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[Home Rehabilitation Chapter 48 ] Lumbar intervertebral disc herniation refers to the degenerative changes in the lumbar intervertebral disc. Under the action of external force, the fibrous annulus is partially or completely ruptured, and the nucleus pulposus and cartilage endplate protrude outwards alone or together. A series of clinical symptoms caused by compression of nerve roots, blood vessels, spinal cord or cauda equina in the lumbar spine. Lumbar disc herniation is a common and frequently-occurring disease in orthopedics and is the most common cause of low back and leg pain. At present, for the treatment of lumbar disc herniation, doctors generally consider conservative treatment, interventional treatment, minimally invasive surgery, and open fusion surgery, so that patients can get the best treatment. Generally speaking, surgery is only required unless the lumbar disc herniation seriously affects work and life, the pain is unbearable, or the cauda equina nerve injury occurs. If the symptoms are not too severe, conservative treatment is usually used. However, many patients have difficulty choosing non-conservative treatment options, especially between minimally invasive surgery and open fusion surgery. Taking this opportunity, the following author will talk about whether to choose minimally invasive surgery or open fusion surgery when suffering from lumbar disc herniation and whether surgery must be performed.
Minimally invasive surgery is to remove the protruding intervertebral disc that compresses the nerve through a small surgical trauma. The most significant advantage of the operation is that the trauma is small and the patient recovers quickly after the operation, including percutaneous endoscopic lumbar discectomy (PELD) and Lumbar discectomy (MED) under microendoscope, but the trauma of MED operation is slightly greater than PELD. But intervertebral disc herniation is a degenerative disease, which is caused by the aging of the human body. The degeneration of the intervertebral disc occurs with age. The lumbar intervertebral disc of a normal person reaches its peak at the age of 25, and then begins to gradually degenerate. The trend is difficult to reverse. Even if surgery is performed, the degeneration of the intervertebral disc, the narrowing of the gap, and the destruction of the fibrous annulus cannot be completely repaired. Therefore, even if minimally invasive surgery has one or other advantages, there are still about 20 % Of the recurrence rate, there is also the possibility of lumbar instability.
open fusion surgery is to completely remove the intervertebral space of the herniated intervertebral disc and implant bone or bone material. In the future, bone connection will grow in this segment of the space. The simple thing is that removes the herniated intervertebral disc and the nucleus pulposus or removes them all, and then implants a bone or artificial intervertebral disc in the vacated position, and finally fuse the two lumbar vertebrae together, can be said to be open Sexual fusion surgery is the ultimate surgery for this segment of the lumbar spine. However, the adjacent segment of the fusion, especially the upper segment, is prone to disc herniation due to increased pressure. That is to say, we are facing the problem of recurrence of lumbar disc herniation, which leads to the degeneration of the adjacent segment and requires another operation. The incidence of this situation is relatively small, but it is still possible.
We know that the physiological structure of the intervertebral disc is almost irreversible, and the same is true for surgical treatment. The effect is nothing more than a faster and greater release of nerve compression after completion, thereby eliminating pain and other symptoms, but it does not fundamentally solve the problem. Therefore, whether to choose minimally invasive or open fusion and internal fixation for lumbar disc herniation, it is necessary to consider the patient’s condition and the patient’s wishes. If the patient wants to minimize the reoperation rate, fusion and internal fixation can be selected. If the symptoms are to be resolved, the minimum If you want to leave the ultimate surgery to new technologies that may appear in the future, you can choose minimally invasive surgery. However, surgery is not a panacea. Both minimally invasive surgery and open surgery have risks and iatrogenic trauma. should be completely emphasized and try to avoid re-operation in the future. Therefore, the author's suggestion of is , can do no surgery without surgery, and can do minor surgery without major surgery. If surgery is absolutely necessary, then is the first to be minimally invasive under the same curative effect. In the same curative effect, is the first choice for a more minimally invasive method is a principle of lumbar disc herniation treatment .
When we choose minimally invasive or fusion internal fixation, we should also consider the hospital equipment conditions and the doctor’s technical level. Because minimally invasive and fusion internal fixation surgery require a certain level of equipment and technology, but due to the unbalanced development of medical and health conditions, not every hospital has the corresponding equipment and technology level. Doctors with rich surgical experience can handle many surgical indications, but not every doctor can perform these two types of operations proficiently. In addition, if the method of internal fixation is used, the cost is between 60,000 and 90,000 depending on the difference between domestic and imported equipment. For minimally invasive surgery of lumbar disc herniation, the price is determined according to the amount of consumables. Now with the improvement of the material level, it generally requires more than 40,000.
Generally speaking, not all patients with lumbar disc herniation need surgery. As for the choice of minimally invasive surgery or fusion and internal fixation surgery, the most important thing is to look at our own lumbar spine, as well as the combination of hospital equipment conditions and the doctor’s technical level and ourselves The financial situation and personal wishes of the patient, and choose under the advice of a doctor. Remember to follow and like if you like
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If you want a different point of view, leave a comment below and let’s talk together. Extended reading of
:
1, " is to diagnose lumbar disc herniation by X-ray, CT or MRI? After reading it, you will understand "
2, " got lumbar disc herniation, should I undergo conservative treatment or surgery? Give you a reliable answer! "
References : 1, "Surgery" Chen Xiaoping, Wang Jianping, editors, p753~757
2, "Rehabilitation" Zhang Shaolan, editors, p174~180
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