Lumbar disc herniation

DID YOU KNOW THAT...

Lumbar disc herniation is one of the most common spine conditions and is caused by damage to the intervertebral disc (known simply as ‘disc’) whose section compresses the nerves in the spinal canal. The compression of the nerve root causes pain in the lumbar region or pain in the lower limb, sometimes accompanied by plegia.
For short-lived pain physiotherapy is the treatment of choice. Surgical treatment should be considered if physiotherapy is not effective or there are symptoms of plegia (such as foot paresis). If paresis occurs, the surgery should take place as soon as possible. Any delay increases the risk of the paralysis becoming permanent.

Benefits:

  • After fast and minimally invasive surgical procedures patients can quickly return to work, and day-to-day activities are no longer painful.
  • Minimally invasive procedures also carry a smaller risk of complications associated with damage to nerve roots and wound healing.
  • Importantly, after procedures performed with the aid of the microscope or endoscope wounds measure from 5 mm to 15 mm, which translates into a much smaller trauma to the body.
  • For the whole body a smaller trauma means a smaller impact on the immune system, a lower decrease in immunity and fewer general complications.
  • Minimally invasive procedures require a shorter hospital stay. Recovery is also quicker.
  • After our procedures you will be able to get up and move independently one hour after the surgery.

INDICATIONS AND CONTRAINDICATIONS

  Indications:

Absolute indications – requiring fast surgical treatment:

  • paresis/plegia of the lower limb, the feeling that a foot ‘gives way’, urinary incontinence

Relative indications – depending on pain severity and its impact on day-to-day activities:

  • pain radiating to the lower limb (sciatica), sometimes pain in the lumbar spine lasting over 3 weeks and not responding to conservative treatment
  • if a large fragment of an intervertebral disc in the spinal canal (‘sequester’) is visible on an MRI scan and causes acute pain, real recovery within a few weeks is rather unlikely. In such cases the patients may undergo a surgery directly after diagnosis is made.
  Contraindications:
  • medications which significantly decrease blood coagulation,
  • serious conditions of other system when general anaesthesia cannot be used.

TREATMENT OPTIONS:

Discectomy

This is an older and less effective surgical method and we no longer perform it (these are all open surgeries to treat DDD, where the post-operative wound is larger than 2 cm).

Microscopic microdiscectomy

A minimally invasive procedure performed under microscope guidance. Skin incision is about 15 mm long. At St Adalbert Hospital we use the Piccolino spinal spreading systems made by Medicon, which ensures that the injury is minimal but at the same time the operator has a very good view of the surgery site. During the procedure the damaged fragment of the intervertebral disc is removed to release compression on affected nerves. Thanks to the magnification through the use of microscope the procedure is much safer. The operator can see all the structures at a magnification of 10 to 12x. At our hospital we use cutting edge F50M525 microscope made by Leica, which ensures a full view and safety of the surgery. Currently this type of procedure is considered to be the best option and is the gold standard.

Endoscopic microdiscectomy

This procedure, performed with the use of the Vertebris endoscopic sets made by Wolf, is one of the most modern and most effective techniques for lumbar DDD surgery. This surgical procedure can be applied in some patients, after the evaluation of an MRI scan and the patient’s anatomy. The procedure is performed under general anaesthesia. A tube and endoscope are inserted into the spine. They measure 7 mm in diameter (like a pen). The damaged fragment of the vertebra (disc) is removed. The whole procedure is performed in water environment (saline solution), to ensure that the surgical field is rinsed. This stops all bleeding and prevents the formation of scar tissue in the canal (which may cause problems later). After the endoscope is removed, the incision is closed with one suture.

