Should a herniated disc be removed? How to do without surgery

The spine is the main element of the musculoskeletal system, which provides the ability to make any movements and also supports the functioning of all internal organs. Spinal discs are a kind of shock absorber that protects all elements of the spine from premature wear associated with heavy loads.

Over time, various destructive pathological processes can develop in the human body, which cause thinning of tissues, including intervertebral discs.

How intervertebral discs wear out

Intervertebral disc in Latin - disci intervertebrales. Its structure is quite complex and deserves special attention.

The fibrous ring of the intervertebral disc is an integral part of the vertebral disc, as are two annular plates - the upper and lower. Most often, a person experiences any painful sensations if it is the plates that undergo changes as a result of the development of pathology .

A healthy body quickly responds to microdamage, launching the regenerative process and tissue restoration.

With the development of a pathological process, the basic order of “damage-recovery” is disrupted, and a degenerative process begins to develop, which affects the tissue itself and its structure .

That is, with regular microtraumas, regeneration does not occur, bone growths, otherwise called osteophytes, are formed.

The developing process is called “spondylosis”, it is characterized by pathological changes:

• pinched nerves,
• narrowing of the spinal cord canal,
• malnutrition of the intervertebral discs,
• displacement of the spinal bones and change in the distance between them.

Note. Osteochondrosis is not a consequence of salt deposition; the development of pathology is provoked by other factors.

What to do if intervertebral discs are worn out: useful tips

Degeneration, wear and dehydration of intervertebral discs can be stopped if you follow simple recommendations from specialists regarding lifestyle, regimen and nutrition.

1. The bulk of the intervertebral disc is water, so it is very important to maintain a drinking regime. The normal fluid intake for an adult is 30 ml per kilogram of body weight.
2. To stop further progression of osteochondrosis, it is important to ensure a sufficient supply of vitamins and nutrients. To this end, you should take vitamin and mineral supplements (selected by your doctor) and enrich your diet with foods high in vitamins: fruits, herbs, berries, vegetables, nuts, high-quality meat and fish.

   
   Proper nutrition is very important

3. Morning exercises and special therapeutic exercises must be performed daily.
4. If you have any addictions (smoking, alcoholism), you must consult a specialist and undergo a course of treatment, since chronic intoxication of the body negatively affects the absorption of certain substances necessary to maintain the firmness and elasticity of the intervertebral discs.
5. The mattress and pillow for sleeping should have an anatomical shape and a medium level of hardness.

Anatomical mattress

To identify possible complications in a timely manner, it is necessary to undergo a scheduled examination 2 times a year (if you have alarming symptoms, for example, severe back pain, you should consult a doctor immediately after your health worsens).

Video - Intervertebral disc

Intervertebral discs are the main “shock absorbers” of the human axial skeleton, and the work of all segments of the musculoskeletal system depends on their functional state. If the intervertebral discs are worn out, the cause in the vast majority of cases is osteochondrosis, therefore the treatment of the pathology is carried out according to standard treatment regimens for acute and chronic degenerative-dystrophic diseases of the spine. The prognosis can be considered conditionally favorable only if the patient strictly complies with all doctors’ prescriptions and takes a responsible attitude towards his health, since spinal degeneration is an irreversible process, and any treatment is aimed only at preventing further progression and relapses.

Causes

Damage to the intervertebral discs, their erasure, occurs as a result of the following reasons:

1. Scoliosis, kyphosis or lordosis.
2. Abnormal pelvic structure, flat feet.
3. Narrow shoulder girdle.
4. Spinal injuries.
5. Metabolic disorders.
6. Osteoporosis.
7. Gastrointestinal diseases.
8. Genetic predisposition.
9. Diseases of the cardiovascular system.

These reasons are important both individually and in combination with each other, since together they can have a permanent effect on the body. The presence of these factors does not mean that the disease will necessarily develop and progress, but people suffering from the listed diseases and pathologies are at risk and should be especially attentive to their health.

The development of pathology is accelerated due to poor nutrition, lack of vitamins in the body and due to regular increased stress. Hypothermia can trigger inflammation of the intervertebral disc.

Magazine "Regions of Russia" (October 2021)

– Yan Evgenievich, what caused the creation of the Pain Treatment Clinic? What are its features?

– Multidisciplinary clinic “Health 365”

has been operating in Yekaterinburg since 2008. Today it consists of five divisions in different areas of the city, including our Pain Treatment Clinic. This is a complex that brings together expert doctors with special training in the field of pain treatment. We use special techniques, laboratory methods and equipment, our activities are regulated by general rules and approaches to the diagnosis and treatment of pain, and internal management.

