intervertebral disc herniation is a very common disease in clinical spine surgery. However, with the continuous improvement of the current medical level and the continuous improvement of medical technology, clinical surgical treatment of intervertebral disc herniation is also diverse. To this end, Professor Long Houqing of Spine Surgery of the East Hospital of the First Affiliated Hospital of Sun Yat-sen University visited the Family Doctor Online and gave a detailed explanation.
Surgical treatment of intervertebral disc herniation which is effective?
It is understood that there are currently three surgical treatments for disc herniation:
1. Minimally invasive surgery, but it is not recommended. Professor Long Houqing explained that the advantage of minimally invasive surgery is that it can reduce the impact on surrounding tissues, reduce muscle damage, and speed up the recovery of patients after surgery. At present, the most commonly used are the minimally invasive methods such as disc mirrors, foraminal mirrors, and side mirrors. No matter which kind of minimally invasive, the scope of operation is displayed through the screen under the working channel. If it is not handled well, it is easy to cause nerves. Damage affects the effect of surgery and increases the possibility of postoperative recurrence.
Clinically, there are many cases of recurrence after minimally invasive surgery, and the long-term treatment effect still needs multi-case and multi-center research and long-term observation. Professor Long Houqing said, "There are a lot of foreign materials that show that these methods have too many negative effects. From a professional point of view, the previous methods of radiofrequency, ablation, and solvents have also done a lot of work at home and abroad. It is not too scientific, or a better feasible method is found, so it is not recommended now."
2. Intervertebral discectomy is currently the most widely used and recognized surgical method. Professor Long Houqing said that there is also a case study of and for this operation abroad. The study found that the results of patients were very good 10 and 20 years after surgery, and the recurrence rate was not high, only 3% to 5%.
3. Various fusion surgery and fixation surgery. The operation clears the herniated intervertebral disc space, and then fixes it with a pedicle screw to fuse the two segments into one body, which can completely solve the disease and prevent recurrence. But this kind of surgery will still have some complications. Professor Long Houqing said:
1, nails are easy to accidentally injure the nerves, and for patients with poor bone quality, the nails may break or grow poorly in the future;
2, for patients with osteoporosis, it may be Nails may loosen easily. Nailing is not recommended for patients without loosening and other unstable conditions between the two bones;
3, patients under the age of 40 are also not recommended to use internal fixation, it is better to choose intervertebral discectomy.
There is also an operation that does fixation but does not fusion. Compared with the former, is only fixed but can be moved slightly. There are still many problems with the method of dynamic fixation. At present, there are not many clinical applications of in this operation.
Why does the patient still feel pain after the operation for intervertebral disc herniation?
It can be seen that for patients with herniated disc, the choice of surgery is better based on the patient's condition and related clinical data. But some patients with herniated disc still have pain symptoms that have not improved after surgery. What is going on? During the interview, Professor Long Houqing pointed out:
1, patients with severe nerve compression will experience obvious pain with nerve root edema three or four days after surgery. During this period, if the patient still takes related drugs, it may be affected. The cause of irritation to nerve roots.
2, the residual debris generated during the fusion surgery stuck on the nerve can also cause postoperative nerve pain. Professor Long Houqing said: “The pain depends on low back pain or leg pain. If the low back pain may be a reactive inflammation of the muscle and soft tissue, this condition will not last too long and will gradually disappear by itself; but if it is a nerve root symptom, Clarify the symptoms of nerve roots, determine the location of numbness, and where the body is not good. Do CT and MRI examinations to find out where there is something left, and clarify the source of pain."
3. It is true that there is no reason for the pain. This situation mainly comes from the patient's mental factors, which amplifies the postoperative reaction. This situation mostly occurs in menopausal women. Such patients can use anti-anxiety sedation. Medicine to improve it.
Professor Long Houqing reminded that this kind of situation is rare but it may happen clinically. The most important thing is to understand the painThe problem can be solved by targeted treatment.
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