A prolapsed disc is represented by a vertebral pulp displacement, which is accompanied by a fibrous ring breaking. A prolapsed disc of the lumbosacral region of a spine is the most widely spread, a prolapsed disc of the cervical region of a spine is rarer, and the rarest case of this disease can occur in the thoracic region of a spine.
Overwhelming majority of people, ill on this disease, can successfully recover after a course of conservative treatment. Excision of a prolapsed disc is performed only in case when a conservative treatment turns out to be ineffective; it is quite rare case, and surgical interference is necessary only in less than 10% of cases.
Manifestation of symptoms of a prolapsed disc depends on the part of a spine in which degenerative changes take place.
So, if a prolapsed disc is formed in the lumbosacral region, then it is characterized by local pains in the affected region, irradiating to the cluneal area or to the led accordingly to the affected side (ischialgia). Innervation of the affected roots produces an effect of prickling, numbing and leg weakness, abnormality of leg sensibility may develop. Under nasty forms of this disease malfunction of pelvic organs occurs (a straight intestine and a urinary bladder).
In the result of the development of degenerative changes in the cervical region of a spine, pain irradiating to the hand or to the shoulder appears. It may be accompanied by faintness, numbness of fingers, and increase in the arterial pressure. In some cases there are headaches, which may be accompanied with faintness and the increase in arterial pressure.
Contraction of a prolapsed disc in the thoracic region of a spine goes along with constant pains in the chest, especially, when a person is in a constraint, uncomfortable position. Also it is possible that a scoliosis or kyphoscoliosis forms in the thoracic region of a spine.
The main method of diagnostics of the disease is a magnetic resonance tomography. In the overwhelming majority of cases a surgical operation for a prolapsed disc removal is not necessary, symptoms of the disease gradually disappear, and there happens a remission. Majority of patients (more than 70%) have considerable improvements of their state during 12 weeks, if to take into consideration more prolonged period of time, this number increases.
Generally a surgical excision of a prolapsed disc is considered as a last resort method, it is recommended to apply only in that case if conservative methods of treatment cannot cope with a pain syndrome.
The base of conservative treatment is a therapy applying nonsteroidal anti-inflammatory medicines in complex with analgesics. In some cases it is possible to apply corticosteroids. And movement therapy is applied as an additional solution; it is aimed at the restoration of a spine muscles corset. Taking into consideration tremendous abilities of a human body to recover independently, it is not the main point of treatment, but a very important one.
You should take into consideration, that alternative methods of a pain syndrome treatment (for example acupuncture) area far from being always effective.
Surgical interference, as it has been said before, is a last resort method. It is recommended only in case of development neurological disturbances and a strong pain syndrome, which is impossible to remove by methods of conservative treatment. For example, surgical interference is necessary in that case when «horsetail» compression occurs, in the result of which not only strong pains start, but functioning of pelvic organs is disturbed.
The price paid is very high – excision of a prolapsed disc with the help of surgical interference gives a quick effect, but at the same time there are some disadvantages of this solution. As far as it is necessary to operate on enough inflamed already area, so more often than not it is necessary to deal with a weaken muscle corset on this area, and as a result it may lead to disease recurrences (new prolapsed discs and intervertebral disc protrusions).
Consequently, excision of a prolapsed disc in the cervical part of a spine, for example, which was not accompanied by a normal process of rehabilitation, in combination with a weaken muscles corset of a neck almost reliably will lead to a disease recurrence and formation of one or several prolapsed discs.
Types of operations
Not long ago, a laminectomy was applied while removing a prolapsed disc and that was considered to be a standard solution. This method of treatment had very serious drawbacks: for example, that is quite large injury for an operative approach. Specifically after- affects of this injury were sources of many problems during further rehabilitation after excision of a prolapsed disc. Particularly, it was necessary much time for wounds repairing, and during this period of time a muscles corset and ligamentous apparatus weakened on the injured area, and this led to the occurrence of recurrences. That is why it was necessary to develop new methods, which make allowance for maximum possible reduction of sizes of a trephine opening and, respectively, of an injury.
Applying of a surgical microscope became the first serious change. In virtue of possibility to use it, there appeared a method of intralaminar operative microsurgical removal of a prolapsed disc; nowadays it is considered an optimal method of a surgical treatment.
Further on a microsurgical removal of a prolapsed disc and different methods of endoscopic removal were applied more and more often. And nowadays development of surgical methods of treatment is aimed at reduction of an operational injury.
Removal of a prolapsed disc by a laser, in spite of all reassurances of advertisements, is not some kind of an extraordinary method. Application of a laser is used as an advertising trick, which is to show that the technology of treatment is very advanced. And what actually happens is that it is quite difficult to control the beam formed by the laser, so there is a risk to damage the neighbouring internal organs. Besides, price for such operation, removal of a prolapsed disc by laser, will be higher than for treatment with the help of other methods, not so „trendy” methods.
Microdiscectomy is a microsurgical removal of a prolapsed disc. It is a neurosurgical operation, which is recognized as a very efficient method of surgical treatment. In this case operations are made under condition of high-power magnification, which is achieved with the help of a surgical microscope or a binocular eye loupe.
This method gives an opportunity to remove a prolapsed disc of any location and thickness. Thereby high-power magnification, used during operation process, gives an opportunity to work very precisely; a possibility to injure nervous structures of a spinal canal will be minimal. A skin incision in the process of operation is only 3-5 cm, thanks to this a risk of postoperative complications is minimal, specially under condition of correct rehabilitation procedure application after removal of a prolapsed disc.
In general, nowadays the neurosurgery presupposes quite early activity of a patient, already on the third day after operation. Term of hospital stay of a patient is less than one week, and in this case a patient will be able to work, but not physically already in one or two weeks, and to work physically he or she will be able in a month. In this regard it is recommended to limit the term of being in a sedentary position during the first month after the operation.
After a prolapsed disc removal by no means unimportant will be a remedial gymnastics – exactly by its help it is possible to restore a muscle corset and to form correct posture.
Endoscopic removal of a prolapsed disc
Endoscopic method is one of new trends, that is why it is criticized a lot. Application of endoscope gives possibility to reduce operational injury considerably, but there are some strict limits for its application, particularly it depends on size and location of a prolapsed disc. Minimal size of cutting can be considered as the main advantage of this method (up to 3 cm, that is why this method is sometimes called non-operational removal of a prolapsed disc of a spine), thanks to this all possible negative implications become minimal removal of a prolapsed disc of a spine, and quick rehabilitation is guaranteed. For example, a patient can walk in the day of operation, and he/she can leave the hospital on the 3-4 day after operation.