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Lumbar Disc Herniation Surgery

 

 

Lumbar hernia surgery is performed in patients who have severe back and leg pain due to herniated disc disease and sometimes who develop paralysis. Such patients; They do not benefit from conservative treatments such as medication, physical therapy, prolotherapy, epidural steroid injections. Depending on the surgeon's preference, different lumbar hernia surgery techniques can be used according to the patient's current need. These are three types of surgical intervention.

1. Lumbar hernia surgery performed with classical open surgery

2. Microsurgical lumbar hernia surgery (Microdiscectomy)

3.Endoscopic lumbar hernia surgery

 

When Is Lumbar Hernia Surgery Recommended?

 

The most curious issue by patients is the question of when should I have surgery. If leg pain due to lumbar hernia is severe, if the pain does not disappear with conservative treatments; For example, if the patient is unable to sleep due to pain, has difficulty in going to work, or is difficult to do daily activities, surgery may be recommended to the patient. If paralysis of the legs and feet has developed and urinary incontinence has started, the situation is even more serious and an indication that emergency surgery is required. A neurosurgeon should be consulted as soon as possible.

 

Classic Open Lumbar Hernia Surgery

 

A microscope is not used in this surgical technique. 4 cm at the waist. and an incision is made on it. The waist muscles are stripped. Then, the spine and some of the ligaments are removed. Lumbar hernia is removed by excluding the nerve root. The difference from microsurgery is that a microscope is not used and a large incision is made. It is a technique that is not preferred much today.

 

Microsurgical Lumbar Hernia Surgery (Microdiscectomy)

 

The main feature of lumbar hernia surgeries performed with microsurgery is that they are performed using a microscope. Why do we use microscopes? You can see the tissues 40 times larger in operations. This makes the surgeon better distinguish the tissues and minimizes the possibility of damage to the nerve. This procedure is also called microdiscectomy.

 

The surgery is performed under general anesthesia. The way the patient lies on the operating table is in the prone position. The waist is slightly bent. 1.5-3 cm to the area that fits the targeted area in the surgery. A skin incision is made in between. The back muscles are stripped from the spine bones. With a laminectomy, some spinal bone is removed and an area where the surgeon can work is opened. Microscope is brought to the surgical field. After the connective tissue we call yellow flavum is removed, the nerve root is pulled aside towards the midline with the retractor. The part that puts pressure on the nerve is found and removed with surgical tools. It is sufficient to reduce the pressure on the nerve.

In the video below, you can watch the lumbar hernia surgery performed with microsurgical technique.

http://www.youtube.com/watch?v=qhyuvTIGeko

 

Full Endoscopic Lumbar Hernia Surgery

 

Lumbar hernia surgery performed using endoscopic devices is called " full endoscopic lumbar hernia surgery ". It is referred to as "Full Endoscopic Spine Surgery" in English. It is the most current lumbar hernia surgery technique.

 

Minimally invasive spine procedures have evolved rapidly over the past decade. Efforts to reduce muscle crush injuries during prolonged operative periods, avoiding significant soft tissue injuries, and efforts to minimize bone resection are surgical principles used to reduce postoperative pain and disability to patients. Full endoscopic lumbar hernia surgery enables the spine surgeon to reach the spine pathology using these principles. Endoscopic techniques have evolved and innovated for over 30 years. Currently, endoscopic techniques are used for pathologies in the cervical, thoracic and lumbar spine. There is a great deal of literature supporting its advantages in terms of less morbidity and fewer complications. The endoscopic spine technique has also started to be used in cases of degenerative spinal stenosis , spondylolisthesis , scoliosis , previous fusion surgery, tumor and infection. As technological advances continue to simplify the surgical technique and expand the indications for use; Endoscopic spine surgery will provide surgeons with a hands-on approach to the treatment of spinal diseases and will further raise the standard of care in the treatment of patients.

 

Performing the surgical procedure requires special equipment and surgical experience. The hand tools used are smaller than those used in microsurgery. The advantage over microsurgical technique is that the same procedure can be easily performed without damaging the muscles and bone tissues.

 

According to the surgeon's preference; It can be easily applied under general or local anesthesia. The surgeon can perform this operation on a compatible patient, preferably without putting the patient to sleep. 0.5 - 1 cm to the waist area. A small incision is sufficient. We have the opportunity to reach the spine from the middle of the waist (interlaminar) or from the lateral side of the waist (transforaminal). You can imagine this method as follows. A pen-sized tool is sent through your waist. In such a small working area, this procedure can be performed with surgical instruments. Thus, the process is carried out without damaging the tissues. After the operation, the patient can be sent home 3-4 hours later.

 

Advantages of endoscopic lumbar hernia surgery compared to microsurgical lumbar hernia surgery:

 

  • It can be performed with local anesthesia and mild sedation. So the patient is not put to sleep. This eliminates the risks that general anesthesia may bring to the patient.

  • Making a small incision of 1 cm means that there is very little cosmetic scar on the patient.

