What is disc herniation?
The intervertebral disc helps with the movement of the spine by acting similar to the shock absorbers in a car. The outer ring of the disc is made up of thick tendons and houses an interior of flexible, gel-like tissue that absorbs the impact. When weight is placed on it, the disk expands, and when the weight is removed, it returns to its original shape.
When the intervertebral disc begins to deteriorate, flexibility is reduced. If there is tearing of the outer ring, the soft central portion may bulge out and compress the surrounding nerves, causing a number of symptoms.
What are the symptoms of disc herniation?
There are three types of symptoms of nerve compression: pain, weakness, and numbness.
Pain caused by the compression of nerves will occur in the arms or legs, and may feel like an ache that travels along the path of those nerves. Depending on which nerves are compressed, pain will be unique to those nerves.
The nerves of the spine control movement of muscles. Compression of these nerves causes a disruption to the electrical signals that are transmitted, leading to weakness of the muscles.
Compression of the nerves can lead to loss of sensation on the surface of the skin to which the nerves are connected.
What many people believe is that conditions that affect the spine cause back pain, but in reality, symptoms that are more important are those that affect the limbs as these demonstrate that the nerves have been disturbed.
The symptoms of disc herniation are similar to those of spinal canal stenosis as both have to do with nerves being compressed. The difference is that in the case of disc herniation the pain is often acute and more severe due to the inflammation that occurs around the nerves. Patients with severe symptoms may not be able to perform daily activities independently.
Severe pain is not always an indicator for surgery and disc herniation can usually be treated without surgery. The surgeon will carry out a detailed assessment of the function of the nerves to select the most appropriate treatment option.
Treatment begins with medication and regular physical therapy. If symptoms are not alleviated, the next treatment option is the injection of steroids into the spinal canal
. This medication will reduce inflammation at the source of the problem and allows for quicker recovery of the patient.
If none of the treatment options mentioned work to manage the patient’s symptoms, or if the patient has indicators for surgery, including muscle weakness, chronic pain that has lasted more than three months, or the inability to control bladder and/or bowel, then the doctor will recommend surgery to reduce compression of the nerves as the final treatment option.
Treatment by Endoscopic Surgery
In traditional surgery using a microscope the surgeon must cut through healthy tissue to access and trim the excess bone or disc that is compressing the nerves. Sometimes it is necessary to expand the incision to allow for a better vision field for surgery.
In endoscopic surgery the surgeon will insert an endoscope through an incision of just eight millimeters. The lens at the tip of the endoscope is similar to the eyes of the surgeon inside the patient’s body, allowing more clarity and accuracy in detecting abnormalities. The surgeon can then remove only the problem area without unnecessarily damaging the surrounding healthy muscle and tissue.
An endoscope is a surgical tool that includes a camera and is “smaller than your fingertip.” It is a small tube with a diameter of just eight millimeters, with a lens at the tip. The lens is slightly angled for better view of surrounding organs. Furthermore, an endoscope has fiber optics allow brighter lighting for improved vision and a small water pipe. All surgical instruments will pass through this tiny pipe, which means that the incision required will only be eight millimeters wide.
Advantages of Endoscopic Surgery
- Smaller incision site
- Less pain from surgery
- Low risk of infection
- Less damage to healthy tissue surrounding the surgical site
- Quicker recovery; patient is able to return home within 24 hours
- Lower cost
Spinal Endoscopic Surgery Procedure
Once the patient is under anesthesia the surgeon will insert the endoscope through an incision of eight millimeters directly to the nerves that are being compressed, without damaging any of the healthy tissue surrounding the site. The endoscope will allow the surgeon to clearly see the nerves so they may trim only the area where the nerves are compressed, whether compression is caused by a bulging disc or degenerated joints and tendons. The entire procedure takes approximately 30 to 45 minutes. The patient can walk immediately after surgery.
Indicators for Spinal Endoscopic Surgery
Generally the indicators for surgery include: unsuccessful treatment by alternative methods, chronic pain, clear weakness of the legs, or the inability to control bladder and bowel.
The Spine Institute at Bumrungrad International
The team of physicians at the Spine Institute of Bumrungrad International has received training from Dr. Sebastian Rütten (the inventor of the tools and pioneer of this type of surgery) has performed spinal endoscopic surgery on more than 600 patients in Thailand with good to excellent outcome rates of up to 95%.
Bumrungrad International Clinic (BIC) Building , 20th floor
Bumrungrad International Hospital, Bangkok, Thailand
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