Operations on the spine with a hernia: to be or to be?

In the arsenal of leading foreign neurosurgical clinics there is a large number of surgical methods of treating the intervertebral hernia. Operations on the spine are minimally invasive, that is, they are distinguished by a small scale of surgical intervention and, accordingly, do not require a prolonged recovery. The erroneous choice of a patient (including on the recommendation of a doctor, sometimes deliberately mistaken) in favor of conservative treatment, dictated by personal fears and preferences, means giving up a full-fledged surgical operation when it really is needed. With proper performance and correct diagnosis, microsurgical and endoscopic operations involve a minimal risk of complications.

Consider the problem of choosing the form of treatment of the intervertebral hernia. Indeed, when can we do without surgical intervention and when is conservative treatment quite applicable? A single-valued answer to this question can not be given. Everything depends not only on the results of the diagnosis, but also on the experience of the surgeon, his personal understanding of the causes of the development of the disease and other personal factors. In the case of a hernia, localized in the cervical or lumbar spine, most often resort to surgical intervention. According to statistical data, in 90 cases out of 100 the operation ends successfully.

There is a need for a clear separation of the hernia of the intervertebral disc and prolapse (displacement of the disc or its protrusion) from bone stenosis (loss of elasticity of the intervertebral disc). If there are symptoms of permanent bone stenosis, accompanied by neurogenic intermittent claudication, then conservative treatment is contraindicated, since it can lead to deterioration (especially in myelopathy).

Stenosis of the spinal canal, characterized by pronounced symptomatology, can be confused with the developed prolapse of the intervertebral disc. Since stenosis leads to horse tail syndrome and often to permanent paraplegia, the disease should be treated with surgical methods, especially if there is stenosis of the cervical region with pronounced myelopathy. The choice in favor of conservative treatment in this situation can be regarded as a gross error.

Treatment of a spinal hernia without surgery is acceptable only with a slight protrusion (protrusion) of the intervertebral disc, which is characterized by the absence of neurologic symptoms, mild pain and slight protrusion seen in the picture. In the case of such a hernia with mild symptoms, there is no tangible difference in the choice of operative or conservative treatment. It is believed that conservative methods have produced the desired effect if the pain has decreased within 6-8 weeks and the patient's mobility has increased, that is, the pain is no longer felt at various positions of the body.

The use of invasive methods in practice is conditioned by the consistency, similarity of the history of the disease, the symptoms and results of the examination, obtained with MRI or CT. In this case, the doctor takes into account the possible cause of the disease and the lifestyle of the patient. Based on these factors, the specialist chooses adequate therapy.

There are cases when surgical intervention should be carried out urgently. Direct indications for surgery on the spine are:

• Severe paralysis;
• Threat of death;
• Influence on nerve roots;
• Deviations of the nervous system (hyperaesthesia, parasthesia);
• Pronounced prolapse.

In case of intense pains that cause pain to the patient, a surgical operation is also shown. The operative methods of treatment of the hernia of the spine include endoscopic discectomy, percutaneous nucleoplasty, epidural catheterization, intervertebral disc prosthetics, as well as a modern method - laser vaporization.