Endoscopic surgery to remove a herniated disc, cost and rehabilitation

September 24, 2019

25366

4 out of 5

Diseases of the musculoskeletal system, and especially the spine, are steadily becoming younger. Today, intervertebral hernia, which previously became the property of older people, is increasingly being diagnosed. Now it is increasingly found in patients of young, working age. And since the disease provokes severe pain, which knocks a person out of the usual rhythm of life for a long time and deprives him of the ability to work, it is of increased interest to the medical community.

New, minimally invasive treatment methods are regularly emerging that make it possible to achieve a significant reduction in hernia formation in a short time, as well as an improvement in the condition, and at the same time do not require long-term rehabilitation. One of these is endoscopic surgery to remove a herniated disc. It is successfully carried out by vertebrologists at the SL Clinic.

Our specialists will be able to select the optimal method of treating the existing pathology, taking into account and comparing many factors, including the size of the protrusion, its location, the presence of concomitant diseases, etc. This ensures the high efficiency of the measures taken, and the price of endoscopic hernia removal at the SL Clinic remains consistently affordable.

The insidiousness of intervertebral hernia

An intervertebral hernia is a pathological protrusion of part of the fibrous ring. In the vast majority of cases, it forms in the lumbar spine, somewhat less often in the cervical, and only sometimes in the thoracic.

It is not able to regress on its own, and even complex, extremely well-chosen conservative therapy does not always lead to significant positive changes. Over time, the hernial formation increases and can:

compress the nerve roots, which causes severe pain, and subsequently leads to paresis - loss of motor ability of the upper or lower extremities;
provoke strokes at a young age;
cause severe disruption of the functioning of the intestines and pelvic organs, which is accompanied by uncontrolled separation of urine and stool.

Often, a spinal hernia is formed against the background of osteochondrosis, which today affects more than 90% of the Russian population, i.e., almost every person of working age. Progressive degenerative changes provoke the formation of a minor hernia, which is easiest to treat. But since at this stage the disease does not manifest itself in any way, it often remains undiagnosed until pronounced symptoms appear.

According to a recent experiment, out of 100 randomly selected people, 30 were found to have mild or moderate disc herniation. At the same time, almost none of the subjects even admitted the thought of its presence, although many admitted that they regularly experienced pain in the lower back and neck.

Endoscopic hernia removal: features of the method

Endoscopic removal of intervertebral hernia is a minimally invasive technique that provides effective reduction in the size of the hernial formation. It is not associated with significant risks of complications either directly during the operation or during the recovery period. Moreover, the procedure does not require long-term rehabilitation and does not impose serious restrictions on the usual way of life.

Properly performed endoscopic surgery to remove a hernia makes it possible to:

eliminate local and radiating pain to other parts of the body of varying degrees of severity, including very severe ones;
normalize the functioning of the intestines and bladder, if negative changes are caused by a violation of their innervation;
improve muscle tone;
restore proper functioning of the spinal cord;
achieve stability of the spinal column, which has a positive effect on posture and gait, which often change when pathological protrusion is localized in the lumbar region.

The essence of the method is to remove directly that part of the intervertebral disc that has gone beyond its anatomical boundaries. Removing a hernia endoscopically takes no more than an hour and is often performed under general or spinal anesthesia. To ensure psychological peace, the patient may be given intravenous sedatives before surgery.

The operation is performed using a specialized endoscopic unit. They are produced by different companies and have significant differences in the quality of the resulting image, ease of handling tools and other parameters. Therefore, equipment of different generations is distinguished.

The SL Clinic has installed the latest generation endoscopic unit, which allows you to minimize the likelihood of complications, visualize the slightest deviations from the norm and effectively eliminate them in a gentle way. Endoscopic removal of a herniated disc is carried out as follows:

the patient lies on his stomach, the skin is treated with an antiseptic and local anesthesia is administered;
the spinal surgeon punctures the soft tissue above the location of the hernial formation from the posterolateral approach (when removing a formation in the lumbar region);
under X-ray control, an endoscope is inserted and brought to the modified disc through the foramen (the place where the spinal root exits the spinal canal);
a microsurgical instrument is brought to the hernia through an endoscopic tube and the protruding portion of the nucleus pulposus is gradually removed in small parts;
all manipulations up to the complete elimination of the hernial formation are performed under the strict visual control of the spinal surgeon, since the endoscope is equipped with a powerful camera that produces a greatly enlarged image on the monitor in real time;
After completion of the procedure, the treatment area is washed, the instruments and endoscope are removed, and one suture is applied to the puncture and covered with a sterile bandage.

