing these fragments.
Closure:
The operation is completed when your surgeon closes and dresses the incision.
Recovery:
Your surgeon will have a specific post-operative recovery/exercise plan to help you return to normal life as soon as possible. The amount of time that you have to stay in the hospital will depend on this treatment plan. You will normally be up and walking in the hospital on the same day after your surgery. Lumbar microdiscectomy is usually performed on an outpatient basis, with no overnight stay in the hospital.
As you read this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of spinal surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.
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Microscopic Discectomy
What is it?
The procedure using the METRx™ System is an operation on the lumbar spine performed using microscope and microsurgical techniques.
The METRx™ System procedure requires only a very small incision and will remove only the portion of the ruptured disc, which is "pinching" one or more spinal nerve roots. The recovery time for this particular surgery is usually much less than is required for traditional lumbar surgery.
Why is it done?
Lumbar microdiscectomy using the METRx™ System is usually recommended only when specific conditions are met. In general, surgery is recommended when a ruptured disc is pinching a spinal nerve root(s) and you have:
- Leg pain which limits your normal daily activities
- Weakness in your leg(s) or feet
- Numbness in your extremities
- Impaired bowel and/or bladder function
The Operation
Incision:
In the operating room, the METRx™ System begins with a small incision in your lower back. Through this opening, your surgeon will insert the endoscope and surgical instruments. Because the work is viewed through an endoscope, this approach requires a relatively small incision.
Reaching the "Pinched" Nerve:
Guided by diagnostic studies, your surgeon may remove a small portion of bony material from the back of your vertebra. Once this material is removed, the surgeon can locate the exact area where the nerve root is being pinched.
Identifying the Cause of the Pressure:
Once the "pinched" nerve is located, the extent of the pressure on the nerve can be determined. Using endoscopic microsurgical procedures, your surgeon will remove the ruptured portion of the disc and any disc fragments which have broken off from the main disc. The amount of work required to complete your METRx™ System will depend in part on the number of disc fragments present and the difficulty presented in finding and removing them.
Closing the Incision:
The operation is completed when the endoscope is removed and the incision is closed with suture materials and a bandage.
As you read this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of spinal surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.
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Spinal Fusion
The Incision:
The patient is positioned on the operating table in a prone position. The incision is made over the anatomic position of the spinous process.
Bone is Removed:
When indicated, soft tissue and bony decompression are performed to relieve neurological compression.
Screw Placement:
For a degenerative spondylolisthesis case, a blunt probe is inserted through the pedicle and into the vertebral body.
Once the pedicle canals are prepared and the screw length determined, the TSRH-3D® screws are sequentially inserted.
Bone Graft:
The facet joint capsules are removed and cancellous bone graft is placed into each facet joint. The transverse processes, sacral alae, and the lateral walls of the facet joints are decorticated with high-speed burs and curettes.
Corticocancellous bone graft taken from the iliac crest, along with any fragments of bone taken during decompression are firmly pressed into the bone fusion bed.
Compression:
Once the construct has been assembled, segmental distraction and compression may be carved out.
It is important that you discuss the potential risks, complications, and benefits of TSRH-3D® Pedicle Screws with your doctor prior to receiving treatment, and that you rely on your physician's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.
As you read this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of spinal surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.
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Interbody Fusion
What is it?
An Interbody Fusion is the uniting of two bony segments, whether a fracture or a vertebral joint. In time, normally within 4 months, the bone grafts will unite with the vertebrae above and below to form one piece of bone.
Why is it done?
The reasons for the operation are to:
- Remove the degenerative disc
- Separate the two vertebral bodies, as they were before the disc degenerated
- Keep them in that position by interposing several pegs of bone (bone graft)
The Operation
Incision:
There are a number of techniques for an interbody fusion of the lumbar spine.
Lamina are Removed:
First the suregon removes the lamina or the portion of the vertebra that covers the spinal cord. Removing the lamina relives some of the pressure on the spine.
Bone is Removed:
Then any bone that may be pinching the nerve roots is removed.
Bone Grafts:
Bone grafts are added.
Rods and Screws:
Rods are secured to the spine with screws in order to hold the discs in place while the bone graft fuses.
Closing the Incision:
The incision is closed. The bone graft will fuse over time.
As you read this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of spinal surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.
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Interbody Fusion with Cages
What is it?
An Interbody Fusion using cages is designed to be a less invasive method to obtain spinal fusion. The procedure can be performed through an anterior or posterior approach.
Why is it done?
The reasons for the operation are to:
· Remove the degenerative disc
· Separate the two vertebral bodies, as they were before the disc degenerated
· Keep them in that position
The Operation
Incision:
The disc space is approached through an incision. The muscles are not cut because they run vertically and can be moved to the side. The disc is removed by excising the front portion and removing the disc material back to the spinal canal. This removes the inflammatory proteins within the disc.
