Removal of intervertebral hernia: is it dangerous to perform the operation?

• What is an intervertebral hernia?
• Classification
• Symptoms
• Diagnostics
• Causes and risk groups
• Treatment methods Operation
• Non-surgical treatment methods

Back pain is a common companion for people who lead a sedentary lifestyle. But if you do not visit a doctor on time, then even due to habitual scoliosis, a complication may arise - a herniated disc. It will be much more difficult to get rid of such a disease.

A herniated disc is a rather dangerous and complex disease of the musculoskeletal system. It occurs frequently - approximately 100 cases for every 100 thousand people. In Russia alone, more than 500 thousand people are diagnosed with this diagnosis every year.

This disease poses a serious health hazard. Very often, a hernia affects the nerve that connects the spine with one of the internal organs, thereby causing disturbances in its functioning. In the worst case scenario, a hernia can lead to partial paralysis. In addition, a herniated disc is rarely painless and in almost all cases is accompanied by severe pain in the affected areas.

What is an intervertebral hernia?

To understand what an intervertebral hernia is and how this disease occurs, you need to have some understanding of the structure of the spine.

Our spine is a long chain of vertebrae. Between the vertebrae there are intervertebral discs, which soften the friction between the vertebrae and reduce the pressure between them, acting as a kind of shock absorber. It is these discs that allow our spine to be flexible, elastic and elastic.

Each intervertebral disc consists of a nucleus pulposus that surrounds an annulus fibrosus. Due to severe physical exertion or injury, the fibrous ring bursts and the nucleus pulposus emerges from the intervertebral disc. This is an intervertebral hernia or it is also called a hernia of the spine. The pain occurs due to pinching of the nerve roots near the vertebra. And due to the connection of nerve fibers with the spinal cord, the pain is not concentrated in the damaged area of ​​the back, but can also spread to the arm or leg.

Classification

All intervertebral hernias are formed according to the same principle. They have features depending on the location and severity.

By localization

There are three localization options:

• Hernia of the cervical spine. It is painful for the patient to move his head, turn and tilt it. In this case, the pain radiates to the arm and back at the level of the shoulder blades. There is also numbness and weakness in the hands.
• Hernia of the thoracic spine. There are girdling pains, loss of coordination of movements, decreased tone, and there may be urinary disorders.
• Hernia of the lumbar spine. At any stage, protrusion is accompanied by pain. If the hernia is small and does not put pressure on the spinal cord, pain occurs periodically, increases with loads and activity, and with uncomfortable body position. When the size of the hernia increases, the symptoms intensify and lumbago appears. There are difficulties with straightening the back, limbs become numb, and tingling becomes more frequent. At this stage, the shape of the spine changes, and the functions of the excretory and reproductive systems are disrupted.

Depending on size

Depending on what stage the protrusion is at, pathologies are divided into:

• Protrusion or prolapse. The size of the hernia is no more than three millimeters, can be considered a physiological norm and does not cause any unpleasant symptoms. The disc bulges without rupture of the annulus fibrosis.
• Prolapse. The second, pathological degree, the formation reaches six millimeters and begins to cause pain. The nucleus pulposus is displaced to the outermost layers of the anulus fibrosis.
• Extrusion. The bulge can be up to one and a half centimeters in size and causes severe pain. The functions of internal organs are impaired, the quality of life decreases. The fibrosis of the intertubular space is perforated, and the gelatinous material is pressed against the epidural membrane enclosing the spinal cord.
• Sequestration (a subtype of extrusion). The disc is fragmented and may be found as free-floating material within the spinal canal, causing significant pain and neurological symptoms.

According to the mechanism of occurrence

Depending on the factor that caused the protrusion, hernias are divided into:

• Bone – caused by the proliferation of bone tissue and the concomitant narrowing of the spinal canal.
• Pulpous - the option that occurs most often and is characterized by penetration of the pulpous nucleus of the disc outward. Exit is provided through cracks in the destroyed annulus fibrosus.
• Cartilaginous. They are formed from intervertebral cartilage, which is deformed under the influence of inflammation or injury.

