Not all patients with hernial intervertebral protrusions are aware of their pathology. Often, such an ailment proceeds secretly, developing without any symptomatic manifestations.
Some patients, having felt the soreness characteristic of a hernia, mistakenly attribute this symptom to the result of hard physical labor or prolonged sedentary work in an uncomfortable position.
Since such an orthopedic disease often develops against the background of osteochondrosis, being a logical consequence of incorrect or absent treatment of this pathology, in most patients the pains that arise are associated with the next manifestation of osteochondrosis lesions.
Due to such circumstances, the disease is often found in an advanced stage, when only surgery can help the spine.
Indications for surgical treatment of intervertebral hernia
The decision on the need for an operation is usually made by several doctors, taking into account the research and diagnostic data and the patient’s condition.
In general, there are several indications that are divided into two groups: absolute and relative. The group of absolute contraindications is made up of clinical cases in which the surgical operation can no longer be postponed and it is an inevitable method of treatment.
- Intervertebral hernia, complicated by sequestration, which is characterized by prolapse of the nucleus;
- Paralysis and necrosis of the muscle tissue of the legs;
- Significant disruptions in the activity of the organs of small organs, manifested by the syndrome of the “horse tail”, which is characterized by erectile dysfunction, frequent constipation or urinary retention;
- Spinal cord compression or pinching;
- Prolonged severe pain symptoms that cannot be eliminated.
Relative indications are determined by clinical and pathological situations, against which conservative therapy was powerless.
Classification of therapy methods
Like the treatment of other pathological conditions, the therapeutic methods of intervertebral hernia are based on conservative (more about it here) and surgical treatment.
But more often, specialists have to resort to surgical intervention, which can be carried out in minimally invasive or innovative ways.
An innovative approach to the treatment of hernial protrusions between the vertebrae is characterized by ambiguity, since such a surgical intervention has many negative sides.
After all, the muscles as a result of damage are severely depleted, therefore, after the operation, relapses, new hernias, disc bulges , etc., may occur .
A huge advantage of such an intervention is the result obtained immediately after the procedure. The operation relieves patients from dizziness and migraine pains, soreness at the site of the lesion and musculoskeletal stiffness, etc.
Among the most common innovative operations, there are open, microsurgical and endoscopic types of procedures.
Endoscopic surgical interventions are carried out only with the use of local anesthetic drugs. A small incision is made in the affected area, through which the endoscope is inserted, bringing it directly to the site of hernial localization. Through it, the surgeon controls all ongoing operational actions – removal of the nucleus pulposus and hernia.
Such an operation is a low-traumatic one, due to which the risk of complications after such operations is minimal. In addition, rehabilitation recovery after endoscopy takes much less time.
Within a day or two after the operating procedure, the patient goes home, and after a month and a half he can engage in physical labor activity.
When there are any obstacles and contraindications for endoscopic intervention, doctors resort to microsurgical surgery.
This intervention has many advantages, such as:
- Low trauma ;
- The minimum likelihood of inflammatory complications;
- Minimal risk of nerve damage;
- Possibility of performing an operation for any hernial localization;
- A short postoperative and recovery period.
This procedure involves the application of several incisions through which the hernia is removed.
This operation is considered the most primitive, since it does not involve the use of additional optics. Such an intervention is carried out through significant tissue incisions, and involves open access to the operated area.
Minimally invasive methods
A spinal hernia does not always require surgery. Quite often, a hernia does not cause complications of a neurological nature, so there is no need to remove it, you just need to eliminate the pain symptoms. It is for this purpose that they resort to minimally invasive surgical procedures.
The most popular among minimally invasive techniques is laser nucleoplasty , which involves a laser heating effect on cells in order to stimulate their division.
The result is a rapid formation of new cells that fill the sites of disc injuries, which helps to eliminate pain. The procedure is carried out for 2-3 days in a row.
Another laser technique is also used – vaporization. Under the influence of a laser, the disc fluid turns into a vaporous state, which causes a decrease in intradiscal pressure, eliminates nerve pinching and reduces nerve receptors. Such a procedure takes no more than an hour, does not cause complications and does not require long-term rehabilitation.
cold plasma nucleoplasty
Such an operation is performed by a puncture method under the control of X-ray equipment. Cold plasma is passed to the site of hernial localization through the installed electrode, which destroys the disc nucleus. The procedure is carried out under local anesthesia and is characterized by low trauma and a short recovery time.
Such an operating procedure belongs to the category of minimally invasive surgical interventions. Hydroplasty involves the elimination of the intervertebral disc by injecting saline into the area of its localization, which is supplied through a cannula under high pressure. As a result, the destroyed particles of the disk are, as it were, washed off with saline.
As a result of such an operating procedure, there is some reduction in the size of the disc and hernia. Hydroplasty lasts about half an hour under local anesthesia.
The intervention is characterized by a minimal likelihood of complications, the absence of postoperative adhesions and scars, one-day hospitalization, and minimally invasiveness . The recovery period lasts no more than a month, during which it is impossible to engage in heavy physical activity and intense stress must be avoided.
Any surgical intervention is a severe stress shock for the organism operated on, so there is no need to talk about a 100% success of such treatment. In any clinical situation, there is always a certain percentage of risk, which is very difficult to avoid.
The most frequent complication of operations performed on a vertebral hernia is various kinds of inflammatory and infectious processes caused by wound tissue damage. In addition, problems may arise during the surgical procedure (nerve damage, etc.).
Consequences of surgical removal
In general, operations for a spinal hernia are not considered particularly dangerous and difficult, but due to various circumstances, they can also lead to undesirable consequences:
- Hernia recurrence;
- The inevitable need for conservative therapy.
Therefore, throughout the entire rehabilitation period and after its end, the patient should be regularly monitored by his doctor.
The cost of surgical treatment of a spinal hernia is formed from a combination of many factors such as the status of the clinic, the qualifications of the doctor, the complexity of the surgery, the equipment and drugs used, etc.
Approximate price ranges for various types of surgery:
- Endoscopic surgery – 11-130 thousand rubles;
- Microsurgical intervention – 13-150 thousand rubles;
- Open surgery – 24-110 thousand rubles;
- Laser treatment – 15-117 thousand rubles;
- Hydroplastics – 15-100 thousand rubles;
- Cold plasma nucleoplasty – 40-160 thousand rubles
For a long time I could not decide on the operation, although the pain in the lower back due to the hernia was constantly tormented. Doctors offered me several removal options. Having compared the possible consequences, having weighed all the pros and cons, I nevertheless decided on laser vaporization. Miracle. I have almost forgotten what it is like to live without back pain. In vain I was afraid, everything went fine and without complications.
I was also given several options to choose from, but I leaned in favor of traditional microdiscectomy , since I have a hernia sequestration. Everything went fine too, and, most importantly, there is no such wild pain and the sensitivity is normal at the feet.
Regardless of the type of intervention performed, any patient needs postoperative rehabilitation. In general, the rehabilitation period consists of several stages:
- Early stage – the first or second week after the intervention;
- Late – 0.5-2 months from the operation;
- Delayed stage – after 2 months after the intervention and throughout the rest of your life.
The main requirement of the doctor is to wear a corset in the first weeks. With its help, the vertebrae will be in a tight state, which will help to consolidate the operational results.
In addition, patients are advised to follow several mandatory recommendations:
- The first two days after the intervention, getting out of bed is strictly forbidden, and in the first week you cannot even sit;
- It is forbidden to lift weights and jump from high distances and hypothermia;
- To normalize blood circulation and accelerate recovery, procedures such as electrophoresis, laser or ultrasound therapy are indicated .