Herniated Disc (Lumbar Herniated Disc)
Lumbar hernia is a disease that occurs as a result of the disc between the lumbar vertebrae slipping from its place due to excessive force and pressing on the nerves coming to the legs and spinal cord. Although it is frequently seen in the adult group between the ages of 30-60, it can occur at almost any age. Risk factors include being overweight, inactivity, smoking, and heavy lifting, or occupations (construction worker, long-distance driver, football player, wrestler, etc.).
The patient complains of pain radiating from the lower back to the hip and leg. This pain can extend to the heel and toes. Over time, foot numbness and loss of strength begin to develop. In advanced cases, difficulties in urination and defecation,
One of the diagnostic methods, Magnetic Resonance Imaging (MRI) can easily diagnose a herniated disc. EMG (Nerve measurement test) is also required in some cases. However, the gold standard in the diagnosis of a herniated disc is the experience
If there is only low back and leg pain, if there is no numbness, loss of strength, or limitation of movement, it means that herniated disc is in the initial stage. In this case, it is recommended to give muscle relaxant drugs to the patient, rest in bed, and avoid movements that will force the waist. If the patient's complaints continue, physical therapy can be administered. However, some patients may not be able to tolerate physical therapy due to intense pain. The next option is epidural or foraminal epidural steroid injection procedures. In this application, a solution consisting of a mixture of cortisone and local anesthetic is applied around the spinal nerve root. Thus, the edema around the nerve root is reduced and the pain is expected to be relieved or relieved. If the patient's complaints do not go away despite physical therapy and injection treatments, there is a progressive loss of strength and sensation in the leg, thinning of the leg, urinary incontinence, and unbearable pain, the solution is surgical intervention.
Surgical treatment can be applied in 3 different ways.
1. Classical method: Under general anesthesia, a 4 cm incision is made in the lower back, the hernia is reached, and the disc is removed. Since it causes relatively greater muscle and bone tissue damage, this method is not used much nowadays.
2. Microdiscectomy (microsurgery) method: Applications in the classical method are performed under the operating microscope. It has advantages such as the incision being as small as 2.5 cm and less volume of muscle tissue being affected. Patients stay one day at the hospital. The probability of hernia recurrence and problem development after surgery is lower than the classical method.
3. Fully closed (endoscopic) hernia surgery: It is the method of removing the hernia in a closed and non-bleeding way in an aqueous environment by means of a 4 mm thick camera through a 0.5 cm tube inserted in the lumbar region using epidural, spinal, or general anesthesia. In this method, since the procedure is performed with minimal intervention on the patient's muscle and bone tissue, the postoperative pain is very low and the patient can stand up and walk within 4-5 hours after the operation. Since there is a continuous flow of water in order to obtain a clear camera image in the surgery, it is expected that the infection rates will be lower after the surgery. The patient can take a shower the next day. It does not require prolonged wound care. In our practice, we apply the herniated disc treatment method with the closed method.