Disk removal
Disk removal, often related to conditions like herniated or prolapsed intervertebral disks in the lower back, is a surgical procedure performed to alleviate pain and other symptoms caused by nerve compression. Intervertebral disks are cartilage structures that separate the vertebrae in the spine and can become damaged through aging, injury, or improper lifting techniques. When the soft center of the disk bulges out, it may exert pressure on nearby nerves, leading to pain, numbness, or muscle weakness, particularly in the lower back and legs.
Diagnosis typically involves imaging techniques like X-rays, CT scans, or MRIs. While many cases can be managed with conservative treatments such as pain relievers and physical therapy, surgery may be necessary if symptoms persist. The surgical process commonly involves general anesthesia, an incision in the back, and careful removal of the affected disk material, with attention given to minimizing complications such as nerve damage or bleeding.
Despite the risks associated with disk removal, including infection and the potential need for further surgery, the procedure generally has favorable outcomes. Newer minimally invasive techniques and artificial disk replacements have enhanced the success rates of these surgeries. Preventative measures, such as proper body mechanics and regular exercise, are encouraged to reduce the likelihood of disk-related issues.
Disk removal
Anatomy or system affected: Back, bones, nervous system, spine
Definition: A surgical procedure used to remove intervertebral disks that are compressing nerves that enter and exit the spinal cord
Indications and Procedures
A relatively common disorder that causes lower back and sometimes leg pain is the herniation or prolapse of an intervertebral disk in the lower back. These disks are made of cartilage and serve to separate the bones that make up the vertebral column. The spinal cord is located within the bony structure of the vertebrae and has nerves that enter and exit between these bones. These sensory and motor nerves must pass alongside the intervertebral disks. When a disk’s jellylike center bulges out through a weakened area of the firmer outer core, the disk is said to be herniated or prolapsed. This may compress the spinal cord or the nerve roots and yield such symptoms as interference with muscle strength or pain and numbness of the lower back and leg.
More than 90 percent of disk prolapses occur in the lumbar region of the back, but they may also occur in the cervical vertebrae. Occasionally, disk herniation is caused by improper lifting of heavy objects, sudden twisting of the spinal column, or trauma to the back or neck. More typically, however, a prolapsed disk develops gradually as the patient ages and the intervertebral disks degenerate.
To diagnose a prolapsed disk, a physician will likely want to visualize the vertebrae and spinal cord using X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI). Once diagnosed, most cases can be treated with analgesics, muscle relaxants (such as cyclobenzaprine and methocarbamol), and physical therapy. If the symptoms recur, however, it may be necessary to have the protruding portion of the disk or the whole disk surgically removed. This procedure usually requires that the patient have general anesthesia and remain hospitalized for several days.
For a lumbar procedure, the patient is anesthetized and placed on the operating room table in a modified kneeling position, with the abdomen suspended and the legs placed over the end of the table. The lower back is then prepared for a sterile procedure, and the surgeon makes an incision in the middle of the back along the spine. The surrounding tissues are retracted, and the vertebrae are exposed. At this time, the surgeon must make a careful dissection of the tissues to identify the affected nerves and intervertebral disk. Once the prolapsed disk is found, the physician will cut away the fragment of the disk impinging on the nerve. It is important that all free fragments be removed, as these could cause symptoms at a later time. Often, the surgeon must remove some of the vertebrae to gain access to the disk. This is known as a laminectomy.
Uses and Complications
Because the vertebral column houses the spinal cord, any surgical manipulation of this area must be approached with extreme caution. Very large arteries (the aorta) and veins (the vena cava) lie adjacent to the spinal column, and accidental cuts can lead to rapid blood loss. The spinal cord is surrounded by a covering called the meninges, which helps to protect the cord and which contains the cerebral spinal fluid. Trauma to the meninges may cause the fluid to leak out or lead to meningitis (inflammation of the meninges). One surgical approach to reduce the adverse effects of a lesion on the meninges is to use some of the patient’s fat to pack the leak and help prevent scarring. Patients with operative trauma to the meninges may complain of headache, which usually decreases in severity as the lesion heals.
Other complications that may arise include infections in between 3 and 9 percent of patients, thromboembolism in less than 1 percent, and death in about one patient per 1,000. These percentages vary widely with the age and general health of the patient. Unfortunately, one of the major long-term complications reported in the study involved a worsening of symptoms after surgery.
Perspective and Prospects
Even with some potential complications, disk removal typically has a favorable outcome, although this varies somewhat depending on the patient, the treatment method, and what the patient and physician consider to be a good result. Typically, favorable outcomes range from 50 to 95 percent, with the average rate of favorable outcomes in the 80 percent range Reports of the number of patients who need a second operation range drastically but have been reported up to 25 percent.
Healthcare professionals are beginning to emphasize the importance of prevention of back pain . Educating patients on proper lifting techniques, such as bending the legs rather than the back and avoiding twisting, will reduce the potential for damage to the intervertebral disks. Individuals who are overweight are also at risk for developing lower back pain because of the added stress to the lumbar spine, as well as because of their relatively weak abdominal muscles. The abdominal muscles are important in stabilizing and supporting the lower back. Exercises that help strengthen these muscles are recommended for a weight-reducing exercise and diet program. Patients who must sit for long periods of time are also at risk for lower back pain. These people should take several quick breaks to stand and stretch, which reduces the constant stress on the lumbar spine. Still, new technologies were developed in the twenty-first century to more easily facilitate disk removal and repair. Several new minimally invasive surgical procedures had become the norm for diskectomies, and an artificial replacement disk was developed, which raised the overall success rate of the surgery.
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