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An intervertebral disc hernia is most common in people between the ages of 30 and 50. It often does not cause complaints. But it can also cause severe back pain, emotional upsets and even paralysis - then quick action is important.

In some patients, a hernia of the intervertebral disc causes symptoms such as pain, a tingling sensation or ants in the arms or legs, numbness or even paralysis in the limbs. The cause of discomfort is that the inner core of the intervertebral disc arises and presses on the nerves of the spinal canal.

Not every disc herniation causes symptoms such as pain or paralysis. Then it is often discovered by chance only as part of the investigation.

If a hernia of the intervertebral disc causes symptoms, this indicates that the disc has slid off from individual nerve roots, the spinal cord, or a bundle of nerve fibers in the lumbar spine.

Most patients are especially interested in: “What if a herniated disc?” The answer depends mainly on the symptoms. More than 90 percent of patients have enough conservative treatment of herniated disc, that is, treatment without surgery. This is especially true when a herniated disc causes pain or weak muscle weakness, but there are no other / more serious symptoms.

As part of the conservative treatment of hernia of the intervertebral disc, a doctor rarely recommends immobilization or bed rest today. But this may be necessary, for example, with prolapse of the cervical disc, immobilization of the cervical spine using a neck brace. In case of severe pain due to a hernia of the lumbar disc, support of the stepladder can help as soon as possible.

Do I need to perform a disk hernia operation, the doctor and the patient decide together. There are several methods for the surgical treatment of herniated discs. Microsurgical procedures are standard today. They reduce the risk of scarring. Alternatively, in some cases, minimally invasive procedures may be considered in disc herniation surgery.

GermanMedicalGroup + 49 (7221) 39-65-785 Flugstrasse 8a
76532 Baden-Baden
Germany
Herniated disc (slipped disc) is when a spinal disc ruptures and bulges, putting pressure on nerves that causes pain. Symptoms, diagnosis, treatment, surgery. 2020-03-27 Herniated Disc Treatment
Profiles of Doctors for Herniated Disc Treatment
Herniated Disc Treatment
Herniated disc treatment

Treatment of a hernia of the intervertebral disc is one of the main areas of focus in German clinics. Over 3,200 intervertebral prolapse surgeries are performed annually. Modern methods of diagnosis and therapy can save patients from this problem and unpleasant symptoms. Treatment is always carefully thought out after a thorough examination.

The price for mobility and the function of the shock absorber of the spine is wear with age. Bone thickening, weakening of the ligament and degeneration of the intervertebral disc occur. These signs of wear begin at age 20 and are accelerated by one-sided loading, improper posture during lifting, and other factors. They are almost inevitable.

Changes in the spine and bulge of the intervertebral disc can be seen in most people on MRI, but usually the disease does not matter. A herniated disc is called a common disease because it affects about 5% of all people at least once in a lifetime.

What happens with a herniated disc?

The most common synonyms for herniated disc are herniated disc, herniated disc, or prolapse of the pulpous nucleus. These terms describe a pathology. Tears in the annular ligament, the fibrous ring, cause the appearance of tissue from the inner part of the intervertebral disc in the direction of the spinal canal or nerve roots.

If the tissue is still connected to the inside of the intervertebral disc and the fibrous ring only protrudes, they speak of protrusion of the intervertebral disc. A true herniated disc occurs when a piece of tissue inside the intervertebral disc is completely repelled and breaks through the fibrous ring. This piece of intervertebral disc can have any size, from a few millimeters to 2 cm. This becomes problematic when a piece of intervertebral disc enters the spinal canal or neuroformation and compresses the nerve roots or spinal cord there. Depending on the size and location of the incident, typical symptoms of lumbar, thoracic, or cervical disc herniation may occur. Details can be found under the relevant clinical photographs.

When should you consider the possibility of surgery?

Most complaints of the intervertebral disc disappear after a few days or weeks due to mild 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 loss of strength, prompt relief should be checked. The absolute need for an immediate appointment for neurosurgery is when there is a complete loss of muscle strength or impaired bladder emptying.

How does it work?

Neurosurgical interventions in case of a herniated disc are performed in a minimally invasive manner using a surgical microscope. It is advisable to start with the smallest and most gentle procedure. Depending on the herniation of the intervertebral disc, replacement of the intervertebral disc 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 neurosurgery procedures in Inselspital. Fully endoscopic or assisted endoscopic techniques can facilitate surgical intervention and improve the recovery of some herniated discs.

Cervical disc herniation

A herniated disc is a herniated disc. Like lumbar herniated discs, this herniated disc is usually the result of a wear process. The incidence is constantly increasing up to 45 years, after which it again decreases. This phenomenon can be a consequence of the great stress that people experience in the middle of their lives.

Causes of a herniated disc

Disc hernias are the result of degenerative changes in the spine. Injury can only be claimed as a cause if there is significant violence in previously completely asymptomatic patients. So-called “lifting dreams” are generally not recognized by insurance companies as the cause of an accident of a herniated disc.

Epidemiology

Men suffer about 1.4 times more often than women. The most commonly affected vertebra is HWK 5/6, then HWK 6/7 and HWK 4/5.

