The spine is a long chain of bones, the vertebrae, connected to each other by bony interfaces called intervertebral discs made up of the periphery of a fibrous ring and the centre of a gelatinous nucleus.
These discs are essential. They ensure all the mobility, all the anatomy of the spine.
The disc herniation corresponds to the projection of the gelatinous nucleus outside the disc. This can be caused by a decrease in flexibility, natural body hydration, aging with bone wear.
The nerves that allow the sensitivity and motor skills of all our limbs pass between these discs. During the hernia, they are compressed. This generates the famous pains called according to the location, the degree of severity, low back pain, or sciatica.
The most common cause of sciatica is herniated discs, but this is not always the case. These may be arthrosic lesions of the spine reaching the posterior joints or a narrowing of the lumbar canal.
More rarely, the roots of the sciatic nerve can be attacked by other diseases of the spine and its surroundings: traumatic lesions, tumours and metastases, infection. There may also be damage to the sciatic nerve itself: shingles, neuritis of inflammatory or toxic or even metabolic origin.
SYMPTOMS:
• Pain, sensations of electric shock increased with effort
• Tingling, numbness
• Depending on the nerve affected: abdominal pain, constipation…
• A paralysis
Duration of hospital stay
3 to 4 days.
Classical general anaesthesia.
Average length of stay
2 weeks.
The length of stay depends on the patient.
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DIAGNOSIS:
It is essentially clinical and it is during the interview and examination of the patient that the diagnosis is made. And it is after the initiation of medical treatment that the diagnosis is confirmed.
Additional examinations:
The main purpose of the intervention is to remove nerve compression, freeing the compressed nerve root by removing the herniated disc.
The disc should also be emptied by removing damaged nucleus fragments that could cause a new disc herniation. Sometimes, if arthrosic phenomena are added to the hernia, the compressed nerve must be released by an osteophyte (parrot's beak) or by a ligament that is too thick.
Before any operation, you have your appointment scheduled with the surgeon and the anaesthetist and the entire preoperative check-up is organised according to their request.
It usually takes place under general anesthesia. The patient is placed on his/her stomach. The level to be operated on is marked on the skin after identification with the help of the radio. After careful disinfection of the skin and placement of the sterile surgical fields, a short incision (3 to 4 cm) is made in an intervertebral space.The ligament that closes the spinal canal backwards is open to access the nerve roots. If the hernia is excluded from the disc and the posterior common vertebral ligament is torn, it is often easy to remove the hernia after dissociating it from the nerve. Otherwise, the ligament is incised and the hernia removed. You have to look for a possible disk fragment that has migrated. The disc is then carefully cured and almost all of the nucleus is removed to prevent a free fragment from mobilizing and causing compression to recur.
In other cases, the approach may be broader and the root release may require a complementary release action. It is sometimes necessary to remove part of the vertebra to sufficiently release the compressed root or roots.
The disc having been emptied, it will lose a little height, as could be seen on control radios. This has no particular consequence and there is no need to replace the nucleus. A healing tissue will occupy the disc space within a few weeks.
More and more the surgeon uses the operating microscope. The scar is smaller, the approach is limited to the space between two vertebrae without having to widen on the bone or joints. The procedure is finer and the surgeon can better distinguish the nerve and its surroundings. Often, the procedure is faster, less hemorrhagic and the consequences simpler. Bleeding during the procedure is minimal.
It should be noted that a surgical procedure always leaves scarring, superficial and deep marks.
The usual length of hospitalization for an uncomplicated herniated disc procedure is 3 to 4 days. Your arrival at the clinic is scheduled the day before or the morning of the operation. You should be fasting from 8am in the morning. You must bring all your medical documents, including your scanner and/or MRI and spinal X-rays, even if they are old.
Take your usual treatments and the latest prescriptions with you.
If you are a smoker, it is strongly recommended to reduce or stop your consumption in the days before the intervention.
Before the procedure, you will need to take a shower with an antiseptic soap. Before going to the operating room, you will usually receive premedication.
