Endoscopic surgery for disk hernia
Written by:Disk hernia is a rather common vertebral pathway, favored by both sedentary and physical inactivity and overloading on the column such as overweight and physical stress. In Italy, this disease has a rather high incidence, in fact affects about 8% of the population and is most common in the age group of 30 to 50 years. As the Prof. Gaetano Gulino, an expert in Orthopedics and Traumatology at Paternò (Catania) , is able to intervene surgically with minimal invasiveness
When the inner part of the vertebral disk (polposum nucleus), for various causes, exceeds the external disk structure (anulus fibrous), the disk hernia is formed in the vertebral canal. Usually, this herniated material, in size from a grain of rice to that of a hazelnut, results in a reduction in the spine space at the expense of the nerve structures which consequently suffer from alterations.
Symptoms of disk hernia
The clinical herniation of the disk hernia is characterized by lumbar symptoms (pain, contractures of paravertebral muscles, rigidity and occasionally scaly analgia) and peripheral symptoms (often monolateral sciatica, which can be acute with a cough, sneezing or defecation , muscle deficiency and skin sensitivity alterations characterized by paresthesia - tingling, numbness, cold feeling - hyperexia to real anesthesia).Diagnosis is essentially clinical (young age, abrupt adulthood of the symptomatology and irradiation of lower leg pain) and is supported by instrumental examinations ( Nuclear Magnetic Resonance and / or CT of the spine and lower limb electromyography) that help to locate the seat and size of the hernia and the degree of injury of the nerve root.
How to Treat Disk Hernia
In most patients with disk hernia painful symptom regress spontaneously with or without any therapy. In 50% of cases regression occurs in two to three weeks and in 90% of cases in three months. This is basically related to the characteristics of the intervertebral disc: the nucleus of the pulp (which hernia) contains a high concentration of water that, with the passing of days, is absorbed causing a loss of nerve volume and hence a reduction in the compression of the nerve structures with progressive regression of painful symptomatology.Medicines are only used as symptomatic. Generally anti-inflammatory and cortisone drugs are used to eliminate the inflammation of the nervous root, affected by the hernia disc, which is the cause of the pain. The use of muscle relaxants may also be associated with central action, which counteract muscular contractions.Physiotherapy treatment becomes crucial: analgesic therapy, muscle relaxation, and overall functional re-education help resolve symptoms.
Hernia of the disk: the treatments to avoid
At this stage, benign and transient, you must avoid unnecessary treatments. These include:
- nucleus suction (removal of the polposo nucleus with cannule);
- chemonucleolysis (chemical destruction of the nucleus polposo) which, if previously considered valid, has now been abandoned both by the high rate of neurological complications and by the large number of failures;
- nucleoplasty that consists in decompressing the radiofrequency disk. The current generated inside the disk creates a molecular dissociation that in turn increases the local temperature between 50 and 70 ° C, resulting in a thermal coagulation zone and important biochemical modifications;
- percutaneous discectomy Laser consists in the vaporization of the herniated tissue mediated through the use of Laser cannulas. It is a dangerous procedure for the high possibility of damaging the nerve root near the disk hernia.
Ozone Therapy for Disk Hernia: Is It Really Helpful?
Particular mention deserves ozone therapy , a recent fashionable and expensive procedure. It consists in inserting a mixture of ozone and oxygen into the intervertebral disc. Such a procedure to be performed would require proper patient preparation with appropriate antibiotic therapy prophylaxis and an anesthesia equipped room with TAC or brilliance amplifier and specialized personnel to actually inject the ozone and oxygen mixture into the disk. Today, this procedure is carried out with frequent and expensive cycles and the blend is injected into the paravertebral muscles, such as simple intramuscular injections with dubious efficacy. The action of the free radical release free radical reducing the polpo nucleus appears unlikely especially if the technique is that of intramuscular injection.He points out that the specialist must be very cautious in setting up directions for the intervention: only after careful clinical evaluations. The intervention should never be performed urgently if we are in those rare cases where the patient charges obvious neurological deficits ingrowing.When the lumbar pain becomes chronic and / or radiates to the lower limb preventing the normal physical activity of the patient it becomes necessary to resort to the surgical treatment. The purpose of the surgical treatment is to correct the problem that creates the compression or irritation of the nerve roots, causing the painful symptomatology.
Endoscopic microdiscectomy for disk hernia
In our operative complex, equipped with the most modern spinal surgeon equipment, the most innovative surgical techniques are used, among which a procedure that provides optimal results: endoscopic microdiscectomy in peridural anesthesia. The peculiar nature of endoscopic technique, the result of research in recent decades, is to perform an intervention by introducing a cannula through a very small surgical incision (1.5 cm), as in the knee arthroscopy. The cannula is crossed by an optical system connected to a monitor for enhanced visualization of operating images; this allows a good visual operative and a great facilitation in the surgical operation that facilitates the total removal of the disk hernia.
The Benefits of Endoscopic Surgery
The post-operative complications of endoscopic surgery - meningitis, adherent cicatricial phenomena, residual lumbar pain - are minimized. On the one hand, endoscopic technique minimizes surgical trauma and therefore, while respecting anatomical structures, it improves results, on the other hand, peridural anesthesia allows easier recovery and hence the reduction of postoperative degeneracy. The patient begins to walk after a few hours of surgery and resigns the next day. The patient, after several days of physiotherapy treatment and a satisfactory state of health, returns to normal work; this usually occurs within two weeks of surgical intervention, rarely beyond that period. Some heavy work activities and some sports practices that cause abnormal stress on the lumbar area (golf, horseback riding) are resumed after about two months of intervention.
Editor. Valerio Bellio