Causes of pain in the cervical spine

Damaged intervertebral disc with low moisture content. © joint-surgeon

Degenerative changes due to wear:

• Distortion of intervertebral discs (protrusion or hernia)
• Ligamentous disorders (functional disorders of the retaining ligaments)
• Dislocation of intervertebral joints
• Osteophytic (nodular) reactions (bone growths on the cervical spine)

Congenital disorders:

• Scoliosis or Scheuermann's disease
• Hereditary developmental anomalies (wedge-shaped vertebrae and spinal fusion/vertebral fusion)

Inflammatory diseases:

• Rheumatoid arthritis
• Ankylosing spondylitis (acute inflammatory rheumatism, primarily affecting the spine)
• Infectious diseases (spondylitis or spondylodiscitis due to the presence of bacteria)

Metabolic diseases:

• Osteoporosis (low bone density)
• Rickets (musculoskeletal and bone formation disorders)

Tumors:

• Primary neoplasms (plasmocytoma/myeloma)
• Metastases

Injuries:

• Fractures
• Whiplash-like lesions in the neck

Symptoms of intervertebral hernia

Our spine consists of five sections: cervical, thoracic, lumbar, sacral and coccygeal. A herniated disc can develop anywhere in the spine. The first and main symptom of a herniated disc is back pain, which gets worse when moving or lifting heavy objects. The localization will be indicated by shooting or pulling pain at the site of cartilage destruction. The area may enlarge and begin to hurt more when moving. In addition, the following symptoms indicate a hernia:

• aching pain in the limbs, shoulders, or chest
• decreased spinal mobility
• decreased sensation and weakness in muscles in the legs or arms
• neurological disorders: headaches, insomnia, changes in blood pressure, weakness, dizziness
• disorders of the genitourinary system and intestines

What exactly the symptoms will manifest depends on where the hernia is located. Shoulder pain, numbness and weakness of the arms are a sign of damage to the cervical spine. If the intervertebral disc in the lower back is destroyed, problems with the intestines and pelvic organs will begin. Numbness and pain will spread to the hips, feet or legs completely.

A cervical hernia is accompanied by pain radiating to the shoulder or arm, headaches, regular bouts of dizziness, increased blood pressure and numbness of the upper extremities, especially the fingers.

A thoracic hernia causes difficulty breathing and pain in the heart area. This type of hernia can manifest itself as frequent aching pain in the chest and thoracic spine, a pressing sensation in the area of ​​the chest and heart. It should be noted that such a hernia is relatively rare - in approximately 1% of cases.

A lumbar hernia provokes pain that radiates to the lower back, hips, buttocks, legs, and causes numbness in the toes and groin area. Sometimes there is numbness or tingling in the area of ​​the damaged disc. In severe cases, the patient's legs become numb, he feels weak and quickly gets tired when walking. There may also be problems with bowel movements, urination and potency. Intervertebral hernia occurs especially often in the lumbar region, because it is this part of the spine that bears the main load.

If you have these symptoms, make an appointment with a neurologist

You can sign up for a consultation by calling the numbers on the website or using the feedback form.
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Where to have the operation?

Russian and Ukrainian patients prefer to be treated abroad, where they will be provided with maximum prospects for a favorable prognosis. The most popular destination among domestic citizens in need of high-quality removal of cervical hernias and impeccable restoration is the Czech Republic.

Central Military Hospital of Prague.

Medical centers in the Czech Republic successfully practice the most advanced neurosurgical techniques and always provide highly specialized rehabilitation care in full after surgery. Thanks to their high professionalism, they manage to return even the most difficult patients to a full life, whose clinical condition was regarded in other countries as hopeless. And the best part is that prices for high-tech spinal surgery in the Czech Republic are significantly lower, at least 2 times, than in Israel or Germany.

Diagnosis of intervertebral hernia

Spinal diseases, including hernias, are dealt with by a neurologist and an orthopedist. You can also meet with other specialists: with conservative treatment, you will be referred to physiotherapists, a massage therapist and an exercise therapy specialist, and if surgery is necessary, it will be performed by a neurosurgeon.