Thus, the intervertebral disc is not completely removed, but only its pathological protrusion - a disc herniation. Resection ensures natural intactness of the vertebral and paravertebral structures, which eliminates the possibility of vertebral instability.

The patient is allowed to walk 2 hours after completion of the operation. It is recommended to spend 24 hours in the hospital and be discharged if you remain in satisfactory health. Each patient is provided with comprehensive recommendations on the rules of behavior during the recovery period. It is worth noting that the effectiveness of endoscopy largely depends on the correctness of their compliance.

The most technically difficult operations are on the cervical spine. They require full dedication from the neurosurgeon and high qualifications, since in this area the spinal cord passes into the brain.

The result of endoscopy is assessed 2 months after it is performed. Most patients notice significant improvement almost immediately or within a few days after surgery.

Modern equipment

The operation is carried out using special equipment from the world's leading manufacturers of medical equipment, such as DePuySynthes, Karl Storz, Joimax and others.

Radiation diagnostics at the stage of surgery planning, intraoperative visual control, and evaluation of treatment effectiveness are carried out using Philips expert systems, which show a detailed picture of the condition of the spine and surrounding tissues.

The results of spinal surgeries performed by our spinal surgeons were highly appreciated by colleagues from the USA, Germany, specialized orthopedic centers in Russia, as well as numerous grateful patients who were saved from pain, regained mobility and a decent quality of life.

Indications for use

Endoscopic removal of a hernia is carried out when it forms in the lumbar, cervical or thoracic region. It is indicated when it is impossible to eliminate the pressure of the hernia on the surrounding tissues and nerve roots using more gentle methods, in particular conservative therapy, as well as using nucleoplasty or hydroplasty. These microsurgical interventions involve inserting a puncture needle with an electrode that produces cold plasma, a laser pulse or radio wave energy, or washing out the contents of the nucleus pulposus with saline.

Their main advantages are the absence of any incisions, high safety and an extremely short rehabilitation period, since all instruments are inserted through a pinpoint puncture of soft tissue, the diameter of which is no more than a couple of millimeters. But they cannot be used when the size of the intervertebral hernia exceeds 7 mm and a number of other disorders are present. In such situations, endoscopic hernia removal comes to the rescue. The emergency procedure is indicated for:

Sequestering hernia, which is accompanied by the separation of a cartilaginous fragment from the disc and its penetration into the epidural space. This is fraught with severe complications in the form of blockage of blood supply to the spinal cord, which leads to paralysis or paresis of the lower extremities.
Prolapse of the core of the intervertebral disc in the lumbar or lumbosacral region by more than 8 mm.
Disturbances in the functioning of the pelvic organs caused by compression of the nerves that form the cauda equina. This is accompanied by pronounced changes in the functioning of the urinary organs and lower gastrointestinal tract, which is manifested by involuntary urination and defecation. Men may additionally have problems with potency.
Lower monoparesis, i.e. severe weakness of the muscles of one of the legs, caused by compression of the nerve roots of the lumbar region and blocking the transmission of signals from them. Most often, there are disturbances in the functions of flexion and extension, as well as the supporting ability of the foot, which invariably affects the gait.

In the above cases, the problem is localized in the lumbar or lumbosacral spine. However, endoscopic removal of a disc herniation is also possible if it is located in the cervical region. It is shown when:

protrusion sizes greater than 6 mm;
sequestering formation, which requires emergency surgical intervention;
decreased motor ability of one or both hands, paresis of the upper limbs;
compression by bulging blood vessels that provide blood flow to the brain.

An indication for endoscopy is also the absence of positive changes after 3 months of conservative therapy, selected individually taking into account the characteristics of the patient.

