LUMBAR DISK HERNIATION

Disk herniation is the most common diagnosis among the degenerative abnormalities of the lumbar spine. Factors such as greater access to medical care, early requests for imaging examinations and safety of surgical procedures have led to high rates of surgical treatment.

What is herniated lumbar disk?

Lumbar disk herniation consists of displacement of the content of the intervertebral disc through its external membrane, generally in its posterolateral region. Depending on the volume of herniated material there may be compression and irritation of the lumbar nerve roots and the dural sac.

SYMPTOMS OF LUMBAR DISK HERNIATION

Disk herniation is most often the result of a gradual, aging-related wear and tear called disk degeneration. The most common symptom is pain in lower back and leg pain. Also numbness, tingling and weakness of the legs may occur.

HERNIA OPERATION IS A MUST?

The majority of hernia patients can be treated with medical treatment. There are several stages depending on the degree of hernia and clinical findings of the patient. Surgery is required in 5-10% of all hernia patients. The necessity of surgery should be determined by the physician.

WHAT ARE THE NON-SURGICAL TREATMENT OPTIONS?

In patients who do not require surgery, resting, medication therapy and physical therapy can be beneficial. The aim of the treatment is to relieve pain and stimulate neurological recovery, with early return to activities of daily living and to work.

WHEN SURGICAL TREATMENT SHOULD BE PREFERRED?

In advanced lumbar hernia, surgical treatment may be preferred if the pain does not disappear with the treatment and/or in the presence of progressive neurological findings. The aim of surgical treatment is to decompress nerve structures.

WHAT ARE SURGICAL TREATMENT METHODS?

Current surgical techniques;

1. Classical discectomy: Also, known as open surgery.
2. Micro discectomy: It is performed with a smaller surgical incision under the microscope.
3. Endoscopic surgery: Translaminar and transforaminal interventions are performed in appropriate cases.

Appropriate surgical technique should be chosen for each patient separately in order to achieve the best results. Some spinal problems such as narrow canal, segmental instability and listhesis accompanying hernia can change the type of the surgery that is needed.

WHICH TREATMET METHODS ARE USED IN OUR HOSPITAL?

Microdiscectomy is used in degenerative diseases of the spine. Spine fractures, tumors, infections and slips are treated with most current medical treatment and in some cases surgical treatment is performed along with prosthesis or screwing methods. This helps and ensures that our patients can return to daily activities and work as soon as possible.

NARROWING OF SPINAL CANAL

If the degenerative process (see Spinal degeneration) progresses, the space required for the spinal cord and nerve roots in the spinal canal decreases.

The reasons for this narrowing are;

• Thickening of the ligaments connecting both vertebrae
• Disc distance reduction
• Thickening of the intervertebral joints
• Bone protrusions around the vertebrae

This condition causes compression of nerve roots and vessels passing through the spinal canal.

Main complaints in spinal canal stenosis;

• Increased pain in the legs when walking and standing for a long time
• Pain disappears when sitting or leaning forward
• Pain on both legs. Pain on one side may be more.

Similar pain can be seen in leg vessel problems or hip joint calcification. It is recommended to consult a spinal surgeon for the differentiation of these diseases.

NON-SURGICAL TREATMENT OPTIONS

• Pain relievers and muscle relaxants
• Exercise and physical therapy
• Weight control
• Steroid and / or pain relief injections into the spinal canal
• Selective injections into nerve roots

Surgical treatment is very effective and beneficial in spinal canal stenosis.

When is surgical treatment required?

• The symptoms do not go away despite the non-surgical treatment
• Muscle weakness in the legs
• Inability to control bladder and bowels
• Complaints due to impaired balance in the spine

Among the surgical techniques;

• Removal of the bone structure that forms the roof of the spinal canal (laminectomy)
• Relieving pressure from bone spurs, ligaments, and disc structures (herniated disc) in order to increase the space for nerve roots (foraminotomy)
• If the removal of these structures will cause deterioration in the balance of the spine, an instrument (platinum) and fusion process may be required.

SCOLIOSIS & SPINE SURGERY

Scoliosis is the leaning of the back or waist areas of the spine to the side. It can be seen alone or together with kyphosis (hump). The vertebrae that lies flat from top to bottom in the normal spine turn right, left or around their own axes in the scoliosis spine.