A visual examination can be of little help in diagnosing a hernia. During clinical examinations, the doctor records your medical history, including recent and past injuries, lifestyle, physical and neurological symptoms. If a disc herniation is suspected, the doctor conducts a neurological examination and directs you to more accurate studies:

• Magnetic resonance imaging . MRI of the spine is considered the best type of diagnosis, since the image will show soft tissues, nerve roots and the structure of the spinal cord,
• CT scan . CT scans of the spine are more often used when injuries are suspected. CT is faster than MRI, but is less accurate.

A herniated disc should not be taken lightly. That is why in our center, at the first suspicion of a spinal hernia, your attending physician will refer you to undergo magnetic resonance imaging (MRI). This diagnostic method is the most effective, allowing you to quickly, safely and reliably determine the presence of a hernia, its location, the degree of degenerative changes in the disc and vertebrae, and, most importantly, identify the presence of compression of the nerve endings by the hernia.

Cold plasma nucleoplasty

An electrode is passed through a puncture needle into the cavity of the intervertebral disc to the prolapsed fragment of the nucleus pulposus. This electrode creates a cold plasma or heat wave, the impact of which destroys part of the disk material (reduces or completely removes the core). In this way, intradiscal pressure can be reduced. Endoscopic radiofrequency annulonucleoplasty, unlike cold plasma nucleoplasty, takes place under absolute visual control. Cold plasma nucleoplasty does not allow one-step radiofrequency ablation of the Luschka sinuvertebral nerve, aimed at blocking the nerve transmission of pain impulses and treating microcracks in the intervertebral disc. Therefore, the recurrence rate of painful symptoms of protrusion and spinal hernia is higher than after endoscopic radiofrequency annulonucleoplasty.

Causes and risk groups

The intervertebral disc acts as a shock absorber, reducing the load on the vertebrae. There are no blood vessels in the intervertebral discs; all necessary nutrients enter them through diffusion. For normal nutrition of the intervertebral disc, pressure differences are necessary - that is, in simple words, movement.

So what causes a herniated disc?

Today, an increasing number of people lead a sedentary lifestyle, as a result of which degenerative processes in the intervertebral discs begin earlier.

At the same time, excessive loads - such as sudden heavy lifting or frequent flexion of the spine - can also lead to the risk of a hernia. People who have suffered a back injury or spinal surgery, as well as those who suffer from osteochondrosis, are also at risk.

In addition, excess weight contributes to the destruction of fibrous rings. The vertebrae are already under enormous pressure, and if the body weight is exceeded, they may simply not be able to withstand the high load. Also, the development of a hernia is influenced by factors such as weakening of the body due to old age, autoimmune diseases and impaired metabolism. All this affects the strength of the cartilage and bones in the spine.

Trauma, single or repeated, is the most common mechanism of disc herniation caused by rupture of the annulus fibrosus. This causes the disc material to bulge and/or squeeze into the spinal canal. When the disc erodes, the space between the vertebrae decreases.

Disc degeneration is often the result of life-related work and wear and tear on the tissue. It usually occurs in older people due to disc fibrosis and narrowing of the disc space, destruction of the annulus, sclerosis of the vertebral end plates and the presence of bone formations (osteophytes) in the internal space of the vertebrae. A prolapsed disc puts pressure on nerves and possibly the spinal cord.

Causes of hernia

• Injuries of various types (stab in the back, falling on the back)
• Body weight is above normal
• Rachiocampsis
• Unsuccessful sharp turn of the body to the side
• Osteochondrosis
• In addition, there are groups of people who are most susceptible to intervertebral hernias.
• The age group is 25-50 years, while the likelihood of the disease only increases with age
• People whose work involves lifting weights (loaders, builders, etc.)
• Office workers and those who spend more than four hours at the computer daily
• Drivers and those who drive more than two hours a day

Risk factors

Disc herniation most often occurs in men between 30 and 50 years of age and in all older adults.

Recently, there has been a significant trend towards “rejuvenation” of pathology.

