Do you also have unbearable back pain? Perhaps the pain starts in your back and goes all the way down your leg. Some people say it feels like an 'electric shock '. This could be because a disc between your vertebrae has slipped out and is pinching a nerve. In medical terms, we call this condition a herniated disc. When we hear this name, some people get scared and think, "Oh, I'm going to have to have surgery now." But not everyone needs surgery. Let's talk about it all today.
Simply put, what is a herniated disc?
Think of your spine as a set of small bones (we call them vertebrae) stacked on top of each other. To stop these bones from rubbing against each other, like the 'shock absorbers' in a car, there is a cushion filled with something like jelly between each of these bones. This is what we call a 'disk'. This disk is what allows us to bend forward, backward, and rotate our spine easily.
But sometimes, when lifting something incorrectly, in an accident, or as we age, the outer covering of this disc weakens and the jelly-like part inside it bulges out. It's like squeezing a jam-filled donut and the jam comes out. The problem starts when the protruding disc presses on a nearby nerve . That's when symptoms like unbearable pain, numbness, and weakness in the legs occur.
When is surgery really necessary?
This is the most important thing. Not everyone with a herniated disc needs surgery. In fact, most people recover within a few months with rest, pain medication, and physical therapy. Your doctor will try these nonsurgical treatments first.
However, there are a few special cases where you should consider surgery. Let's take a look at what they are.
| When to consider surgery | |
|---|---|
| Unbearable pain | If the pain cannot be controlled with other treatments, and if the pain is so severe that you cannot perform your daily activities (getting up, walking, going to work). |
| Nervous system disorders | If the disc is pressing on a nerve, symptoms such as numbness, weakness, and muscle weakness in the legs or arms become more severe. |
| Difficulty walking or standing | If you are unable to stand or walk properly due to back pain and weakness in your legs. |
| Medical Emergency | This is the most important and dangerous symptom . If the disc is pressing on the spinal cord and causing incontinence, it is an emergency . If this happens, you should go to the emergency room (ETU) of a hospital immediately. |
The important thing is, this decision is not one you make alone. Your doctor will review your symptoms, MRI scan results, and give you the best advice on whether or not you need surgery.
What are the main types of surgeries performed for this?
The main goal of surgery is to remove the herniated disc that is pinching the nerve and free the nerve. There are several main types of surgery for this.
Diskectomy
This is the most common surgery. Here, the surgeon removes the damaged part of the disc and releases the nerve. This can also be done in two ways.
- Open diskectomy : A small incision is made in the back or neck and the damaged disk is directly removed.
- Microdiscectomy: This involves making a very small incision, inserting a thin tube with a camera attached, and removing only the damaged part of the disc. This procedure requires less recovery time.
Laminotomy / Laminectomy
Sometimes, to get to the disc, a small piece of the bony part of the vertebra called the lamina must be removed. This lamina is a protective covering that protects the spinal cord. Removing a small piece of this also reduces pressure on the nerve.
- LAM inotomy: A small portion of the lamina is removed.
- Laminectomy: Most or all of the lamina is removed.
Spinal Fusion
This is the name given to the process of fusing the two vertebrae on either side of a disc after it has been removed. This involves using small screws and metal rods to hold the two bones together. This increases the stability of the spine and prevents future pain from recurring.
Artificial Disk Surgery
This is not a surgery that most people can do, as it can only be done on certain discs in the lower back. In this procedure, the damaged disc is completely removed and replaced with an artificial disc made of plastic or metal.
How is the recovery time after surgery?
The good news is that most herniated disc surgeries are very successful. Symptoms such as pain and numbness begin to subside faster than with other treatments. You will feel a big difference within a few weeks of surgery.
But you also need dedication to recover quickly.
- Physiotherapy: This is a must. As directed by your doctor, exercises that strengthen the muscles around your back will help speed up recovery.
- Walking: Starting to walk slowly can help restore back mobility.
- Avoid these things in the first few weeks after surgery:
- Weight lifting
- Sitting for a long time
- Bending or pulling at once
Your doctor will decide when you can return to work and when you can drive. Typically, you can return to an office job in about 2-4 weeks. However, if you have a job that requires lifting weights or operating machinery, you may need to wait at least 6-8 weeks.
Are there any risks? What are the results?
As with any surgery, there are some risks. Although herniated disc surgery is generally very safe, there are a few things that can happen very rarely:
- Infection
- Damage to nerves or blood vessels
- Bleeding
- Spinal fluid leak
- Problems with transplanted parts
Also, a very small number of people (about 5%) may have a herniated disc again after surgery. Sometimes, surgery may not completely eliminate the pain.
Take-Home Message
- Don't be alarmed when you hear the word "herniated disk." Most people don't need surgery.
- Surgery is only considered in cases of unbearable pain, severe neurological deficits, and when other treatments have failed.
- Incontinence is a medical emergency . If this happens, go to a hospital's ETU immediately.
- Talk to your doctor carefully to decide which treatment is best for you.
- If you have surgery, it is very important to follow physiotherapy and medical advice for a speedy recovery.
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