Herniated discs’ treatment is one of the major directions to which special consideration is given in German clinics. More than 3200 surgeries of intervertebral prolapse are performed annually. The modern methods of diagnosis and therapy allow helping patients to be freed this problem and unpleasant symptoms. Treatment is always considered carefully after thorough examination.
The price for the mobility and shock absorber function of the spine is the wear with increasing age. Bone thickening, loosening of the ligament and degeneration of the intervertebral disc occur. These signs of wear start from the age of 20 and are accelerated by one-sided loading, incorrect posture when lifting and other factors. They are practically unavoidable.
Changes in the spine and bulging of the intervertebral disc can be seen in the majority of people on MRI, but usually have no disease value. A herniated disc is called a widespread disease because it affects about 5% of all people at least once in a lifetime.
The most common synonyms for a herniated disc are disc herniation, herniated disc or nucleus pulposus prolapse. These terms describe the pathology. Tears in the ring-shaped ligament, the annulus fibrosus, cause tissue to emerge from the interior of the intervertebral disc in the direction of the spinal canal or the nerve roots.
If the tissue is still connected to the inside of the intervertebral disc and the fiber ring only bulges out, one speaks of an intervertebral disc protrusion. A true herniated disc occurs when the piece of tissue from the inside of the intervertebral disc is completely repelled and has broken through the fiber ring. This intervertebral disc piece can have any size, from a few millimeters to 2 cm. It becomes problematic when the piece of intervertebral disc emerges into the spinal canal or the neuroforamen and compresses nerve roots or the spinal cord there. Depending on the size and location of the incident, typical symptoms of lumbar, thoracic, or cervical herniated discs may occur. You can find details under the corresponding clinical pictures.
Most intervertebral disc complaints disappear after a few days to weeks due to gentle treatment in the acute phase, medication and physiotherapy. If the pain does not improve significantly within 6 weeks or if there is severe pain or even a loss of strength, an operative relief should be checked. An absolute emergency for immediate assignment to neurosurgery is when a complete loss of strength of a muscle or a bladder emptying disorder occurs.
The neurosurgical interventions in the case of a herniated disc are all carried out in a minimally invasive manner using the surgical microscope. It is advisable to start with the smallest and gentlest procedure. Depending on the herniated disc, an intervertebral disc replacement may be useful, especially on the cervical spine. The surgical technique used (microsurgical, endoscopic, with or without an implant) depends on the location of the herniated disc. Intervertebral disc surgery is one of the most common procedures in neurosurgery at Inselspital. Fully endoscopic or assisted endoscopic techniques can facilitate surgery and improve recovery in certain herniated discs.
A cervical herniated disc is a herniated disc of the cervical spine. Like the lumbar herniated discs, this herniated disc is usually the result of a process of wear and tear. The incidence of disease increases continuously up to the age of 45, after which it decreases again. This phenomenon may be a consequence of the great stress that people in the middle of their lives experience.
Disc herniations are the result of degenerative changes in the spine. Trauma can only be claimed as a cause if there is considerable violence in previously completely symptom-free patients. So-called “lifting dreams” are generally not recognized by insurance companies as an accident-related cause of herniated discs.
Men are affected about 1.4 times more often than women. The most frequently affected vertebra is HWK 5/6, followed by HWK 6/7 and HWK 4/5.
Suffering often begins with unspecific neck pain that begins to radiate into one arm as the process progresses. The severity or resistance to therapy of the pain then leads the patient to the doctor. In addition to pain, emotional disturbances and paralysis can also occur. In contrast to lumbar intervertebral disc herniations, symptoms in the lower extremities (gait disorders, pain, paralysis and feeling disorders) up to the cross-sectional syndrome can also occur in the presence of hernias that press on the spinal cord.
The examination method of choice is the magnetic resonance imaging (MRI). Computed tomography (CT) is usually less suitable because of bone artifacts.
The Myelo-CT is also available for special questions. Here a contrast medium is injected into the spinal canal, the distribution of which is then analyzed both in a normal x-ray image of the cervical spine (in several projections) and in a CT scan.
First and foremost, the therapy is conservative, that is, not operated. Unless paralysis requires an operation, conservative therapy (pain reliever, physiotherapy, work stoppage) of 8 weeks is quite common.
A rapid surgical procedure is advisable in the case of severe pain, paralysis and disturbances in water loosening (urinary retention, involuntary urine leakage) or during bowel movements. On the other hand, the indication for surgery in the case of therapy resistance with moderate pain is relative and depends on the patient's suffering.
Treatment is usually with an access at the front of the neck. The intervertebral disc is removed together with the incident under the microscope. Either a titanium or plastic ring (so-called cage) or an intervertebral disc prosthesis are installed as placeholders. The risk of nerve or spinal cord injury is low and is well below 1%. There is also a low risk of a mostly temporary hoarseness. Swallowing is often painful in the first few days after surgery. The hospitalization period is 2-4 days.
If the incident is far out, an intervention from behind (neck) can also be considered. Only the incident is removed, the intervertebral disc is left.
After the operation of the herniated disc, a recovery time of approximately 6 weeks can be expected. This can vary from case to case depending on existing neurological deficits and physical stress at the workplace.