These are the main risk factors:

• Being overweight or obese increases pressure on the spine and intervertebral discs, especially in the lumbar region.
• Smoking reduces peripheral circulation and reduces blood supply to the disc, promoting disc degeneration.
• Genetic factors cause anatomical changes in the spinal endplate, reducing disc nutrition and predisposing to subsequent pathological changes.
• Poor physical fitness, including: A sedentary lifestyle weakens the supporting muscles of the spine
• Frequent driving
• Incorrect sports technique
• Poor posture while sitting at a desk or lifting weights
• Sudden pressure on the spine
• Repetitive strenuous activities in workers performing heavy physical work.

Surgeries to remove a herniated disc

Laminectomy

This operation to remove a spinal hernia involves partial removal of the vertebral arch in order to provide access to the contents of the spinal canal. The operation is performed through a skin incision along the spine in the projection of the prolapsed disc herniation. Then the back muscles are pushed back bluntly, and further along the course of the intervention, dissection of the connective tissue structures, suturing or electrocoagulation of the vessels is performed. To open an overview of the contents of the spinal canal and for manipulation, the vertebral arch is removed, then the nerve root, usually swollen to the size of an index finger, is carefully moved to the side and the spinal disc is examined. Subsequently, the nucleus pulposus of the disc, visible in the surgical field, is removed, but curettage (curettage) of the disc is not performed. Next, the surgeon leaves the wound, and the tissue is sutured layer by layer.

Counterlaminectomy

Intervention is performed more often with paramedian hernias. The tissues are also dissected during the intervention, the spinal canal is released, the hernial contents are removed, but the vertebral arch is removed from the opposite side. It is believed that in the postoperative period, the spinal motion segment with this type of operation will be more stable and recurrence of the hernia is less likely, since there is practically no bone tissue defect on the discectomy side in this option.

Ligamentectomy

An operation to remove a herniated disc from the posterior approach using a traditional incision from the back and excision of the yellow ligament. During the operation, the disc is removed and curetted, followed by disc replacement using an interbody cage or spinal fusion surgery.

Microdiscectomy

Discectomy literally means “disc removal.” The advantage of this operation is that the surgical intervention is less traumatic. In the projection of the affected disc from the back, a skin incision of up to 5 cm is made. In order to inspect the contents of the canal, the vertebral arch is not removed, but a section of the yellow ligament located in the intervertebral foramen is bitten out. Then the nerve root is also moved back, the prolapsed nucleus pulposus and fragments of the torn fibrous ring are removed, no curettage is performed. It is worth noting that the absence of curettage of the nucleus pulposus in the structure of the operation suggests the occurrence of recurrences of disc herniation due to the fact that the nucleus pulposus is not completely removed. Curettage requires wider access with removal of the arch and part of the facet joints, which then creates instability of the segment on which the operation was performed. But just with such an operation as microdiscectomy, the stability of the spinal segment is not disturbed.

Laparoscopic discectomy

The operation is performed from the abdominal cavity under endotracheal anesthesia. Most often, mechanical removal of the disc is performed with curettage and subsequent disc prosthetics using a special dynamic design, the so-called interbody cage. Currently, this type of operation is not often used in neurosurgical practice.

Disc vaporization

If there is no effect from conservative therapy, a small spinal disc herniation up to 5 mm can be eliminated using disc vaporization. The operation is a laser evaporation of the nucleus pulposus of the disc that has prolapsed into the spinal canal with relative preservation of the fibrous ring of the disc. Surgical intervention is performed more often through an optical device - an endoscope, and less often using traditional wide approaches. Laser evaporation is used only for disc protrusions and intervertebral hernias with relative sizes of up to 5 mm. Considering that the operation is performed using the same approaches as other types of operations, it is not possible to talk about lower risks and minimal tissue trauma during the intervention. It is worth noting that the long-term results of exposure to tissue with a laser in order to perform, we emphasize, not a tissue incision, but essentially a burn, have not been studied follow-up and it is quite difficult to predict scar-ischemic processes during laser evaporation of the disc. In addition, protrusions and small hernias without surgery are perfectly amenable to conservative treatment in specialized medical centers.

Microscopic laminectomy

The intervention involves removing part of the arch of the facet joint of the vertebra and part of the end plate of the vertebral body in order to decompress the nerve root strangulated by the hernia using an optical microscope. Next, the prolapsed nucleus pulposus with fragments of the fibrous ring is removed.