  • Little damage to the tissues in the operation area. It reduces the scar tissue that may occur on the nerve. Even in case of recurrence of herniated disc, it ensures that the operation can be performed easily and possible complications are minimized.

  • The patient can quickly return to his normal activities.

  • The patient can be discharged on the same day.

  • It greatly reduces the risk of infection. There is very little bleeding.

  • Multiple hernias can be intervened through the same hole.

In the video below, you can watch the operation of a case performed with the interlaminar technique, as a full endoscopic procedure.

http://www.youtube.com/watch?v=0kAo5Ud2Zzo

 

The Questions Patients Are Curious About About Lumbar Hernia Surgery

 

  • Will the lumbar hernia recur, that is, it recur?

There is a recurrence rate of 5%. This ratio is based on the patient's compliance with the doctor's recommendations.

in case it drops even more. It is imperative not to do heavy work after the operation.

  • Are fully closed endoscopic lumbar hernia surgeries repeated more frequently?

There is a possibility of recurrence at the same rate as lumbar hernia surgeries performed with microsurgery. So this rate is again 5%.

  • Will the lumbar hernia surgeries performed with microsurgery repeat?

Yes it can. This rate is 5%.

  • Is paralyzed in lumbar hernia surgery?

Technological imaging devices such as microscopes and endoscopes that we currently use help surgeons a lot because they enlarge the surgical area. That's why; The probability of developing a stroke is low in an operation performed by an experienced surgeon.

  • Is lumbar hernia surgery a failed surgery?

No way. As long as you are careful after a good surgery and listen to your doctor's recommendations, you will not have any complaints for many years.

  • Will my pain and numbness continue after lumbar hernia surgery?

Although the pressure on the nerve is removed after surgery, the nerve continues to give a pain signal. This is called neuropathic pain. Postoperative pain and numbness may persist for 1-3 months. Patients should not worry about this. Medications to reduce this pain will be given by your doctor.

  • How do I know if my lumbar hernia has recurred?

With the removal of pressure on the nerve after lumbar hernia surgery, the pain decreases dramatically in terms of score compared to pre-surgery. If; If the pain reappears as severe as before the surgery, your lumbar hernia may have recurred. In such a case, it would be beneficial to have your doctor examined again.

  • Before the lumbar hernia surgery, he was paralyzed, what now?

After the surgery, if your doctor deems appropriate, you may need physical therapy. Exercises recommended by your doctor and physical therapy must be done. The recovery process of the paralysis may be immediate in some patients after the surgery, or it may take a period of 6 months in some patients. Therefore, patients who develop paralysis are recommended not to delay surgery too much.

 

Rules to Follow After Lumbar Hernia Surgery

 

  • After lumbar hernia surgery, pain may be felt in the wound area, but the general severe leg pain and low back pain are much less than before the operation.

  • Sitting for a long time is inconvenient at first. Weight should not be lifted, excessively leaning forward and stretching the spine should be avoided for the first 1 month postoperatively.

  • Your waist wound area should be kept clean and dry. If there is redness, swelling, warmth and discharge in the wound area, call your doctor.

  • After 3 days, you can take a warm shower with waterproof dressings such as Tegaderm.

  • Use your pain relievers according to the prescription given by your doctor.

  • In the early days, short walks can be made at home.

  • It is okay to go up and down the stairs.

  • For the toilet, use European style toilets.

  • It is appropriate to start sexual activity after waist surgery 2 weeks after surgery. Nevertheless, it is useful to be careful. Waist movements can increase your pain. It would be appropriate to have a passive relationship.

  • Driving is allowed 2 months after lumbar surgery. In particular, place a brace behind your waist when driving and traveling.

  • After a few weeks, cycling or swimming may be allowed.

  • Generally, desk workers can start their light work after 2 weeks. Those who work in heavier jobs and have professions that require heavy physical load can start work after 4-6 weeks.

  • If you are overweight according to your body mass index, try to lose weight by dieting.

Dr. Tamer Tekin

Fully Closed Lumbar Hernia Surgery (Endoscopic)

Herniated disc surgery performed using endoscopic devices is called "fully closed herniated disc surgery".  It is the most up-to-date lumbar hernia surgery technique.

Minimally invasive spine surgeries have developed rapidly in the last decade. Scientists working on and developing the technique; shortening prolonged operative times; avoidance of muscle injuries, soft tissue injuries; They aimed to reduce postoperative pain and complications that may occur during the operation. Full endoscopic lumbar hernia surgery (Full closed lumbar hernia surgery) enabled the spine surgeon to treat spinal pathologies using these principles. Endoscopic techniques have shown evolution and innovation for over 30 years. Currently, endoscopic techniques can be easily used for pathologies in the cervical, thoracic and lumbar spine. There is a great deal of literature supporting the advantages it offers in terms of less morbidity and fewer complications. Endoscopic spine surgeries,  degenerative spinal stenosis ,  spondylolisthesis ,  It has also been used in cases of scoliosis , previous fusion surgery, tumor and infection. As technological advances continue to facilitate the surgical technique and expand the indications for use; Endoscopic spine surgery will provide surgeons with an advantage in the treatment of spinal diseases, strengthening their hands, and will further raise the standards of care in the treatment of patients.