WHAT ARE THE TYPES OF SCOLIOSIS?

IDIOPATIC SCOLIOSIS

It is the most common type of scoliosis. Idiopathic scoliosis is examined in 3 groups according to age ranges;

• Infantile idiopathic scoliosis occurs between newborn and 4 years old.
• Juvenile idiopathic scoliosis occurs between the ages of 4 and 9.
• Adolescent idiopathic scoliosis occurs between the ages of 10 and 18 years.

NEUROMUSCULAR SCOLIOSIS

It is scoliosis that occurs as a result of muscle and nerve diseases (meningomyelocele, cerebral palsy, etc.). It is the second most common type of scoliosis in our country. Corset treatment is not generally beneficial. Surgical treatment may need to be applied at an earlier age and at lower curvatures.

CONGENITAL SCOLIOSIS

It is scoliosis that occurs as a result of some structural anomalies in the spine during the development of the baby in the womb.

• The vertebrae cannot be fully formed (hemivertebra)
• The vertebras are attached (bar formation)
• Both conditions are seen together
• In this type of scoliosis, there is a risk of anomaly in other systems (kidney-bladder, heart, etc.).
• If there is no improvement during follow-up consultations, surgery is not required until the child completes his or her growth.
• If progress is made in the follow-up consultations, surgery is required as soon as possible.

TREATMENT OPTIONS IN SCOLIOSIS

When scoliosis is diagnosed or suspected, it is necessary to undergo periodic follow-up consultation in a center with experience in this regard. Surgical treatment may not be required for every type of scoliosis.

FACTORS AFFECTING TREATMENT;

• Age of the patient
• The degree and localization of the curve
• Whether he or her is in adolescence or not
• The progress of the curve
• Personal factors
• Experience of the surgical team

Observation is made in 0-20 degree scoliosis. The patient is examined periodically and scoliosis x-ray is renewed. Following the evaluation of the spine surgeon, the follow-up plan may change.

CORSET TREATMENT

It is applied in scoliosis between 20-40 degrees. It is thought that its application in neuromuscular scoliosis is not beneficial. Its application in patients with congenital scoliosis is controversial. There are many different corsets available. For corset treatment and the most suitable corset, it is necessary to contact the spine surgeon. Correction is not expected with corset treatment. The main goals of corset treatment are to prevent or slow down the progression.

SURGICAL TREATMENT

It is applied in curvatures over 40 degrees or in curves increasing more than 10 degrees in 1 year.

EARLY-ONSET SCOLIOSIS

Early-onset scoliosis is a definition for scoliosis in children under 10 years of age. As the growth continues in children in this age group, their follow-up and treatment is different from scoliosis seen in adolescence years. Although corset application is an treatment option in case of early-onset scoliosis, the need for surgical treatment is higher than in case of adolescent scoliosis. Fusion surgery applied in adolescents and adult patients in the surgical treatment of early-onset scoliosis is inconvenient for various reasons. Surgical treatment of early onset scoliosis should allow both correction of scoliosis and growth of the patient.

INSTRUMENTATION AND FUSION

Another technique applied in surgical treatment is fusion surgery. This technique is generally applied at the age of 10 or spine development is completed. With this surgery, the parts of the spine involved in scoliosis are welded to each other after the correction of scoliosis. The postoperative period may vary depending on the type of scoliosis, the patient, and how many vertebrae are included in the surgery.

SPINAL DEGENERATION

The basic structures that make up the spinal structure are the vertebrae, the discs which function as pads between the vertebrae and the surrounding tissues. Degeneration of the spine occurs due to excessive strain, trauma, aging and similar causes resulting disruption of the discs between the vertebrae.

During this degeneration process;

• Disc structure, nutrition and metabolism
• Amount of water that retains in the disc
• Resistance of the disc
• Disruption of the joints between both vertebrae
• Resisting ability of spine to normal weights changes and decreases

As a result of the degenerative changes in the spine;

• Neck hernias
• Slip in the neck vertebrae
• Waist hernias
• Lumbar vertebrae slipping
• Spinal canal stenosis
• Diseases such as adult scoliosis may occur.

