You can get relief from sciatica or back pain caused by a herniated disc. Your doctor might recommend physical therapy or exercise. A chiropractor may recommend chiropractic care. Steroid injections may also be recommended to reduce inflammation from a herniated disc.
If you are experiencing persistent pain that does not go away after trying conservative treatments, you might need to see a neurosurgeon for surgery to repair your herniated disc. Surgery is used to remove any disc material or pressure on the spinal nerves. This can help you to reduce your pain and improve mobility.
You should be aware that there are several surgical approaches when you consider surgery. Traditional surgery involves an incision that is large and open. The surgeon will have to cut your lumbar muscles from your bone in order to view your disc.
What is a herniated disc and how can it be treated?
An injured disc can affect daily activities and cause severe pain. The vertebrae are the individual bones that make up the spine. Intervertebral Discs are cartilage-covered discs that sit between the vertebrae. The intervertebral discs are there to support the spine, and act as shock absorbers between the vertebrae.
The human spine has 23 discs. Each disc is made of three components.
- Nucleus Pulmonosus: This inner, gel-like section of the disc gives the spine flexibility and strength.
- Annulus Fibrosus: This tough outer layer surrounds nucleus pulposus.
- Cartilaginous endplates are cartilage pieces that are between the disc, adjacent vertebrae and each other.
- An annulus fibrosus ruptures or is torn in a herniated disc. This causes a part of the nucleus fibrosus to push into the spinal channel. Sometimes, herniated tissue can press on a nerve, causing movement to be affected and pain.
Between the ages of 20-49 years, around 5-20 percent of 1,000 adults suffer from herniated discs. Any disc can herniate. The cervical spine is the second most common. The lower back is called the lumbar, while the cervical refers to the neck.
Who has to have herniated disc surgery?
Most herniated discs can be treated without surgery. Symptoms usually resolve within days to weeks in 9 out 10 patients. Some people with a herniated disc do not feel any symptoms. Sometimes however, the herniated spine presses against a nerve within the spinal column. This can cause weakness, pain, and numbness in the area of the body that the nerve runs.
If the pain persists, a person should contact their doctor. Based on the individual’s disability and level of pain, the doctor may recommend surgery. A herniated disc can cause nerve damage to the bladder and bowel. It will be necessary for the nerves to be relieved and to restore bladder function.
When possible, patients may prefer to seek treatment at a hospital using a multidisciplinary approach for making surgical decisions. A pilot study from Trusted Source shows that a group of healthcare specialists, including anesthetists and surgeons, may be more likely to recommend unnecessary spine surgery than one individual.
Procedures
A surgeon can use a variety of procedures to treat a herniated or bulging disc. The goal of herniated disc surgery is to relieve pressure on the nerves, which can cause pain.
One of the three methods a doctor can use to relieve nerve pressure is the following:
- Open discectomy (or discectomy): The surgeon performs an open procedure to remove the herniated portion of the disc.
- Endoscopic spine surgery is performed using a long, thin tube or endoscope to remove the disc. The procedure is minimally invasive and only requires a small incision. A small scar will be left, which allows for a faster recovery.
- The core of the spine disc is surgical: A surgeon uses tools to access the disc’s core and then uses a vacuum pump to extract the core. This shrinks the spine disc, which decreases nerve pressure. The surgery can only be performed if the outer layer is intact.
There are also other surgical options for a herniated spine:
Laminotomy/laminectomy
The lamina covers the spinal canal. Sometimes, doctors may need to remove a portion or all of the laminate to fix a herniated disc. A laminectomy is the total removal of the lamina. Both procedures require a small incision to be made at the center of the neck and back, over the area where the herniated disc is located. After removing some or all of this lamina, the surgeon will perform a discectomy to remove herniated disc.
Laminotomies/laminectomies are available in lumbar and cervical locations.
- Lumbar procedures are used to alleviate leg pain and sciatica that can be caused by a herniated disc in the lower back.
- Cervical procedures are performed to relieve pain in neck and upper extremities from a herniated disc.
Spinal Fusion
After a laminectomy or laminotomy, a spinal fusion (SF), may be required to stabilize the back. An SF is a procedure that joins two bones together using screws. People who have received SF treatment may feel some pain afterward. The extent of the herniated disc will affect the probability of needing an SF. Typically, lumbar lumbar laminectomies need an SF.
Cervical laminectomies are performed from the front. If the surgeon works from the back of your neck, you will not need an SF. The exact location and extent of the herniated disc will dictate the point from which the surgeon operates. Laminotomy patients may be candidates to have artificial disc surgery, instead of an SF.