Backstory

Suffering often begins with nonspecific neck pain, which begins to spread in one hand as the process develops. The severity or resistance to pain treatment then leads the patient to the doctor. In addition to pain, emotional disturbances and paralysis can also occur. Unlike hernias of the lumbar intervertebral disc, symptoms in the lower extremities (gait disturbances, pain, paralysis and disorders of feelings) up to the cross section syndrome can also occur in the presence of hernias that press on the spinal cord.

Diagnosis of a herniated disc

The choice of research method is magnetic resonance imaging (MRI). Computed tomography (CT) is usually less suitable due to bone artifacts.

Myelo-CT is also available for special issues. Here, the contrast medium is introduced into the spinal canal, the distribution of which is then analyzed both on a conventional X-ray image of the cervical spine (in several projections), and during computed tomography.

Therapy of the herniated disc

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.

Operative procedure of herniated disc

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.

Recovery time

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.

Thoracic herniated disc

Thoracic herniated disc

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.

Epidemiology

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.

Prehistory

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.

Diagnosis of thoracic herniated disc

The examination method of choice is the magnetic resonance imaging (MRI).

Therapy for thoracic herniated disc

The therapy is primarily carried out conservatively with pain relievers and physiotherapy. If this treatment fails, surgery can be considered.

Surgical procedures for thoracic herniated discs

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:

  • Unilateral removal of the arch root (transpedicular), possibly with removal of the base of the rib (costotransversectomy), indicated for masses that tend to compress from the side,
  • Access through the chest area (thoracoscopy or thoracotomy), indicated in the case of medium-sized masses with compression of the spinal cord from the front

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.

Recovery time

The recovery time is variable and depends on the initial findings. If necessary, inpatient rehabilitation is carried out in a corresponding clinic.

Lumbar disc herniation

Lumbar disc herniation

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.

Surgery is rarely necessary

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.

Typical complaints

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.

Frequent complaints

Typical findings (not complete) for the nerve root are

  • L4: pain in the thigh up to the knee, numbness in the front of the thigh and the inside of the lower leg, no strength when climbing stairs (knee extension)
  • L5: pain in the buttocks and in the outer edge of the thigh down to the foot, numbness in the big toe, weakness of the foot lift, especially the big toe lift (heel stand)
  • S1: pain in the buttocks and in the back of the leg up to the foot, numbness in the outer edge of the foot and in the small toe, weakness of the foot depressor (toe position)

When does surgery have to be done?

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.

Methods of diagnosis in our clinics

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:

  • Computer aided tomography;
  • Magnetic resonance imaging (MRI);
  • MRI in motion;
  • X-ray examination.

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.

Methods of treatment in our clinics

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.

Herniated discs’ treatment with traditional methods may include:

  • Cryopreservation of painful terminals;
  • Spine cord electrostimulation;
  • Percutaneous laser decompression;
  • Chemonucleolysis – dilution and exhausting of hernia.

If traditional methods fails, doctor can make a decision for surgery. The following surgical methods are used for herniated discs’ treatment in Germany:

Surgical methods in our clinics

  • Percutaneous nucleotomy – partial excision of herniated disc with a special helical probe. This surgery is considered minimally invasive and requires only local anaesthesia.
  • Percutaneous thermocoagulation of intervertebral discs – impact on the nociceptor with high temperature by means of special thermoprobe.
  • Endoscopic microdiscectomy – surgical treatment for large-sized hernias. All manipulations are performed with endoscope and do not require extensive cuts as well as bone resection. This approach allows patients to recover promptly and also to avoid postoperative complications.
  • Prosthetics of an intervertebral disc – in case intervertebral disc is impaired significantly, its replacement may be required. High quality titan prosthesis fixed by experienced surgeons can help restoring mobility and forget about pain.

Thus, modern orthopedy has numerous methods to provide highly effective treatment of herniated discs. It is important to asked for qualified help timely.

Advantages of treatment

Herniated discs’ treatment in Germany means possibility to take on advantages from state-of-the-art medicine:

  • Minimally invasive surgery reducing complications’ risks and recovery period;
  • Endoscopic surgery;
  • Usage of intraoperative computer system providing maximum precision;
  • Safe high quality certified materials;
  • Therapy efficiency is as high as 99%;
  • Individual complex services meet all relevant requirements.

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.

Information: intervertebral disc replacement

  • Hospitalization period: 2 days after the cervical discs prosthetics and 10 days in case of the loin discs prosthetics
  • Hospital rehabilitation: 14 days after the cervical discs prosthetics and 21 days in case of the loin discs prosthetics
  • The price of the herniated disc surgery: 10,000 euros – 20 000 euro

We will gladly consult you concerning the herniated disc surgery and can help you to plan your medical travel to Germany.

Latest News in Herniated Disc Treatment

Back problems: Three new therapies rejuvenate the spine

15.05.2019

Perhaps the most exciting new development in back pain and disc problems are outpatient therapies that significantly rejuvenate thin and worn intervertebral discs and vertebral joints. But what can the new therapies do, how do they work and which back problems do they make sense?

