According to statistics, 10% of patients with lumbar disc herniation require surgery. There are currently minimally invasive and traditional surgical methods. Which one is more suitable for the patient? Xiaojiu consulted with Wu Yi , chief physician of the Second District of Spine Surgery, the Third Affiliated Hospital of Southern Medical University.
After standard conservative treatment, the condition of lumbar intervertebral disc herniation is gradually aggravated, and symptoms of nerve root damage such as leg pain and leg numbness appear, especially the recurrent lumbar intervertebral disc herniation, which affects work, study and life, combined with spinal stenosis, etc. Wait, these conditions should be considered for surgical treatment.
Wu Yi emphasized that the operation is not to insert the herniated intervertebral discs back, but to take out the problematic intervertebral discs.
Will lumbar disc surgery cause paralysis?
Because the patient himself and his family did not understand the operation process, he was very worried before the operation, and even feared that the operation would cause paralysis. Most patients have been procrastinated before the operation, and they are not a last resort.
Of course, the patient's worries are not unfounded. At , there are people who have suffered nerve root damage due to lumbar intervertebral disc surgery, or damage to the cauda equina, affecting urination and defecation difficulties and sexual dysfunction.
"Spinal cord injury is the main cause of paralysis. The most common location for lumbar disc herniation is the level of the third lumbar vertebra-the first sacral vertebra. Only the cauda equina and nerve roots are here. Surgery generally does not damage the spinal cord and is not easy to cause paralysis. Unless it is an irregular operation." Wu Yi
said that to reduce surgical complications and even prevent surgical failure, the key is for to choose a professional spinal surgery.
and improve the preoperative assessment and check . Especially lumbar spine X-ray, lumbar spine CT, and magnetic resonance examination are very important to understand the condition of the spinal canal, the position of the nerve root and the compression. If the patient has symptoms of nerve damage such as leg numbness, an electromyography is also required. At the same time, the accurate positioning of the C-arm X-ray machine, operating microscope and other equipment used in lumbar spine surgery can reduce the complications of nerve injury.
Third, it is very important for to choose a suitable surgical method . Currently, there are two main surgical treatments for lumbar disc herniation. The first is traditional posterior lumbar spinal decompression, lumbar discectomy, or lumbar fusion. The second is minimally invasive spinal endoscopic surgery. Many patients also take it for granted that minimally invasive surgery is suitable for all patients, and the effect of small trauma must be good. In fact, it is not. Traditional methods and minimally invasive surgery have their own advantages and disadvantages, which are suitable for different patients. It must be evaluated by a professional spine surgeon, and a specific treatment plan should be formulated according to the specific situation of the patient.
Minimally invasive surgery or traditional surgery, which is better?
Wu Yi said that the single condition of the lumbar disc herniation, and the protrusion is in the position of the neural tube, and the protrusion is not very large, and the patient's intervertebral disc degeneration is not too serious, and the patient is relatively young. minimally invasive surgery is recommended.
For older people, lumbar disc herniation combined with spinal instability, severe degeneration of the lumbar facet joints causing bone stenosis of nerve roots, or severe disc degeneration, so that there are not many normal and useful intervertebral discs remaining, and even intervertebral spaces Patients with pathological changes such as collapse and obvious stenosis of the lumbar spinal canal, as well as patients who relapse after minimally invasive surgery, are recommended to undergo traditional surgery. The advantage of minimally invasive
is that the surgical damage is small. It only removes the protruding intervertebral disc. At the same time, it only performs decompression measures around the local nerve roots, so there is a certain recurrence rate. Medical literature reports show that the average recurrence rate of minimally invasive endoscopic surgery of lumbar intervertebral disc is about 5%-10%. If recurrence occurs after minimally invasive surgery, consider traditional lumbar fusion surgery.
Wu Yi said that any surgery has certain risks. The incidence of nerve injury in lumbar spine surgery is 1%, most of which are nerve root damage. CSF leakage and cauda equina injury caused by dural sac injury are also common complications of lumbar spine surgery.
lumbar spine surgery is a relatively delicate operation, which requires a relatively high level of doctors, and should be a highly qualified doctor with professional training. Minimally invasive surgery of the lumbar spine has higher requirements for doctors than open surgery.
Wu Yi pointed out that in traditional open surgery, doctors operate under direct vision with a full field of vision. Minimally invasive surgery is performed under the spinal endoscopic system. The original three-dimensional anatomical concept becomes a two-dimensional plane image, which is an indirect visual field. must carefully distinguish the nerves, dural sacs, and intervertebral discs in order to perform accurate operations . This is more difficult for doctors who are just engaged in endoscopic operations, and they must be trained and studied.
For patients with lumbar disc herniation that require surgery, whether minimally invasive surgery or open surgery should be used, it is recommended to go through a comprehensive evaluation by a spine surgeon and choose an appropriate treatment plan based on the actual situation of the patient. (Correspondent Chen Xiaolin)
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