The cartilage is an articular disc between the vertebrae in the spine, in the cervical, thoracic and lumbar vertebrae. It consists of a cartilaginous and gelatinous substance surrounded by a strong protective capsule. The wear and tear of the cartilage and its slipping comes as a result of improper movement of the vertebrae, or carrying a heavy object, or an accident that led to injury to the vertebrae.
Patients are more likely to have a herniated disc as a result of hereditary factors, congenital defects in the vertebrae, defects in the histological composition of the cartilage, or patients with rheumatism and its types. It has been proven that smoking leads to dryness and wear of the cartilage, which leads to an increased possibility of a herniated disc. Smoking has become one of the main causes of herniated disc.
Lumbar herniated disc symptoms
By herniated disc, we mean the movement of a crumbled part of the cartilage into place. And the symptoms of the disease depend on the place to which the crumbled part of the cartilage slipped, and these symptoms:
- Localized pain in the lower back, and it may be possible at the beginning - and it develops to the worst or improves, and it is the result of erosion of the cartilage or its protrusion without causing pressure on the nerves feeding the lower extremities.
- If the cartilage slips towards the exit of the nerve - heading to the left or right lower extremity, and causes pressure on the lumbar or sacral nerve, it may lead to pain in the lower extremity, numbness in the leg and foot, and difficulty in walking. If pressure develops on the nerve, it may lead to weakness in the nerve, limb and foot movement, and difficulty walking
- And if the cartilage slips towards the middle of the spinal canal - it leads to pressure on the entire nerve strand inside the spinal canal, causing pain in the legs, numbness of the buttocks and legs, and difficulty in walking. And if the disease develops, it may lead to loss of control over the exits of urine and stool, and this stage is so dangerous that emergency surgery is required
Herniated disc treatment
When the patient reviews the specialist doctor, and makes sure that there is no weakness in the nerves supplying the lower extremities or the nerves that exit urine or stool, priority is given to conservative treatment, which includes:
Analgesic drugs, rest, exercise, swimming, moderate walking, and physical therapy. It may also include cortisone injections into the spinal canal around the lumbar and sacral nerves.
The success rate for controlling the symptoms of a herniated disc with conservative treatment may reach about 80%.
We resort to surgical treatment in the following cases:
- The presence of severe weakness in one or both of the lower extremities
- Poor control of urine and stool exits
- Failure of conservative treatment and the patient's intolerance to pain
In the first two cases, the need for surgery is urgent in order to save the damaged nerves as quickly as possible before permanent damage occurs.
Endoscopic surgical treatment
Neuro-modulated surgery using posterior endoscope is used to remove the herniated disc to avoid the risks of large cuts of skin, muscle and bone tissues as is the case with traditional surgery, reduce the length of stay in the hospital, reduce the financial cost, and expedite the patient’s movement from his bed after the operation. This advanced surgery is done using:
- General anesthesia, and the patient is in a supine position.
- We excise the herniated disc, expand the nerve outlet, and then close the small wound
- After the patient recovers from the effects of the operation and anesthesia, the patient feels the disappearance of the pain in his leg, and we move the patient and allow him to walk the next day, and he can leave the hospital and his patients rest for a period of several weeks.
- We recommend that the patient use some exercises to strengthen the back muscles three weeks after the date of the operation, and two weeks later he can return to work
The success rate of controlling pain by using a posterior endoscope to remove a herniated disc is up to 95%. The complication rate is about 5% and includes the possibility of infection in the wound or cartilage, or inflammation of the nerve, or the possibility of returning the patient to the operating room and removing another part of the cartilage