It is very important not to delay endoscopic removal of an intervertebral hernia in the hope that it will resolve on its own, unreasonably fearing surgical intervention. If a vertebrologist, after examining the results of MRI and other studies, claims that it is necessary to remove the pathological formation as quickly as possible, you should listen to his opinion.

After all, the effectiveness of the operation directly depends on the duration of the pathological process and the degree of its severity, especially when it comes to the development of paresis or numbness of the limbs. If surgical correction is not carried out in time, irreversible changes in chronically compressed nerve endings cannot be ruled out, which can lead to their death and, as a consequence, disability of the patient. In such situations, surgical treatment is absolutely powerless.

Features of preparation

All patients immediately before endoscopic surgery must undergo a series of laboratory and instrumental tests, including:

UAC;
OAM;
blood chemistry;
blood tests for HIV, hepatitis A and B;
Wasserman test;
MRI of the spine;
ECG;
X-ray of the chest organs.

At SL Clinic, each patient can undergo a full list of preoperative tests and undergo the necessary examinations without queues, without stretching it out for an indefinite period of time, but quickly and in comfortable conditions. All examination results are sent to the therapist, who, based on them, gives a conclusion about the absence or presence of contraindications to the upcoming surgical intervention.

Sometimes patients are recommended to be hospitalized the day before endoscopy. Before the procedure, a conversation with an anesthesiologist and a spinal surgeon is required. In any case, 10 hours before surgery, you must stop eating and refuse any drinks, including water. This will allow you to avoid risks associated with the provision of anesthesia.

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Experienced neurosurgeons and advanced equipment
Individual recovery trajectory for each patient

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Recovery after endoscopic removal of intervertebral hernia

A successful operation is only half the journey. The duration of preservation of its results directly depends on the patient himself and how accurately he will follow medical instructions during the recovery period. Must be assigned:

a course of treatment with non-steroidal anti-inflammatory drugs for 10 days, sometimes antibiotic therapy is indicated;
reduction in physical activity for at least a month, but the restrictions practically do not apply to walking and doing light housework;
limiting the time spent in a sitting position is required extremely rarely and for a very long period (for example, 5-6 hours in a row);
wearing a semi-rigid corset or orthopedic collar for a month, which is determined by the location of the operated hernia formation;
Exercise therapy under the guidance of experienced rehabilitation therapists, the nature of which is selected individually.

For a month after surgery, it is forbidden to lift weights, significantly load the operated part of the spine with other work, as well as perform massage, electrical and balneotherapy. But laser therapy and magnetic therapy are often recommended to accelerate the processes of restoration of the fibrous ring and normal intradiscal pressure.

If you load the operated part of the spine more than is recommended, do not undergo physiotherapeutic treatment and do not regularly engage in exercise therapy, the price paid for endoscopic surgery to remove a herniated disc will be a waste of money and after 1-2 months the disease may recur in the same area.

A follow-up examination by a spinal surgeon is scheduled 1 month after the procedure. The doctor will evaluate the results of the surgical intervention and, if necessary, give additional recommendations.

Making lifestyle adjustments will help reduce the likelihood of relapse, namely:

weight loss, which will help eliminate excess load on the spine;
visiting the pool twice a week (when removing an intervertebral hernia in the cervical spine, it is recommended to swim on your back);
strengthening the back and abdominal muscles (with the permission of the attending physician).

Contraindications

Removal of hernia of the cervical, thoracic and lumbar regions is contraindicated in cases of spinal instability.

Intervention should also be postponed if:

Neoplasms
Local or general infectious processes
Spondiolisthesis

There are other contraindications. All of them are identified as part of the examination carried out before surgery. In some cases, patients may undergo interventions. The alternative is selected by the surgeon. If necessary, other specialists are involved in selecting a suitable technique.

Possible complications

In the vast majority of situations, the operation goes well and does not cause any undesirable consequences. They are observed in less than 0.1% of cases. However, if it is carried out incorrectly or errors are made during rehabilitation, the following may develop:

infection of a postoperative wound, accompanied by suppuration;
injury to nerve endings;
the formation of rough scars that have a compressive effect on the nerves and spinal cord;
rapid relapse of the disease.

When contacting the SL Clinic, you will not encounter such complications. But only subject to strict adherence to all recommendations received from the doctor regarding physical activity in the postoperative period. At the same time, our price for endoscopic removal of a spinal hernia is not too different from the cost of a similar service in the regions.