After the operation, you will remain in the recovery room for 2 to 3 hours where close monitoring is carried out and the pain management protocol is put in place. As soon as you wake up, you will receive pain medication by infusion. On the day of the operation, you will stay in bed as well as on the first night.
You can sleep on your back or on your side if this is your habit but not on your stomach. Do not sit or stand up until the next day. A pillow is allowed and you can raise the head of the bed slightly. You will be able to drink and eat a few hours after the operation. Staff will help you with your needs; if you cannot urinate in a lying position, you can sit or stand up but do not try it without the help of staff.
La douleur post opératoire est normalement peu importante. Il s’agit surtout d’une gêne au niveau de la cicatrice. Vous recevrez tous les antalgiques nécessaires. Un drain est parfois mis en place durant l’intervention pour éviter la survenue d’un hématome. Il ne vous gênera pas ou peu et sera enlevé sans douleur au 2ème ou 3ème jour.
The day after the operation, you will be lifted up with the help of the physiotherapist or nurses who will advise you on how to avoid actions that are dangerous for your back. You can wash in the sink and sit on a chair for breakfast. You shouldn't sit on the bed. The infusion is usually removed from the first morning and replaced by pain pills.
It is quite common for pain or tingling (paresthesia) to occur in the sciatic nerve area two days after the operation, less severe than before, due to post-operative edema and giving way to anti-inflammatory medication. In the following days, you will notice that your autonomy increases rapidly, allowing you to move around the corridors, take the elevator and then the stairs. The physiotherapist will visit you daily to show you the "right moves" and some flexibility exercises.
The bandage is removed at D+3 and you can then shower. The exit is usually scheduled for D+3 or D+4 depending on your autonomy. The return trip can be made by private car while sitting down. Do not try to lie down in the car, but rather straighten the seat. If you live far from the clinic it is better to ask for an ambulance. You will be issued a prescription to have the wires removed by a home nurse one week after the procedure.
Once the threads are removed, you can take a bath, being wary of deep baths from which it is difficult to get out. Another prescription of medication will allow you to continue the treatment started at the clinic. Analgesics are not mandatory and must be adapted to your pain. The required work stoppage is usually 5 to 6 weeks. You will have an appointment for a follow-up consultation 4 to 5 weeks after the procedure.
After the operation, the patient experiences unpleasant pain in the operated area and in the back. As a general rule, they will be very well relieved by taking analgesics. On the other hand, persistent back pain or pain occurring a few weeks after the operation may suggest instability of the spine.
This pathology will be treated with exercises to strengthen the muscle belt.
Difficulties in urinating may appear within the first 24 hours after the operation. The bladder must then be emptied using a bladder probe. Unpleasant intestinal bloating can also occur and sometimes justify the use of an intestinal discharge tube. Circulatory disorders can appear when you get up (example: everything becomes black). Report it absolutely to obtain medications that will stabilize your blood pressure.
Like any surgery, there is a risk of hematoma that usually resolves itself on its own. The risk, if it increases significantly, is to compress the surrounding elements and may exceptionally require an evacuation puncture or surgical drainage. Bed rest and individual risks (diabetes, varicose veins, etc.) can increase the risk of phlebitis of the lower limbs (clot in the veins). This phlebitis is likely to lead to pulmonary embolism, a major risk of this condition, usually properly limited by the prescription of anticoagulants.
The infection. This is most often an infection at the site of the operation. It requires a new procedure and antibiotics to clean the wound. Meningococcal infection is very serious but very rare. At the disc level it is also very rare but can leave sequelae such as persistent low back pain (spondylodiscitis). Antibiotics should be taken for several months. A urinary (after placement of a urinary catheter), pulmonary or blood infection (sepsis) may occur after the operation. Aseptic precautions and antibiotics have significantly reduced the rate of these complications.
MEDICAIM organizes your entire stay for you: post-operative nursing care, biological follow-up, therapeutic, nutritional and psychological support.
Any additional questions? Ask your MEDICAIM doctor about it: careteam@medicaim.com
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