SPINE TUMORS

Spinal tumors can be benign or malignant. A multi-disciplinary (multiple branches of interest) approach is required for the follow-up and treatment of spinal tumors. Tumors are called differently depending to the place of origin. For instance, if it is a tumor of the musculoskeletal system, it is called primary, whereas tumors that have occurred in other organs but have spread to the spine are called metastatic tumors. Metastatic spine tumors are malignant (cancer). Primary tumors can be benign or malignant. Spinal tumors can involve any part of the spine (neck, back, waist, coccyx, pelvis (pelvis).

HOW IS SPINE TUMOR DETERMINED?

Conditions to be suspected of spinal tumor;

• Pain that does not respond to long-term medical treatment and is seen at rest and at night
• Involuntary weight loss accompanying pain (eg 10 kilos in the last 3 months)
• Fever, night sweats
• visible or palpable mass in the area of pain
• weakness of leg or arm muscles
• inability to control bladder and bowels
• having a previous cancer history

WHICH EXAMINATIONS ARE DONE IN THE DIAGNOSIS OF SPINAL TUMOR?

Diagnosis begins with the patient's detailed history and physical examination. If the spinal surgeon is applied, he / she may request the following examinations;

MRI:Indicates at what levels and plans of the spine there is a mass. It can also give information about whether there is a spread in tissues and organs in the immediate vicinity of the spine.

Computed Tomography:It may be required for detailed examination of bone structures.

PET / Scintigraphy (Positron Emission Tomography Scan – PET):It provides information about whether there is spreading in other parts of the body.

Biopsy:It is the most important diagnostic tool for the presence and type of tumor. It can be done with closed or open methods. The key is, biopsy should be taken by a Spine Surgeon who can plan and perform the main treatment.

What are the treatment options?

• If it is a benign tumor, observation should be made.
• In malignant tumors, chemotherapy (medicated treatment) and / or radiotherapy (irradiation) are applied according to the type and spread of the tumor. For details on this subject, it is recommended to contact the specialist doctors and spine surgeon.
• Surgery is the recommended treatment option for malignant tumors. Surgical technique may vary depending on the spread of the tumor, the general condition of the patient, and the sensitivity of the tumor to chemotherapy or radiotherapy.

Purpose of surgical treatment

• Removal of tumor tissue
• Relieving important tissues that are pressed against the tumor
• Reduction of tumor mass in patients undergoing chemotherapy or radiotherapy
• Ensuring stability of the spine
• Reduction of the patient's pain

PEDIATRIC SPINAL TUMORS

Spinal tumors are masses in the spine and surrounding tissues that should not normally exist. There are two types of spinal tumors;

• Benign spinal tumors are not cancer and do not spread to other parts of the body.
• Malignant spinal tumors are considered cancer and can spread to distant parts of the body.

Spinal tumors that spread to distant parts of the body in children are rare.

Signs and Complaints in Spinal Tumors

• Prolonged lower back / or back pain
• Involuntary weight loss
• Fever
• Numbness in the legs, tingling, loss of sensation
• Inability to control bladder and bowels

How is it diagnosed?

• If the above mentioned complaints are present, the spine surgeon should be consulted.
• First examinations are spine x-rays and blood tests.
• Magnetic resonance (MR) and special scintigraphy (PET) provide information about the localization and spread of the tumor.
• If malignant tumor is suspected in imaging methods, a biopsy must be done for the type of tumor.
• Biopsy can be taken under local anesthesia with a closed method without putting the patient to sleep.

What Are The Treatment Options?

• Treatment of spinal tumors should be applied in centers where cancer treatment (chemotherapy, radiotherapy) can be performed.
• Benign tumors are usually followed up. However, if the mass is too large, if it is pressing on the surrounding tissues, surgical intervention may be considered.
• Malignant tumors can be completely removed under appropriate conditions. For tumors that cannot be completely removed or have spread, chemotherapy (drug therapy) or radiotherapy (radiation therapy) may be required before and after surgery.
• After any kind of treatment, there is a possibility that the tumor may occur in the same or different place. Therefore, regular follow-up consultations are required.