Brain, Nerve and Spinal Cord Surgeon Prof. Dr. Mustafa Bozbuga shared important information and advice about lumbar hernia.
Prof. Dr. Mustafa Bozbuga said that one of these functions is to provide movement and flexibility, to carry the load on the body, and the other to protect the neural tissue, that is, the nerve tissue.
Noting that when the spine and the nerve tissue within it are considered, the spinal cord extends to the lower level of the lumbar first vertebra and that the spinal cord carries a neural structure consisting of nerves from each segment in the spinal cord. Dr. “One function of the spine is to carry the load, provide movement and flexibility, and the other function is to protect the neural tissue, that is, the nerve tissue.
Therefore, it is necessary to consider the spine together with the spinal cord and surrounding structures. Speaking of the structures around it, there are lung and heart if we think of the neck and the back, and various abdominal organs when we think of it as the waist. All these structures and beyond these, any systemic disease may theoretically cause low back pain or spine pain. We also see these in different proportions, but the most common is low back pain and the causes of this are soft tissue problems and lumbar hernias, ”he said.
Stating that the interfaces of some of the overlapping lumbar vertebrae are covered by the disc structures, Prof. Dr. “These discs have mechanical functions such as carrying the load, providing flexibility, distributing the load equally to the spine, nutritional and many other functions. The discs are an extremely solid structure, but the spine is constantly working. While sitting, walking, doing sports and many other activities, the spine works actively and carries a constant load. Over time, deterioration and weakening occur. Certain places of the disc are weaker. There is a herniation, that is, the deterioration of the structure and its protrusion beyond the area to be located. This is a very common condition and low back pain is the second most common complaint after colds and flu. “The most common cause of low back pain is lumbar hernias,” he said.
Pointing out that there are many different types and degrees of lumbar hernias, Bozbuğu said, “Depending on the situation, very different treatments or applications may be required. Neurosurgeons look for certain conditions and conditions in lumbar hernia for surgery. These conditions are also found in 2-3 percent of patients with lumbar hernias. There are various conditions such as pressure on the nerves, hernia and pressure being at a level that cannot be corrected in any other way, the presence of neurological function losses as clinical reflections, the presence of severe pain, the inability to pass the pain in any other way, and the emergence of urinary or fecal incontinence defects. “Surgery is performed in such clinical pictures.”
Prof. Dr. Mustafa Bozbuga said, ‘The character of the pain is different according to the type and degrees of lumbar hernia’ and continued his words as follows.
“In case of stretching of the capsule surrounding the discs in the vertebrae, severe back pain, stiffness and flattening occur. There will be a severe spasm of the muscles. If the capsule is torn and the cartilaginous tissue inside is protruding, the back pain will pass, but leg pain will occur as a result of this tissue herniation and pressure on the nerve root near it. Many patients describe this situation in a characteristic way. First, they talk about severe back pain, but they state that they experience leg pain after the back pain subsides. When a patient who comes with leg pain is told that there is a herniated disc or that the surgery will be performed on the waist, it causes confusion. Pain is a sign of pressure on nerve roots, but not every leg pain is caused by a herniated disc. “
Stating that the hernia surgery is named as open and closed, Prof. Dr. “This is actually a definition that is not used scientifically. There is no closed surgery in any way. In order to intervene in the problematic area, it must be entered from somewhere. Only the disc problem is that there is no need for a large cut. Microdiscectomy and endoscopic discectomy are gold standards in the surgery of this disease. In both of these methods, it is entered through a small skin incision. This 1-1.5 cm incision does not leave much scar after surgery.
Transactions are made in as many small areas as possible. Therefore, there is very little tissue trauma. Since it is viewed with a microscope, it becomes possible to see the structures in a three-dimensional way, with better illumination of the area and magnification of the structures. The disc is removed, the nerve structure is freed, and the surgery is terminated in this way. On the same day, the patient can stand up, walk and be discharged the next morning. “The rate of recurrence in lumbar hernia after surgery is almost nonexistent,” he said.
Emphasizing that lumbar hernia does not prevent sports, Prof. Dr. “On the contrary, we want patients to be active in the long term and strengthen their waist and abdominal muscles, if they are after surgery or at a stage that does not require surgery and when we apply medication. We recommend that they do regular, correct and conscious physical activities. Patients prefer to use a corset because it relieves their pain and relief in the short term, but we do not want this. In very painful situations beyond the hernia, a very short-term corset can be used; However, when corset is used continuously, it weakens the muscles and unwanted situations can arise. “We want the muscular structure to be strong because the muscles are the most important protective factor against these diseases.”