ELIGIBILITY:

  • The patient’s eligibility is evaluated by an experienced neurosurgeon on the basis of the whole clinical picture, following the examination of the patient and analysis of imaging test results.
  • Diagnostic imaging is necessary: the standard test is a 1.5 or 3-tesla MRI scan. If there are absolute contraindications for an MRI scan (strong claustrophobia, metal implants, others), the patient’s eligibility may be evaluated on the basis of an ‘open’, low-field MRI or computed tomography.
  • If there are any doubts as to the diagnosis, an EMG test is performed to precisely determine the level where the pain and other symptoms originate.

Before the procedure:

Patients should have the basic laboratory tests done: blood type and Rh factor, complete blood count, basic biochemistry tests (sodium, potassium, urea, creatinine, glucose), coagulation parameters (APTT, INR), ECG, a general chest x-ray (for patients over 40 or with a history of pulmonological problems). Additional tests or consultations with specialists may be required, depending on the patient’s condition and other medical conditions (such as a thyroid profile test, urinalysis, consultation with a cardiologist). The meeting with the anaesthetist takes place a few days before the procedure if the neurosurgeon so recommended. Otherwise, the meeting takes place on the day of the procedure, during the admission process.
Please bring to the hospital only the necessary items, such as medical records, neurosurgeon’s consultation documents with the eligibility evaluation, imaging test results (MRI, CT, x-ray) on CDs with descriptions, laboratory test results, routine medications, toiletries, towel, socks, pyjamas and footwear as well as a change of clothes. Please do not bring any jewellery and other valuables. In each hospital room there is a wardrobe and a cupboard for your personal belongings (in two-person rooms each patient has his/her own wardrobe and cupboard).
The final evaluation of your eligibility for the procedure is done on the day of the procedure. You will be asked to give written consent to the surgical procedure and general anaesthesia (you can download samples from our site). You take your blood pressure medications, heart medications and hormonal medications if you take them on a regular basis.

Procedure:

The procedure is performed under general anaesthesia, with the patient lying face down. The surgical treatment is applied using one of the two procedures: microscopic microdiscectomy or endoscopic microdiscectomy. Usually the procedure lasts from 20 to 90 minutes, depending on a specific case and the procedure used. Endoscopic procedures are usually shorter.

After the procedure:

You are woken from anaesthesia under the supervision of an anaesthetist in the theatre recovery room.
On the day of the procedure you may walk around your room and go to the bathroom. However, activity should be rather limited. On the next day, after waking up you should gradually increase your activity level. Before midday you should walk around the corridor and go out on the terrace. During that time you will receive advice on post-operative rehabilitation and further care from a qualified physiotherapist.
The discharge is planned for the afternoon, after a medical examination and receipt of your medical records.
While at home you should avoid effort for 4 to 6 weeks. This is the time when the intervertebral disc is healing and the risk of reherniation is the highest (the risk that a part of the nucleus pulpous will slip again through the damaged fibrous ring). During this period you should avoid straining your spine, lifting, bending, twisting and rotating movements as well as other activities which involve dynamic torso movements. Additionally, you should avoid sitting, as it means static overload for the treated spine section. In special cases you may benefit from wearing back braces after the procedure. In the first week after the surgery you should schedule an appointment to check your wound. The next visit is scheduled 3 to 4 weeks after the procedure to evaluate the preliminary treatment outcomes.
During the whole post-operative period you can call your doctor directly.

Our specialistsNeurosurgery

poznaj naszych specjalistów >

Price listNeurosurgery

przejdź do cennika >

Make an appointment

+48 61 62 33 111

Wielkopolskie Centrum Medyczne
Sp z o.o. S.K.A

st. Bolesława Krzywoustego 114
61-144 Poznań, POLAND

Hospital hours:

Mon-Fri 8:00 – 20:00
Sat 8:00 – 16:00

Contact us to arrange a visit or to learn more!

Call us! +48 61 62 33 111

Write to us

By sending a message, you agree that the St. Adalbert's Hospital would contact with you by phone or e-mail and you declare that you have read the Privacy Policy.


close button Powered by Medidesk
For more information
leave your number,
I'll call you back.
Please leave your number.
We'll call you back.!