Artificial Disc Durgery
ADS (artificial disc surgery) is an alternative for spinal fusion. ADS is when the surgeon replaces the injured disc with an artificial. The surgeon will often associate this procedure with less pain and more restricted movement than SF procedures.
Recovery timeline and process
Study shows that patients who have surgery to repair a herniated disc sooner than expected may experience a quicker recovery. They may also enjoy better long-term health.Most people can return to work within 24 hours after a herniated-disc operation. Some patients may be able return to work the next day.
Doctors suggest that those recovering from herniated disc surgery refrain from the following activities for approximately four weeks.
- Driving
- Long periods of sitting
- Lifting heavyweights
- bending over
For people with herniated discs, some exercises can be helpful. Before they attempt any strenuous activities, they should consult with their doctor. Sometimes doctors might recommend rehabilitation therapy after surgery. Patients who complete a rehabilitation program after disc herniation surgery may experience a quicker recovery and better mobility.
Risks
There are rarely complications with discectomies. Rarely, however, patients may experience the following:
- Bleeding
- Infections
- Tears in spine’s protective skin
- Injury to the nerve
Around 5% of patients may have symptoms that recur after their discs rupture. For many, herniated disc surgery is an effective treatment. Surgery is not a guarantee that the symptoms will disappear. Some people may experience persistent herniated disc pain even after the treatment. The pain may get worse in some cases.
Other options
- The symptoms of a herniated disc may be eased by using pain medication.
- For 2 to 3 days, people who have a herniated disc should be restricted from moving for at least two to three days. It is important to limit movement in order to reduce inflammation. Although this may seem counterintuitive at first, doctors don’t recommend bed rest.
People suffering from pinched nerves in the neck or leg as a result of a herniated disc can try NSAIDs and therapy.
These treatments may not be effective and doctors may recommend alternative nonsurgical options such as selective nerve root block. To relieve pain from herniated discs, doctors may inject local numbing substances into the spinal cord.
Preoperative Preparation
A lot of surgeons require their patients to attend a pre-operative education class. You will be taught about your procedure and how to prepare. The following topics may be discussed:
- Time to recover from a typical herniated disc surgery
- Diverse healthcare professionals are available at the hospital
- The type of diagnostic or surgical equipment used during surgery
- How to manage postoperative pain
- Virtual or live tour of the hospital/surgical center
- Ask questions during this session, if possible. If you have any concerns about your surgery, please let your doctor know.
Day of Surgery
At a designated time, you’ll be reporting to the hospital or surgery center for your scheduled day. You will be given pre-op instructions by your doctor. Follow these instructions closely. It is forbidden to eat or drink prior to surgery.
The surgical team will assess your vital signs, and then start an IV line. Your doctor will check in with you to assess how you are doing, and then review the entire procedure one more time. After that, you will be taken to the operating area where you will receive general anesthesia.
When you get out of the recovery room, you’ll feel tired and confused. Your doctor will assess your vital signs, neurological status, and treat any pain. The doctor will inspect your incisions for signs of infection. If you feel more alert, you might be transferred to a quieter area or to a hospital.
After a minimally-invasive microdiscectomy, the goal is to get you home. The first thing you should do is get out of bed. Next, take a seat in a chair and walk to the bathroom.
Once you feel better you will be able to walk up and down the hospital hallway. You will be provided with food. If you are able to walk normally with your pain under control, urinate and keep your food down, you will usually be able to go home. If you have had an Open Microdiscectomy, you will typically be admitted to the hospital overnight for observation.
The First Week Following Herniated Disc Surgery
When you are at home, be mindful of your movements. You should maintain your posture while sitting and standing. Also, avoid forward bending and heavy lifting. To ensure that your back heals properly, you must protect it. During the first week after surgery to treat a herniated spine, you will be encouraged and encouraged to increase your activity. Walking is an excellent exercise for recovering from surgery. It helps improve your cardiovascular endurance and circulation.
You should gradually increase your activity during the first week after surgery. Your back will still be protected by moderately avoiding bending, lifting and slouched seating. During your first week following herniated disc surgery, you should remain off work. Slowly increase your activity and check your incisions for any redness, swelling, discharge or other signs of infection. You should see your doctor within the first week to check the incisions and monitor any changes.
Three Weeks After Surgery
If you are sedentary during the herniated disc surgery recovery time, you may be able to return to work in the next three weeks. When you are working in an office, it is important to be aware of your posture and maintain a neutral spine position while standing or sitting. Your doctor may suggest that you take a break from work if you have a job that requires a lot of physical labor.