A thoracic herniated disc is a herniated disc of the thoracic spine. Herniated discs along the entire spine are usually the result of an aging and wear process. Since the thoracic spine receives additional reinforcement from the rib skeleton, incidents in this area are much less common than in the cervical and lumbar spine. Even if a herniated disc is discovered in the thoracic spine, it is often an asymptomatic accident that does not require therapy.
Less than 1% of all herniated discs are localized in the thoracic spine, with most of these few incidents occurring in the lower thoracic spine. Middle-aged people are most commonly affected by a thoracic herniated disc.
The symptoms of a herniated disc on the thoracic spine are often non-specific, which can make the diagnosis more difficult. The spectrum of symptoms includes difficult to classify, non-specific pain in the chest or abdomen. The complaints can also occur in one or both legs and very rarely even extend to a cross-sectional syndrome.
The examination method of choice is the magnetic resonance imaging (MRI).
The therapy is primarily carried out conservatively with pain relievers and physiotherapy. If this treatment fails, surgery can be considered.
Due to the anatomical conditions, the operation is much more complicated than on the cervical and lumbar spine. In addition, the herniated discs are often calcified, which makes their removal even more difficult. A distinction is made between the following approaches:
Due to the proximity to the spinal cord and the complexity of pathological changes in the thoracic spine, the risk of neurological deterioration up to paraplegia is greater than in operations of the cervical spine and, in our view, almost always requires intraoperative neuromonitoring of the motor evoked potentials.
The recovery time is variable and depends on the initial findings. If necessary, inpatient rehabilitation is carried out in a corresponding clinic.
A lumbar herniated disc is a herniated disc of the lumbar spine. The microsurgery or endoscopic operation of a herniated disc to quickly and gently relieve a compressed nerve is the most common procedure in our clinic. Our nurses and physiotherapists know the treatment and aftercare after a herniated disc very well and prepare the way for a quick recovery. Because the behavior after a herniated disc plays an important role, we have put together useful information, in particular on the correct lifting and carrying, exercises for back exercises and a special television program for our patients.
Due to the frequency and importance of this disease, research in this area is a focus at the University of Bern. A group of scientists at the ARTORG Institute is particularly researching future options for intervertebral disc regeneration.
Lumbar disc complaints are common, but they rarely need surgery. More than 90% of intervertebral disc protrusions or incidents with pain in the leg improve with short-term protection, warmth, pain medication, relief storage and physiotherapy. It is important to differentiate from pure back pain (lumbar pain or lumbago), which is caused by irritation of the vertebral joints or ligament structures and in which there is no pain in the leg.
Incidents of the 4th intervertebral disc (between 4th and 5th lumbar vertebrae) and the 5th intervertebral disc (between 5th lumbar vertebrae and coccyx) are most common. Depending on the direction in which the disc material emerges, the higher (exiting) nerve or the deeper (traversing) nerve on the way to the neuroforamen may be affected by the herniated disc. Due to the pressure of the intervertebral disc on the nerve, it can no longer guide the feelings and muscle strength of its target areas and additionally reports pain and tingling. Because each nerve that emerges from the spine supplies a different characteristic area, the disturbances can usually be concluded precisely from the affected nerve root. In very large herniated discs, several nerve roots can be affected, in principle all of those that still run down in the dural sac. Large herniated discs that affect the deeper sacral nerve roots are particularly dangerous because they can cause disorders in the emptying of the bladder and stool. This is always an emergency and urgently needs to be briefed on neurosurgery because permanent nerve damage with functional failure threatens.
Typical findings (not complete) for the nerve root are
If the pain does not improve significantly within 6 weeks or if there is severe pain or a loss of strength, one should check the relief of the nerve by surgery. An absolutely urgent emergency for an immediate assignment to neurosurgery is when there is a complete loss of strength in one movement or, as already mentioned, a disturbance in the bladder or bowel emptying.
Despite the high spontaneous healing rate, lumbar disc herniation surgery is the most common surgical procedure on the lumbar spine. The department of neurosurgery has specialized in this disease for many years because the operation is routinely carried out under a microscope. The advantages of microsurgery mean a smaller operation with gentle access, a more targeted exposure, less scarring and more security for the patient. In some of the herniated discs, full-endoscopic technology can further reduce access.
Disc prolapse treatment in the German orthopedic centre always starts from complex diagnosis. German specialists employ following methods of diagnosis to determine severity of pathology and to pick the best way to deal with it:
All of the said methods allow to get precise full information regarding size and stracture of the herniated disc, presence of inflammation and coexistent diseases, as well as to work out the most effective plan of treatment.
There are two basic therapeutical methods in Germany: traditional and surgical. At the same time high skilled orthodedists do their best to choose for the most sparing therapy. Surgery is indicated only when clear indications are present, e.i. intractable pain syndrom, strangury etc.
If traditional methods fails, doctor can make a decision for surgery. The following surgical methods are used for herniated discs’ treatment in Germany:
Thus, modern orthopedy has numerous methods to provide highly effective treatment of herniated discs. It is important to asked for qualified help timely.
Herniated discs’ treatment in Germany means possibility to take on advantages from state-of-the-art medicine:
Herniated discs’ treatment in German orthopedic clinics will be carried out to achieve best results. You can be confident in our specialists and their competency, and to entrust them with your health easily.
We will gladly consult you concerning the herniated disc surgery and can help you to plan your medical travel to Germany.