Chemonucleolysis

The operation is performed using an endoscope exclusively for disc protrusions. Through a skin incision along the spine in the projection of the protrusion of the intervertebral disc, tissue is dissected, the muscles are pushed back bluntly, then, to provide access to the spinal canal, the vertebral arch is removed, the canal is inspected, and a special enzyme, chymopapain, is injected through an endoscope to the site of the protrusion. It is believed that chymopapain promotes lysis, in other words, resorption of protrusion.

Spinal fusion

The essence of the operation is to stabilize the spinal motion segment with fixing structures, grafts or autografts. Titanium plates or the patient’s bone tissue, usually taken from the bones of the lower leg, are used as stabilizing structures that perform the function of, popularly speaking, spacers between the vertebral bodies. The plates or bone fragments are fixed to the vertebrae with screws, which ensures their immobility. The operation is performed both as a primary intervention to remove a disc herniation, and during repeated operations for recurrent disc herniation.

Complications of the operation

Complications after operations to remove protrusions and herniated discs are so numerous and varied that it is not possible to describe them on one page. We will only touch on those that are irreversible and significantly worsen the quality of life to the point of profound disability. All complications of surgery to remove a herniated disc can be divided into complications during surgery, early surgical complications and complications in the long-term period after surgery.

Like any other operation, removal of a herniated disc poses a certain and fairly high risk. Surgical complications are complications during anesthesia and complications associated directly with the surgical intervention itself.

Complications of anesthesia

Complications of general anesthesia can also be divided into complications during anesthesia and in the early period of observation. After introductory intravenous or mask anesthesia, an endotracheal tube is inserted into the trachea using a laryngoscope to deliver a narcotic mixture into the lungs. With this manipulation of this tube, you can unintentionally perforate the esophagus or trachea, which will require another, quite serious operation. During anesthesia, unexpected reactions of the body to anesthetics may occur, both of an allergic nature, such as anaphylactic shock, and cardiovascular reactions, for example, an uncontrollable drop in blood pressure, respiratory and cardiac arrest, cardiac arrhythmias, disturbances in coronary and cerebral circulation, which can lead to a heart attack or stroke directly during surgery. Complications in the early period after anesthesia are the same strokes and heart attacks, which occur more often in adults, occurring, among other things, due to toxic damage to the brain and myocardium. For the same reason, toxic damage to the excretory organs, liver and kidneys may develop.

Damage to a nerve or spinal cord from a surgical instrument

Disc protrusion and herniation are located next to the nerve root, which, in fact, is subject to compression by the prolapsed discs. During surgery, the surgeon's view of the surgical field is hampered by the presence of blood and swollen tissue, and during endoscopic surgery, poor lighting also makes it difficult. If during abdominal endoscopic operations it is possible to straighten the organ with air, and the tubular organs and vessels are clearly visible in the optical instrument, then during operations on dense connective tissue structures and in the narrow spinal canal when removing a herniated disc, it is quite difficult for the surgeon to work. Therefore, the nerve root adjacent to the prolapsed hernia can be damaged either with a scalpel or with an electrocoagulator when stopping the bleeding. In this case, depending on the degree of damage, chronic pain syndrome, weakness with impaired sensitivity in the limb, and most often irreversible paresis and paralysis may develop. Damage to the spinal cord causes myelopathy or transverse lesion of the spinal cord, when, depending on the level of damage, for example, relaxation of the dome of the diaphragm with pulmonary atelectasis, paresis of the larynx, intestines, numbness of the anogenital area, prolapse of the vaginal walls, impotence, urinary and fecal incontinence develops. There is practically no cure.

Damage to the dural sac, liquorrhea and meningitis

This is a rupture of the dura mater. The dura mater envelops the spinal cord and the initial sections of the nerve roots, forming a kind of closed sheath of the spinal cord, called the dural sac. Cerebrospinal fluid (CSF) circulates inside the dural sac. When the dural sac is damaged, cerebrospinal fluid leaks and leads to a decrease in intracranial pressure, which leads to chronic headaches. But the most unpleasant thing is that through the damaged dural sac an infection penetrates into the spinal cord and causes meningitis. with purulent meningitis, at the site of damage to the dural sac, a non-healing fistula opening is formed, through which purulent blood masses will constantly flow into the surrounding tissues with the formation of abscesses and phlegmons. In advanced cases, sepsis develops with a fatal outcome. All this occurs against the background of neurological disorders, chronic pain, paresis and paralysis. There is practically no cure.