Tolerating increased activity and walking is important. You should be able to return to light activities by the end of three weeks. A light course of physical therapy may be initiated if necessary. Patients who undergo minimally invasive spinal surgery often recover quickly and don’t need any formal rehabilitation.
The fourth week should be the most productive for recovery. The fourth week is when you can return slowly to your regular activities, with a complete return to high-intensity activity in the sixth and eighth weeks. You should seek the guidance of a neurosurgeon if you have to undergo surgery for a herniated or bulging disc. It is important to understand what you can expect from your surgery. This will allow you to concentrate on your full recovery, and enable you to return quickly to your former level of activity and function.
How can you take care of your home?
Incision care
Tape should be left on the incision (cut) by your doctor for at least a week. You can wash the area with warm, soapy, water and dry it. Hydrogen peroxide and alcohol can slow down healing. If it rubs on clothing, you can cover the area with gauze. You should change the bandage each day. Keep the area clean.
Medicines
Your doctor will inform you when and if your medications can be restarted. You will be given instructions regarding the use of any new medicines. Use medicines with care. Follow the instructions for pain medicine. You should follow the prescription given by your doctor if you have pain.
Ask your doctor to see if you may be able to take an over-the–counter medication if you do not currently use a prescription. If you feel your pain medicine is making it difficult to swallow,If your doctor has not told you to, take your medicine with meals. Ask your doctor about a new pain medication. Take the prescribed antibiotics as directed by your doctor. Stop taking them just to feel better. You must take all of the antibiotics.
Diet
You can still eat your normal food. Try bland, low-fat foods, such as plain rice, broiled poultry, toast, and yogurt, if you feel upset. Drink plenty of fluids, unless you are told otherwise by your doctor. It is possible that you will notice irregular bowel movements after surgery. This is quite normal. This is a common problem. It may be worth taking a fiber supplement each day. Talk to your doctor if you don’t feel like you are having bowel movements within a few days.
Activity
You should rest when you feel tired. Get enough sleep to help you recover. Walk every day. Start slowly by walking slightly more than the previous day. Slowly increase your daily walking. Walking increases blood flow and prevents constipation. Do not lift any items that might cause strain. These items include heavy grocery bags, milk containers, a bulky briefcase or backpack, cat food or dog food bags, and a vacuum cleaner.
Alternate your position approximately every 30 minutes depending on whether you’re sitting or standing. This will decrease back pain as you heal. Do not engage in strenuous activities such as jogging, weight lifting or bicycle riding until your doctor gives you permission. Ask your doctor when you are allowed to drive again.
You should avoid driving for longer than 30 minutes for the next 2 to 4 week after your surgery. If you are required to drive a long distance in a car, make sure to stop and stretch your legs. How quickly you feel better, and what type of work you do will determine how long you are able to take off work. If you work in an office environment, it is more likely that you can return to work sooner than if the job you do involves a lot of physical activity. Talk to your doctor about your job requirements. Although you can have sex at any time, it is best to avoid positions that place stress on your back and cause pain.
Exercise
Perform back exercises according to your doctor’s instruction. To improve your back strength and flexibility, your doctor might recommend that you see a physiotherapist.
Other instructions
Use a warm water bottle or a low-heat heating pad to reduce stiffness. You should not heat the area directly. A heating pad placed on your skin should not be used to induce sleep. Following-up care is crucial for your safety and treatment. You must attend all appointments. If you are experiencing problems, call your doctor or the nurse advice line (811 in most territories and provinces). It’s a good idea, in addition to knowing your test results, to make a list of all the medicines you use.
When is it best to call for assistance?
When you believe you might require emergency care, dial 911. If you feel the following:
- You fell unconscious (lost consciousness).
- If you have chest pain or are feeling short of breath, you may also be experiencing bloody noses.
- You cannot move an arm or leg.
You can call your doctor, nurse call line or get immediate medical care by calling:
- There is no relief from pain after you have taken pain medicine.
- Your incision is either open or you have lost stitches.
- The bandage covering your incision is now stained with bright red blood.
- A blood clot has formed in your leg, also known as deep vein thrombosis.
- Pain in your calf or back of the knee, thigh or groin.
- You may feel reddening or swelling in your legs.
There are symptoms of infection that include:
- Increased pain, swelling or warmth.
- From the incision, you will see red streaks.
- Pus draining from incision.
- A fever.
You are experiencing new or worse symptoms in your arms or legs, chest or belly. These symptoms may include:
- Numbness and tingling.
- Weakness.
- Pain.
- You lose bladder or bowel control.
Be aware of any changes in your health. Contact your doctor or nurse line immediately if you notice:
- You don’t get as good as you think.