About the service

Endoscopic removal of spinal hernia is performed at MEDSI clinics in Moscow. Our experienced spinal surgeons successfully provide safe, high-quality and low-traumatic treatment to patients. The use of modern techniques allows the patient to be discharged home on the day of the operation without any restrictions. This reduces not only the recovery time, but also the risk of complications. Determining the indications for surgery and obtaining information about possible treatment methods can be obtained during a face-to-face consultation.

Alternative to endoscopic surgery

In a number of situations when endoscopic removal of a vertebral hernia is impossible, microdiscectomy is used. When a hernial formation is localized, the operation proceeds as follows:

the patient is positioned on the operating table, where the anesthesiologist puts him under general anesthesia;
anatomical markings of the surgical field are applied to the skin in the projection of the bone processes, which are obtained using x-rays;
an incision is made on the front surface of the neck in a skin fold, the length of which is 2-3 cm;
the spinal surgeon carefully spreads the muscle fibers with a retractor without violating their integrity;
under the control of an electron microscope with tenfold magnification or a head magnifier, the entire disc deformed by the herniation is removed using special microsurgical instruments;
all instruments are removed, the wound is sutured and covered with a sterile bandage;
The patient is removed from anesthesia and transferred to a hospital.

The duration of the operation is about 40 minutes. For a couple of hours after it, the patient needs to remain in a horizontal position and only with the doctor’s permission can he begin to get up and move around a little independently. As a rule, discharge is carried out after 3 days.

Upon returning home, the patient can perform everyday household and professional duties, but provided that they do not involve heavy physical exertion. It is mandatory to take a number of medications, diet, wear an orthopedic bandage, physiotherapeutic procedures and exercise therapy. Sitting is prohibited for at least 2 weeks.

We can talk about final recovery only after 2–3 months. Returning to the usual physical activity and rhythm of life is allowed only after a final consultation with a vertebrologist and obtaining his permission to do so.

Despite a lot of information about various methods of surgical treatment of intervertebral hernias, you should not insist on one of them if the spinal surgeon recommends another. The doctor can compare disparate data and select the best method for removing a hernia in each individual case. Of course, the patient’s wishes will certainly be taken into account, but the final decision should be trusted to a specialist whose qualifications you have no doubt about.

Experienced vertebrologists who have successfully performed many endoscopic and other operations await you at the SL Clinic. You can confidently entrust your health to our specialists, as we carefully prepare for each operation, follow all the subtleties of the technique and use the best equipment available today.

Endoscopic removal of intervertebral hernia in SL Clinic and abroad, cost

Of course, endoscopic removal of spinal hernia in the SL Clinic is carried out at a high level , provides a lower risk of complications and better efficiency. SL Clinic invites you to a consultation with a spinal surgeon, during which the doctor will be able to determine exactly how much surgery is needed and which technique will give the most pronounced result in a particular case.

The SL Clinic has installed the latest generation of equipment, ensuring minimal tissue trauma and extremely high effectiveness of each surgical intervention. Our spinal surgeons are true professionals, familiar with all the intricacies of the structure of the spine and spinal cord, fluent in both microsurgical and endoscopic surgical techniques, who have undergone training in leading neurosurgical centers and have extensive practical experience. With our help, hundreds of patients have already gotten rid of herniated discs and returned to a full life.

The cost of endoscopic Joimax removal of a disc herniation is 220,000 rubles and depends on: - examination before surgery (if you take tests with us); — Clinic and ward class (where the operation will be performed). The price includes: — Stay at the clinic before and after surgery; — Joimax consumables. — Operation; — Examinations before surgery (if you take tests from us); — Observation and consultation during the rehabilitation period. All clinic services and costs are listed in the price list.

At the same time, endoscopic hernia removal in Moscow is significantly better in price than foreign offers. By contacting us, you entrust your health to the best neurosurgeons who can find a solution in the most severe cases and help the patient return to a full life without pain. We will not leave you halfway and will provide the opportunity to undergo full-fledged rehabilitation under the guidance of specialized specialists to consolidate the results achieved through surgery.

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