Arachnoiditis

Inflammation of the arachnoid mater, which is formed by small vessels. Damage to the arachnoid membrane during surgery and the penetration of infection causes an acute, most often purulent inflammatory process, which, even with adequate treatment, becomes a chronic process with the formation of cerebral arachnoiditis with constant headaches, neurological disorders, decreased memory and intelligence. There is practically no cure.

Spondylodiscitis

Postoperative inflammation of the remaining fragments of the fibrous ring with the nucleus pulposus and the adjacent spongy tissue of the vertebral bodies on which the operation was performed. Spondylodiscitis can occur after complete removal of the disc followed by curettage with prosthetics or spinal fusion. Spondylodiscitis begins as an aseptic-inflammatory process, but can become purulent with the formation of purulent inflammation of the vertebral bone tissue, osteomyelitis.

Osteomyelitis of vertebral bodies

A vertebra consists of a vertebral body, which is a fairly soft, well-vascularized spongy tissue bounded by hard endplates, which give the vertebra its rigidity. The design of the vertebra is complemented by motor and supporting elements, these are the arches, processes and joints that form the facet joint and transverse joints. Ligaments and muscles are attached to these bone formations. The purulent inflammation of the vertebral body that occurs after the operation develops mainly in the spongy tissue, involving nearby tissues; as the disease progresses, the vertebra loses its rigidity; under load, a pathological fracture of the spine occurs with the appearance of neurological symptoms, pain, paresis and paralysis. In weakened and elderly patients, a general septic process, blood poisoning, and sepsis may develop, with possible death.

Damage to the Adamkiewicz artery and acute lower paresis

The spinal cord is supplied with blood by several arteries. The largest of them, 2 mm in diameter, is called the artery of the lumbar enlargement. This artery, called the artery of Adamkiewicz by the author, supplies the entire lower part of the spinal cord starting from the level of the tenth Th 10 thoracic vertebra, and sometimes from the level of the sixth Th 6 thoracic vertebra. The artery of Adamkiewicz enters the spinal canal with one of the roots from Th 8 to L4, most often at the level of Th 10-11-12, in 75% it enters the canal on the left, in 15% it enters the canal on the right. With a high origin of the artery of Adamkiewicz, there is an additional artery of the conus of the spinal cord, which arises from the iliac artery and enters the spinal canal with the L5 or S1 root. But it is at this level that hernias L4L5 and L5S1 most often form, which during surgery can lead to damage to the Adamkiewicz artery, since it is rarely located in these segments. Disabling this artery leads to an infarction of the lower part of the spinal cord with the development of acute lower paralysis with urinary and fecal incontinence. The condition is irreversible and cannot be treated.

Transverse myelitis

Postoperative inflammation of the spinal cord due to unintentional iatrogenic mechanical trauma or infection introduced during surgery. Manifests itself as severe neurological disorders, paresis and paralysis.

Epidural hematoma

Formation of a hematoma in the epidural space due to mechanical damage to the vessel and accumulation of blood in the epidural fatty tissue. With untimely diagnosis and lack of treatment, acute purulent periduritis develops, which, even with adequate timely treatment, forms scar-adhesive epiduritis with persistent neurological symptoms, manifested by pain syndromes, retention or incontinence of urine and feces, weak lower paraparesis, impotence, and in women, decreased tone and prolapse vaginal walls.

Postoperative spinal canal stenosis with blockade of the cerebrospinal fluid pathways

The rapid growth of scar tissue in the spinal canal after surgery, which from the point of view of pathological physiology can be regarded as an adaptive reaction of the body to surgery, narrows the spinal canal to a critical size. Scar tissue on the outside compresses the dural sac and disrupts the flow of cerebrospinal fluid. Further growth of connective scar tissue causes pronounced compression of the dural sac and blockade of the cerebrospinal fluid pathways, which requires urgent reoperation on the spine.