Spacers:
Temporary spacers are impacted into the empty disc space disctracting and realigning the vertebral bodies into the proper position. This maneuver opens the collapsed foramen (nerve canal) and lifts pressure from the pinched nerve roots.
Reamer and Thread Tap:
A hole in the vertebral body is created using a reamer and a thread tap. A threaded titanium cage is packed with bone graft and then screwed tightly into the hole. The threaded cage replaces the distraction plug and maintains the proper position of the vertebral bodies.
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Temporary Plug Removed:
The other temporary plug is removed and the hole is made ready for the second implant. The other implant packed with bone is inserted.
Incision Closure:
The incision is closed and the bone graft will grow through and around the implants, forming a bone bridge that connects the vertebral bodies above and below.
As you read this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of spinal surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.
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Recovery
As you prepare yourself mentally to undergo spinal surgery, you also need to prepare yourself for the recovery period that will follow your operation. While the surgery entails work on the part of the surgeon, after that, the brunt of the work is in your hands. To ensure a smooth and healthy recovery, it is important that, as a patient, you closely follow the set of instructions that your surgical team gives you.
Hospital Recovery
After the operation, you will be brought to the recovery room or intensive care unit (ICU) for observation. When you wake up from the anesthesia, you may be slightly disoriented, and not know where you are. The nurses and doctors around you will tell you where you are, and remind you that you have undergone surgery. As the effects of the anesthesia wear off, you will feel very tired, and, at this point, will be encouraged to rest.
Members of your surgical team may ask you to respond to some simple commands, such as "Wiggle your fingers and toes" and "Take deep breaths." When you awaken, you will be lying on your back, which may seem surprising, if you have had surgery through an incision in the back; however, lying on your back is not harmful to the surgical area.
Prior to the surgery, an intravenous (IV) tube will be inserted into your arm to provide your body with fluids during your hospital stay. The administration of these fluids will make you feel swollen for the first few days after the operation.
When you awake from the anesthesia, you may feel the urge to urinate. So, in addition to the IV, a catheter tube (also commonly called a Foley Catheter) will be placed into your bladder to drain urine from your system. The catheter serves two purposes: (1) it permits the doctors and nurses to monitor how much urine your body is producing, and (2) it eliminates the need for you to get up and go to the bathroom. Once you are able to get up and move around, the catheter will be removed, and you can then use the bathroom normally.
During your hospital stay, you will get additional instructions from your nurses and other members of your surgical teams regarding your diet and activity.
Proper nutrition is an important factor in your recovery. Your surgeon may restrict what you drink and eat, or place you on a special diet, depending on the surgical approach that was used during the operation. Calories and food intake are an important part of recovery. Some patients find that their physician orders are less restrictive than the diet they follow at home. After the surgery, you will continue to receive intravenous fluids until you are able to tolerate regular liquids, which typically involves gradually transitioning you from sips of clear fluids to full liquids (including JELL-O® gelatin). From there, you will be given small amounts of solid food until you are ready to return to a regular diet.
With respect to physical activity, in most cases, your surgeon will want for you to get out of bed on the first or second day after your surgery. Nurses and physical therapists will assist you with this activity until you feel comfortable enough to get up and move around on your own.
Home Recovery
Before you are discharged from the hospital, your doctor and other members of the hospital staff will give you additional self-care instructions for you to follow at home - a list of "dos and don'ts," which you will be asked to follow for the first 6 to 8 weeks of your home recovery. So, if you are unsure of any of these instructions, ask for clarification. Following these instructions is crucial to your recovery.
Nowadays, surgery involves one or more incisions depending on the surgical approach used to perform the operation. Therefore, when you are discharged home you may still have a surgical dressing on your incision(s). Either a nurse will visit your home to change the dressing or a caregiver, such as one of your family members, will be taught to do it for you. It is important that the dressing be changed daily and kept dry.
If any signs of infection are observed while changing the dressing, call your doctor. These signs include:
- Fever - a body temperature greater than 101°F (38°C)
- Drainage from the incision(s)
- Opening of the incision(s), and
- Redness or warmth around the incision(s).
In addition, call your doctor if you experience chills, nausea/vomiting, or suffer any type of trauma (e.g., a fall, automobile accident).
During this recovery period, you will also be instructed to keep your incision(s) clean, making sure only to use soap and water to cleanse the area. In general, you should not shower until your doctor has permitted you to do so.
In addition to caring for your incision(s), you will also be encouraged to:
- Drink plenty of fluids
- Maintain a healthy diet (high in protein)
- Walk or do deep-breathing exercises, and
- Gradually increase your physical activity.
Activities to avoid include any heavy lifting, climbing (including stairs), bending, or twisting. You should also avoid the use of skin lotion in the area of the incision(s); you need to keep this area dry until it has had the opportunity to heal well.
Follow up with your doctor on a regular basis during this post-operative period, and make sure to call your doctor if you have any concerns or questions.
As you read this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of spinal surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.
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