Removal of an intervertebral hernia

Intervertebral hernia is a common pathology that is accompanied by severe pain and can seriously impair the patient's quality of life. In many cases, spinal hernia treatment is possible by conservative methods, however, if therapy does not work, hernia removal is performed surgically. At the EMC Clinic, the operation is performed by international-class neurosurgeons using state-of-the-art equipment.

Indications for removal of herniated discs

Spinal surgery is associated with certain risks, therefore, conservative methods are used primarily for the treatment of intervertebral hernias: correction of motor activity, physical therapy, the appointment of muscle relaxants, pain medications, and therapeuticdrug blockades.

The following conditions are considered indications for surgical removal of an intervertebral hernia:

1. Conservative remedies that have been prescribed to alleviate the patient's condition do not bring results, the patient experiences severe or unbearable pain.
2. An increasing neurological deficit (weakness in the extremities), impaired pelvic organ function, and severe/unbearable pain syndrome that cannot be treated with medication.

For cervical intervertebral hernia, according to national recommendations, the ineffectiveness of conservative treatment for 6 weeks is an indication for surgery. The probability of recovery with the use of conservative methods for the treatment of herniated discs of the cervical region is above 90%.

Hernias of the thoracic spine are extremely rare, however, such formations can reach a large size and often calcify. This significantly increases the risk of myelopathy, so surgery may be prescribed to remove the hernia.

Herniated discs of the lumbar spine often cause complications in the form of radicular syndrome or radicular pain syndrome accompanied by neurological disorders. The increase in the symptoms of the disease can lead to severe consequences, up to the profound disability of patients. The operation makes it possible to stop this pathological process and gives a high chance of recovery.

Contraindications

There are no absolute contraindications to intervertebral hernia surgery. Relative contraindications include:

• acute infectious or inflammatory process;

• decompensated chronic diseases;

• pregnancy;

• blood clotting disorders.

Preparation for intervertebral hernia surgery

When preparing for surgery, the patient will need to undergo a full examination, the plan of which will be developed by the doctor at the initial appointment. Basic list of diagnostic procedures:

• MRI of the spine;

• radiography;

• hospital profile (general clinical analysis of urine and blood, biochemical analysis of blood, tests for HIV, syphilis, hepatitis, ECG, fluorography);

• consultation with a therapist.

It is important for the patient to warn the doctor about all medications they are constantly taking, since some of them will have to be canceled 7-10 days before the operation.

The surgical procedure is performed on an empty stomach 8 hours before arrival at the clinic, the patient must abstain from food and water. On the eve, let's say a light dinner, if you are very thirsty, you can rinse your mouth. Detailed recommendations on preparing for surgery are provided to the patient by the attending physician.

Performing an operation to remove a herniated disc

The technique of surgery depends on the severity of the pathology, the location of the hernia, the structures it affects, the size of the spinal canal, and many other factors.

Removal of pathology is possible in various ways:

1. Microdiscectomy. The most gentle surgical intervention that allows you to remove a pathologically altered area, while only minimally affecting healthy disc tissues. The procedure is performed through open access, then there is a small incision 2-3 cm long, which is performed on the back in the projection of the damaged disc. By monitoring his actions with a microscope, the neurosurgeon excises the tissue particles that form the hernial protrusion. Due to this, the nervous structures are freed from compression, which reduces or completely eliminates the pain syndrome. After the manipulations are completed, the wound is sutured. The intervention takes place under general anesthesia and lasts an average of 1 to 2 hours. Today, microdiscectomy is the gold standard of surgical intervention for herniated discs, which allows safe and effective removal of hernias of most localizations. Advantages of open microdiscectomy: low risk of injury, relatively short period of postoperative recovery.
2. Endoscopic discectomy. The intervention is performed in a closed manner, through a small puncture on the skin (4.7mm), which significantly reduces injury to healthy tissues. The neurosurgeon performs all manipulations under the control of an endoscope, a miniature probe with a diameter of 4 mm with a video camera, which transmits the image to the monitor with magnification. At the first stage, an elastic conductor is inserted into the intervertebral disc, along which an endoscope is performed to examine the inner part of the disc. Next, microsurgical instruments are inserted through special holes-ports of the endoscope, with which the doctor removes the disc herniation fragment in small parts. The advantages of this technique include minimal traumatization of soft tissues in the surgical area, as well as the possibility of removing disc herniations of complex locations that are inaccessible to surgical approaches performed for microdiscectomy. Endoscopic discectomy is performed under general anesthesia.
3. Decompression and stabilization surgery. An intervention performed in the presence of certain indications, usually consisting in the complete removal of the hernia along with the affected intervertebral disc. In such cases, additional stabilization of the segment involved in the pathological process is performed with the help of metal structures (installation of artificial discs/intervertebral cages together or without the installation of a screw transpedicular fixation system. It is performed by open abdominal access through an incision up to 10 cm long, which is performed on the back or neck (in some cases, on its front).The procedure is performed under general anesthesia and lasts from 2 hours. This method is considered the most traumatic, however, with a combination of certain factors, it may be the only possible one.

Rehabilitation

1. The duration of rehabilitation after removal of an intervertebral hernia may vary depending on the severity of the pathological changes prior to surgery, the method of surgical intervention, and the individual characteristics of the body. Thus, the duration of full recovery is most often 1-2 months, but in some cases it can reach 6 months.
In the first hours after the operation, the patient is shown bed rest, then he can get up and walk, but he does not have to sit. Antibiotics are prescribed to prevent complications. From the second day, physical therapy exercises are prescribed to maintain muscle tone, respiratory and cardiovascular systems. The length of stay in the hospital, as a rule, takes from 2 to 7 days. Sutures from the postoperative wound are removed on days 7-14, depending on the type of intervention. Until the end of the rehabilitation period, some patients are prescribed to wear a supportive corset, lifting weights over 3 kg is prohibited, and recommendations are also given on correction of motor activity and orthopedic regimen. A return to work, depending on the type of work and the surgical procedure performed, will be possible in 3 to 8 weeks.

The cost of intervertebral hernia surgery

The cost of removing an intervertebral hernia depends on the complexity of the operation, which, in turn, is influenced by factors such as the size of the pathology, its location, the structures affected, the patient's age, etc. Preliminary prices for surgical treatment can be found in the price list on our website. The exact cost of the operation can only be indicated by the doctor after a full examination.