Excavation of the dural sac

Post-traumatic damage to the dural sac is a complication of surgery to remove protrusion and herniated intervertebral disc. It has an ambiguous clinical picture and unclear prognosis for recovery.

Cicatricial radiculomyeloischemia

Infringement by scar tissue of the spinal cord and nerve root in the spinal segment where surgery was performed to remove a protrusion or herniated disc. It cannot be treated conservatively; as a rule, repeated surgery is required. refers to long-term complications of disc herniation surgery that last more than a year.

Recurrence of disc herniation

Recurrence of a hernia is considered to be the prolapse of a herniated disc at the same level where the operation was performed. It is considered a long-term complication of the operation for more than a year. It is difficult to treat. sometimes a repeat operation is required. Recurrent hernia is often combined with the formation of a hernia in adjacent segments, where protrusions were previously visualized on MRI. Recurrent hernia often occurs in the form of a sequestered hernia, due to a large postoperative defect and vertebral instability. However, recurrent hernia should be treated conservatively.

Segment instability, formation of spondylolisthesis

During the operation to remove a herniated disc, with surgical access to the contents of the spinal canal, not only the connective tissue structures, but also the vertebral arches are dissected. The vertebral arches sometimes have to be resected along with the vertebral joints. Ligaments, muscles and fascia are attached to the bony structures of the vertebra. Excision of a supporting structure such as an arch or part of a marginal plate disrupts the rigidity of the structure and changes the biomechanics of the spine. Therefore, in the adaptive process, the relative position of the vertebrae changes, as well as the configuration of the spinal column and its physiological bends. Spondylolisthesis occurs when the upper vertebra moves anteriorly or posteriorly relative to the lower one. This leads to disc instability, the formation of protrusion and hernia in the segment where there is spondylolisthesis or neighboring segments.

This page outlined only the general concept of surgical treatment of disc herniation and protrusion. Also, not all complications of the operation are described here. But still, a person who takes such a serious step as planned surgery on the spine and, in fact, on the spinal cord, must assess the risk of surgical intervention and choose for himself whether to be treated conservatively or undergo surgery. Adequate treatment of a herniated vertebral disc essentially leads to a complete recovery only when the course of therapy is started promptly and in full. And we must remember that it is better to undergo a second course of treatment for a spinal hernia without surgery than to undergo repeated surgery.

Treatment methods for intervertebral hernia

Surgical treatment

Contrary to the fears of many patients, surgery for a herniated disc is extremely rarely required. Usually, surgery is a last resort, which is taken only if conservative treatment does not give any result. Surgical removal of a hernia, even taking into account all the possibilities of modern medicine, is a very traumatic procedure that is fraught with complications and negative consequences.

The disadvantages of surgery are:

• Long rehabilitation period
• Postoperative complications
• Recurrences and surgery are not a guarantee of complete recovery.
• Qualification of doctors, experience of operating neurosurgeon
• High cost (up to 2 million rubles)

Non-surgical treatment

Conservative treatment

In the absence of serious neurological symptoms, conservative treatment of a herniated disc is recommended.

For acute pain syndrome, short-course nonsteroidal anti-inflammatory drugs are used in treatment. They cannot be used for a long time, as they contribute to the inhibition of resorption (natural recovery).

Blockades with glucocorticosteroids are contraindicated

into treatment, but unfortunately they are still used, and this also slows down the recovery process.

If radiculopathy is present, vascular drugs and B vitamins are also used in treatment.

If neuropathic pain syndrome is present, anticonvulsants are used as painkillers to help relieve pain.

Also, for the treatment of pain, interstitial electrical stimulation (ITES), plasma therapy, and treatment with a BTL device are prescribed.

After treatment, the patient is referred for rehabilitation to a physical therapist. Physical therapy (physical therapy) is contraindicated for acute hernia.

It is performed starting from the first month after treatment, as prescribed and under the supervision of a physical therapist, with a moderate lying load, increasing “verticalization” with each month.