There are many manifestations of pain, and its effective treatment requires a systematic multidisciplinary approach. Chronic pain is dangerous because the longer it exists, the more difficult it is to treat; over time, it leads to the development of very complex structural changes in the central nervous system.

Often, patients turn to specialized specialists to get rid of pain, and they begin to walk in circles: from a therapist to a neurologist, from him to a surgeon, then to a neurosurgeon, a psychologist, and again to a therapist. A multisystem approach disproportionately increases cure and remission rates for various diseases

Our clinic is focused on the diagnosis and treatment of syndromes such as headaches and back pain, pain in the limbs, joints, as well as in the coccyx, sacrum and pelvis - a total of five basic areas. Our Clinic staff includes neurologists, therapists, neurosurgeons, ultrasound doctors, chiropractors, and massage specialists. Including three candidates of medical sciences, which once again confirms the level of qualifications of the staff.

– How is pain treated in your clinic? What innovative techniques and equipment are used?

– It all starts with an appointment with a doctor, who provides assistance in relieving acute symptoms of pain and recommends to the patient diagnostic tests, laboratory and instrumental, necessary for an accurate diagnosis of the cause of pain. After which complex treatment is prescribed - from the use of drug therapy and physiotherapy to invasive treatment - various blockades under ultrasound control, neurosurgical operations. Chronic pain disorder is often accompanied by anxiety and depressive disorders, so psychotherapy and psychopharmacotherapy may be included in the structure of our care.

Treatment also includes various non-drug methods. For common causes of pain (consequences of sports injuries, diseases of the musculoskeletal system), an innovative method such as kinesio taping is used. In accordance with certain anatomical rules, dense adhesive tapes are placed on the patient’s skin, which support the skin, fiber, muscles, relieve certain areas of the body, improve blood supply and lymphatic drainage, thereby significantly reducing pain. Another innovative method is plasma lifting. Plasma, which is obtained in concentrated form from the patient’s own blood, is separated from the blood, enriched with platelets and biologically active substances and injected, for example, into the tissue around a diseased joint. This plasma has good restorative and anti-inflammatory properties. In our clinic, both traditional devices, such as magnetic therapy devices, magnetic laser, ultrasound, amplipulse, and innovative equipment are actively used for physical procedures. For example, the Sympatocor-1 device is used to relieve migraine attacks and preventive treatment of headaches. It successfully and permanently relieves a person from repeated attacks of pain, subsequently reducing their frequency and intensity.

– What kind of pain do patients come to you with most often?

– Headaches and back pain are more common, closely followed by joint pain. If necessary, we use MRI (magnetic resonance imaging) to accurately diagnose the causes of such pain. An accurate and timely diagnosis means a lot for prescribing the correct treatment and saves the patient from going through agony. Our diagnostic complex, in addition to MRI, includes various types of ultrasound. The clinic, the only one in the city, performs ultrasound of peripheral nerves. This is very important when diagnosing compression of nerves, the so-called “tunnel syndromes”, for example, carpal tunnel syndrome, cubital tunnel syndrome, it allows you to see the localization and cause of compression of the nerve trunk. We carry out expert ultrasound diagnostics of the condition of the vessels of the head and neck. Very often, such a study makes it possible to verify the causes of headaches, such as impaired venous outflow, vertebrogenic compression of the vertebral arteries, muscle tension, and dysregulation of vascular tone. This provides a point of support for the general practitioner and neurologist. They gain a lever with which to solve a situation of severe, recurring pain, from which the patient sometimes despairs of finding relief and resigns himself. As a result of accurate diagnosis, we find this cause, which often responds well to treatment.

– What age patients predominate in your clinic?