Too thin discs, bulging discs or even slipped discs, worn-out vertebral joints - especially on the back, degeneration through overweight, wrong load or simply "only" the age is particularly painful. Almost everyone knows about back problems.

Intervertebral disc problems are already in their mid 20s

By the age of 25 at the latest, this misconduct already has significant consequences for muscles, tendons, intervertebral discs and vertebral joints. There are first degenerative changes. Back problems increase afterwards, comparable to a steeply running sinus curve, which reaches its peak at about 55 years.

"Germany is world champion in back surgery"

Of course, too often the surgical procedure is the drug of choice for spinal injuries. The most common operation in Germany is the back operation - intervertebral discs, vertebral body stiffening ... "Germany is world champion in these operations," says the expert. However, the success of these interventions is manageable and often only short-term: Around every third patient undergoes stiffening surgery and every fourth intervertebral disc operation returns within two years and needs to be reoperated.

Back OPS are usually superfluous and unsuccessful

"Only two percent of patients with severe back problems require surgery," says Marianowicz. This is the case when a nerve dies or paraplegia threatens. Nevertheless back operations in Germany continue to be carried on happily. Because "in many clinics, spine surgery is the most economically important department" and because every clinic has to be reckoned with, these surgeries are not reduced.

Three new therapies that stimulate the body to self-heal

In most cases (80 percent), the more successful approach is a conservative, non-invasive method that also stimulates the body's self-healing powers. Because in most cases, the body "heals" itself and arranges itself with a worn disc, so that after some time no more pain occurs.

Particularly promising in this context are three new forms of treatment. The keyword is bioregenerative therapies. "You could revolutionize orthopedics as well as the stents in constricted coronary arteries the cardiology," the spine expert compares.

1. PRP (Platelet Rich Plasma) Concentrate of the body's own platelets

For which back problems is PRP suitable?

PRP is useful in all back problems caused by degenerated discs (black disc), but also in damage to the vertebral joints of the entire spine such as the facet joint syndrome.

2. Adult body stem cells from the body's own belly fat

For which back problems is therapy with adult autologous stem cells suitable?

Intervertebral disc (as in PRP), joint arthrosis, joint problems, such as cartilage damage

3. Hydrogel - not to be confused with hyaluronic acid

For which back problems is hydrogel suitable?

Disc problems due to degeneration, disc protrusion or covered disc prolapse (longitudinal ligament between the spinous processes has been preserved).

If the herniated disc is also a current problem for you, then our experts are here to help you.

Herniated Disc: When and how to operate?

01.05.2019

Back pain is a widespread condition. If the pain radiates into the leg, usually a damaged disc is the cause. An operation is neither necessary nor useful in most cases. Experts have been criticizing for years that too many herniated discs are operated without first applying conservative therapies.

We ask our experts: When does an operation make sense?

After a herniated disc surgery in these cases is recommended:

If the damaged disc is so bad on the nerves that it comes to numbness and paralysis in the pelvis and legs, threatening permanent nerve damage.

When very severe and prolonged pain does not improve with conservative therapies such as medication, physiotherapy and manual therapy.

Then surgery of the disc can relieve pain and prevent dangerous complications. The surgical procedures are much gentler today than they used to be. If there is no paralysis in the leg after a herniated disc, surgery is usually not necessary.

Symptoms: deafness, tingling, paralysis

Which discomfort causes a herniated disc, depends on where it occurs, whether nerves or nerve roots are involved and whether it comes to an inflammation. A severe course can lead to the loss of nerve functions. This manifests itself for example in the form of numbness, tingling and paralysis symptoms.

Disease often goes unnoticed

In around 90 percent of herniated discs, the symptoms disappear spontaneously within six to twelve weeks. Many sufferers do not even notice the herniated disc. In a study of symptom-free people between the ages of 24 and 42 from different occupations, researchers found a herniated disc in 60 percent of those who did not cause any problems. Only in a few cases does chronic ailments develop from acute complaints.

Combination therapy for the intervertebral disc

The treatment of disc discomfort has changed in recent years: While long-term surgery or rest and comfort have been recommended, modern treatments rely on a combination of classic pain medications, physiotherapy, heat treatments, massage, relaxation procedures, muscle training, and psychological support.

Periradicular therapy: injecting to the nerve

Another treatment approach is the periradicular therapy (PRT): Here, the doctor injected under X-ray control a mixture of painkillers and cortisone directly to the constricted nerve root. This leads to a subsidence of inflammation and swelling. This way, surgery can be avoided in many cases.

Intervertebral disc endoscopically operate

If the conservative therapy does not succeed, only the operation remains. In most cases, the gelatinous nucleus escaped from the intervertebral disc is removed endoscopically in a half-hour procedure. If the operation succeeds, the complaints are usually abruptly disappeared.

Should an artificial disc be used?

Under certain conditions, a defect can be replaced by an artificial disc. However, these disc prostheses are useful only in a few cases, especially in younger patients with an isolated herniated disc in the cervical spine. Conditions for an intervertebral disc prosthesis are stable vertebral bones and intact vertebral joints. The prosthesis, modeled on a natural disc, is designed to maintain the space between the vertebrae and maintain their normal mobility, thereby relieving pain.

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