Hernia resorption

Hernia resorption is the reduction of the size of the hernia without surgery. Resorption today has been quite well studied, and from the point of view of pathophysiology, it is a natural process of our body. Normally, this process occurs on its own, but very slowly. The task of our doctors is to create favorable conditions for this process so that it proceeds as quickly and painlessly as possible for the patient.

But this method also has its disadvantages and contraindications:

• Presence of direct indications for surgery
• Direct contraindications to physiotherapy
• Chronic injuries
• With age, the body's ability to recover naturally decreases.
• Resorption is impossible for people who received drug blockades during the acute period

For “chronic” or “old” hernias, when reduction is impossible, but these problems cause pain in the patient, treatment is carried out using the resorption method, in order to improve the internal microenvironment of the disc and neighboring structures. In these cases, the effect of treatment is monitored only by the patient’s well-being and the expansion of his physical activity.

Non-surgical treatment of intervertebral disc herniation at Diagnostic

Treatment in our center is based on modern methods and devices of modern physiotherapy.

Stories from our patients

A man completely got rid of a spinal hernia. The hernia was halved. A girl got rid of a spinal hernia.

What is included in the treatment course

The main goal is to accelerate the natural resorption of the hernia and at the same time reduce pain. To do this, a neurologist prescribes a set of procedures:

• Neuroplasma is a treatment with platelet-rich blood plasma from the patient.
• VTES according to the method of Professor A.A. Gerasimov
• Treatment courses using a high-inductance magnet from BTL (UK)
• Treatment courses using high-intensity laser from BTL (UK)

Additionally, drug therapy is prescribed, consultation with a physical therapy doctor, and sometimes electrophoresis with the drug “Karipazim” is used.

Duration of treatment

The course of outpatient treatment usually lasts 14 days (+/- 2 days).

The need for re-treatment and the number of courses is determined after the first course of treatment.

We do not provide inpatient treatment. Therefore, if you are coming from another city, you need to think about where to live.

Cost of treatment

The cost of treatment depends on the patient’s condition and varies on average between 35-40 thousand rubles. This is an approximate price, the final cost will be known after consultation with a neurologist.

How to make an appointment

Treatment is carried out by neurologist Beskrovny Vladislav Anatolyevich

You can make an appointment for a consultation and appointment by calling the numbers listed on the website or using the feedback form.

How to get a preliminary consultation for patients from another city

You need to send a “fresh” MRI (this is a study that was performed in the last 2-3 months, on a tomograph with a power of at least 1.5 Tesla) by email

Write in the letter:

• complaints to date.
• what treatment you have received or are receiving.
• MRI images are accepted only in electronic format. It is necessary to archive all existing files and send them by email [email protected]

The doctor will answer you within a few days.

Reviews

Pavlovsky Yu.N.
Recently, a nerve in my spine became pinched and my leg began to fail. We turned to the doctor Vladislav Beskrovny - we knew for a long time that he was an excellent specialist, especially since he trained with his father, a well-known neurosurgeon in the Khabarovsk Territory. I did an MRI, the results were disappointing: a prolapsed hernia in the lumbar region with a sequester that had fallen into the spinal canal, which had to be removed only surgically. But Vladislav Anatolyevich suggested trying a new treatment method: for almost a month I visited the physiotherapy room every day at the Diagnost medical center, where they performed electrophoresis with Karipazim, and once every five days they injected me with my own blood, only, as the doctors explained, it was enriched with platelets. After completing the course, I had a repeat MRI. The results were shocking: the professor could not understand what happened, who treated it and by what method! The hernia has gone 3 mm, and at the moment everything has healed. And the prolapsed sequestrum, which needed to be operated on, completely disappeared, as well as all the protrusions that were previously diagnosed. And the doctor assured: if you manage to build up your muscle corset, then you can “wear bags on your back.” I am very grateful to the doctor for the effective treatment.

Alexander K.

He underwent treatment for a hernia with neuroplasma from Vladislav Anatolyevich Beskrovny. The doctor prescribed a whole range of treatments: electrophoresis with the drug Karipazim, neuroplasma and massage. And it works) The pain went away after the first procedures, and after the entire course, a repeat MRI showed that the hernia itself had decreased. Now I get up in the morning without back pain)