– Pain in the cities is getting younger: a person sits at the computer all week without straightening up, and on the weekend he abruptly switches to classes in the gym or on the ski slope. And then he goes to our clinic complaining of back pain. With age, the incidence of diseases of the musculoskeletal system increases, including spinal osteochondrosis, deforming osteoarthritis, and damage to muscles and ligaments. Simple general tips to prevent the development of such diseases: try to lead a healthy lifestyle and promptly seek advice from specialists. Regarding the type and intensity of necessary physical activity. Of course, movement is life, but it is very important that it does not cause pain, but joy. Patients often come to us with complaints of pain in the extremities, in particular in the wrists and wrist joints, where the nerves lie closely together with the tendons. Inflammation occurs due to stress from prolonged routine work, for example, when working with a wrench, driving for a long time in a chair and steering wheel that is not adjusted in height and depth, when playing the piano, or working at an inconveniently located computer keyboard. Such pain can often make a person disabled. In this case, it is necessary to carry out a therapeutic and diagnostic blockade, treat the nerve directly, administer drugs that block pain, relieve inflammation and swelling, prevent further destruction of the nerve, and in some cases, perform neurosurgical intervention on the nerve. When performing pain blockades, our clinic uses high-tech methods: under the control of an ultrasound sensor (this is called ultrasound navigation) or an X-ray image in real time, a needle is brought exactly to the affected area, through which the necessary medicine is administered. The possibilities of such visualization during blockades practically eliminate the possibility of accidental damage to nerves and surrounding tissues and blood vessels and ensure increased safety of the procedure. Thanks to the pinpoint precision of administration, we are able to reduce the dose of the administered drug, thereby reducing the risks of developing unwanted reactions that are possible when administering high doses of the drug.

– How financially accessible are the clinic’s services to patients?

– Our clinic operates in the compulsory health insurance (CHI) system, since a large number of diseases accompanied by pain are included in the compulsory medical insurance system. The clinic also has a voluntary health insurance (VHI) department. According to current legislation, a doctor must advise a patient about the possibility of receiving free medical services. From a medical point of view, complexity and timeliness are of particular importance: if a patient undergoes an ultrasound today and an MRI six months later, this reduces the effectiveness of treatment to zero. We have developed special programs with significant discounts on sets of diagnostic procedures and pain treatment methods. At the same time, high-tech services, by definition, cannot be very cheap.

– In what directions will the clinic develop this year?

– In the coming years, our clinic will continue to introduce new types of medical services for the diagnosis and treatment of pain. These include various types of electrical neurostimulation, physiotherapy, new methods of neuroimaging, ultrasound, x-ray assistance, navigation in the treatment of pain syndromes. There will be a widespread introduction of minimally invasive operations, neurosurgical, low-traumatic procedures, which will allow surgical treatment of the cause of pain in 2-3 days. Further training for our doctors is planned; they will master related specialties, new treatment techniques, including diagnostic and invasive ones. We will also develop connections with other clinics and scientific schools specializing in the treatment of pain, both in our country and abroad. Our goal is to relieve our patients from any pain, from walking through torment: comprehensively, effectively and safely.

Symptoms

Spinal diseases are always accompanied by pain, so it is quite difficult to identify special and specific symptoms that appear when intervertebral discs wear out.

Signs of osteochondrosis or its complications, for example, protrusion, hernia or radiculitis, are much more pronounced.

The most severe pain occurs in the lumbar spine , since it is this part that most often bears the greatest amount of load.

Signs of spondylosis include:

• painful lumbago in the lower back, pinched sciatic nerve,
• lameness, limited movement,
• muscle spasm in the damaged area,
• sensory disturbance,
• neurological problems, for example, insomnia, irritability, weakness.

Diagnostics

Every disease requires diagnosis, despite its specific symptoms and manifestations. In order to determine how to treat worn out discs of the lumbar spine, you need to consult a specialist.

First of all, other pathologies that have similar symptoms should be excluded , for example, heart attack, angina pectoris or neurosis. If the diagnosis confirms the assumptions, then the specialist must determine which intervertebral discs have worn out.

Important! Self-treatment without a diagnosis can lead to a worsening of the condition and the development of complications.

Diagnostic methods include:

• examination and interview of the patient,
• laboratory tests of blood and urine,
• electrocardiography,
• x-ray of the spine,
• ultrasound diagnostics of internal organs,
• magnetic resonance or computed tomography.

Based on the diagnostic results, the specialist will be able to select a treatment that will be effective in a particular case.

Risk and Statistics of Herniated Disc Surgery

Like any surgical procedure, spinal fusion surgery is not without risks and complications that you should be aware of before deciding to undergo surgery. To keep them to a minimum, you should tell the surgeon and anesthesiologist as much medical and personal information about the patient as possible so that they can choose the best treatment for him and pay attention to his complex and sensitive aspects.

Risks of surgery include infection, bleeding, damage to nearby organs, and nerve damage (usually temporary). Temporary difficulties with urination and defecation are likely. The most dangerous is paralysis of the limbs as a result of damage to the spine. This complication is extremely rare.

Additional complications that may arise: breakage or disintegration of the fastening structure, non-fusion of the vertebrae, leakage of spinal fluid, and failure of surgery to solve the original problem. It is also possible for the disc to fall out again if it was not completely removed during the operation.

