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.
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