Dangers of anesthesia include closure of the airway due to suffocation, a drop in blood pressure and pulse, and damage to teeth or vocal cords when a tube is inserted into the windpipe. In the rarest cases, an allergic reaction to anesthesia is possible; those who have already undergone operations under general anesthesia are not susceptible to this danger.

Anesthesia, anesthesia and pain relief

The operation to remove the vertebral arch is performed under general anesthesia. This means that during the entire operation the patient does not feel pain, and a professional anesthesiologist monitors his condition at every moment to make sure that the patient is in deep sleep, his muscles are relaxed and he does not feel anything.

The narcotic drug is usually given as an infusion. After a few tens of seconds, the patient feels his consciousness clouding, and then falls into sleep. When the surgical part of the operation is completed and the doctor closes the incision, the anesthesiologist wakes the patient and stops administering anesthesia. The awakened patient is transferred to the recovery room.

Preoperative preparation

A prolapsed disc is diagnosed by symptoms and a doctor's examination. Subsequently, tomographic analyzes are performed (CT - computed tomography, MRI - magnetic resonance imaging). Before surgery, you should have blood tests that include a complete count, chemistry, electrolytes (including calcium, magnesium, and phosphorus), liver function, and coagulation. In addition, you need to do an ECG and a chest X-ray.

Before meeting with the surgeon, it is important to prepare medical documents and provide both the surgeon and anesthesiologist with a detailed medical history. It is especially important to talk about the patient's previous operations and hospitalizations, chronic illnesses, medications prescribed to him, nutritional supplements taken, and any allergies he suffers from.

Patients with concomitant diseases require consultation with a specialist in the relevant field before surgery. Anticoagulants (such as aspirin or Comadine) should be stopped one week before surgery. It is very important to consult with your family doctor or surgeon about the need for replacement.

On the day of surgery, you should not eat or drink 6 hours before the start. Before surgery, you should remove false teeth, jewelry and clothing, and avoid chewing gum and smoking (or reduce the number of cigarettes as much as possible). Immediately before the operation, the patient will be connected to an IV through which the anesthesiologist will administer sedatives to reduce anxiety.

Treatment

First of all, when this pathological process develops, care should be taken to eliminate inflammation and pain , and then, in the future, to stop the development of the disease and prevent the appearance of a hernia.

Painful sensations are most often eliminated with the help of various medications, since any physiotherapeutic procedures are prohibited from being performed in the acute stage .

The most popular drugs used in the treatment of worn out discs are:

• non-steroidal anti-inflammatory drugs - “Ibuprofen”, “Ketorol”, “Diclofenac”,
• anesthetics - “Lidocaine”, “Novocaine”,
• chondroprotectors for the restoration of cartilage tissue - “Chondroitin”, “Chondroguard”,
• vitamin complexes - “Duovit”, “Calcium D3”.

These products can be used in the form of tablets, injections, ointments or gels.

Also, all drugs have analogues; the selection of the drug should be carried out directly by the specialist who carried out the diagnosis and examination.

In advanced situations, it may be necessary to perform a spinal block for a hernia.

After the exacerbation is relieved, the patient is prescribed additional physiotherapeutic procedures:

• paraffin therapy,
• UHF,
• amplipulse,
• electrophoresis,
• massage,
• Exercise therapy.

Procedures such as paraffin therapy or electrophoresis are prescribed in courses to stabilize the condition and prolong the effect of medications. Exercise therapy and massage promote recovery, improve blood circulation and saturate tissues with useful substances.

If conservative treatment does not have the desired effect, the disease progresses, then the patient is indicated for surgical intervention up to prosthetics.

Rehabilitation period

After surgery, each patient will have to go through a rehabilitation period. He will feel relief immediately after the hernia is removed, but in order for the achieved effect to last for a long time, it is important to carry out rehabilitation correctly.

First of all, a person needs to get used to new living conditions - it is important to take care of the spine and not overload it.

1. You should not bend sideways or forward; it is important to avoid twisting the spine.
2. For the first 1-1.5 months you cannot sit at all. Even in a car, moving around requires lying down as a passenger.
3. You will have to wear a special corset for about 3 hours a day.
4. Every 2 hours it is important to rest - lie down and lie on your back for about 15-20 minutes.
5. Carrying heavy objects is prohibited.
6. It is important not to catch a cold on your back.

Recovery after surgery

After 8 weeks, when all the inflammatory processes have passed and the stitches have healed, the active stage of rehabilitation begins. The patient begins to engage in exercise therapy and swimming in order to strengthen the muscle frame.