Performing this surgical procedure requires special equipment and surgical experience. The hand instruments used are much smaller than the instruments used in microsurgery.  The advantage over the microsurgery technique is that the same procedure can be easily performed without damaging the muscles and bone tissues.

Fully closed endoscopic herniated disc surgery; According to the surgeon's preference, it can be easily applied with general or local anesthesia. The surgeon can perform this surgery on a compatible patient, preferably without putting the patient to sleep. 0.5 - 1 cm to the waist area. A small incision is sufficient. We have the opportunity to reach the spine from the middle of the waist (interlaminar) or from the side of the waist (transforaminal). You can imagine this method as follows. A pen-sized tool is sent inside your waist. This operation can be performed with surgical instruments in such a small working area. Thus, the procedure is carried out without damaging the tissues. Fully closed herniated disc surgery takes an average of half an hour. After the operation, the patient can be sent home after 3-4 hours. I am performing a fully closed lumbar hernia surgery in a private hospital. For information, you can make an appointment at the relevant number by clicking the contact page.

 

Advantages of endoscopic fully closed hernia surgery compared to microsurgical hernia surgery:

  • It can be performed with local anesthesia and light sedation. So the patient is not put to sleep. This eliminates the risks that general anesthesia can bring to the patient.

  • Making a small incision of 1 cm means that there is very little cosmetic scar on the patient.

  • Leaving very little damage to the tissues in the operation area. It reduces the scar tissue that may occur on the nerve. Even in case of recurrence of herniated disc, the operation can be performed easily and possible complications are minimized.

  • The patient can quickly return to normal activities.  

  • The patient can be discharged on the same day.

  • It greatly reduces the risk of infection. There is very little bleeding.

  • Multiple hernias can be intervened through the same hole.

  • Because of the price of herniated disc surgery and the expensiveness of the device and tools used, the fees of a hernia surgery are higher than other hernia surgeries.

In the video below, you can watch the operation of a case performed with the interlaminar technique, fully endoscopically, by clicking. 

Tam Kapalı Bel Fıtığı Ameliyatı - Endoskopik | DRTAMERTEKİN
01:01

Tam Kapalı Bel Fıtığı Ameliyatı - Endoskopik | DRTAMERTEKİN

Dr. Tamer Tekin Tam Kapalı Bel Fıtığı ameliyatı (Transforaminal Endoskopik Diskektomi). Endoskopik cihazlar kullanılarak yapılan bel fıtığı ameliyatına endoskopik bel fıtığı ameliyatı adı verilmektedir. Minimal invaziv bel cerrahisidir. Kimi cerrahlar tarafından tam kapalı endoskopik bel fıtığı ameliyatı olarak da adlandırılsa da bence yanlış bir tariftir. İngilizcede ''Full Endoscopic Spine Surgery'' olarak geçmektedir. ​ Cerrahi işlemi gerçekleştirmek, özel ekipmanlar ve cerrahi deneyim gerektirir. Kullanılan el aletleri, mikrocerrahide kullanılan aletlerden daha küçük ve daha uzundur. Mikrocerrahi teknikten farkı kaslar ve kemik dokulara zarar verilmeden bel fıtığı kolayca alınabilir. Genel ya da lokal anestezi ile rahatlıkla uygulanabilir. 0,5 - 1 cm. lik küçük bir kesi yeterlidir. Belin ortasından ya da belin yan tarafından omurgaya ulaşma imkanımız vardır. Ameliyat sonrasında hasta günlük hayatına çok kısa zamanda dönebilir. Endoskopik bel fıtığı ameliyatının, mikrocerrahi bel fıtığı ameliyatına göre farkı: ​ Küçük aletlerle çalışılması ​ Küçük kesi yapılması ​ Operasyon bölgesindeki dokularda çok az hasar bırakması ​ Hastanın eski hayatına çabuk dönebilmesi ​ Hastanın aynı gün taburcu edilebilmesi ​ Enfeksiyon riskini azaltır ​ Kemiklere zarar verilmemesi implant kullanılma zorunluluğunu ortadan kaldırır. ​ Aynı delikten çok sayıda fıtığa müdahale edilebilir. İletişim: +90 541 5395979 E-mail: info@drtamertekin.com https://www.drtamertekin.com
Transforaminal Endoscopic Lumbar Discectomy | DRTAMERTEKIN
09:42

Transforaminal Endoscopic Lumbar Discectomy | DRTAMERTEKIN

Transforaminal Endoscopic Lumbar Discectomy performed by Dr.T.Tekin Low back and sciatic pain have been one of the most common and disabling spinal disorders recorded in medical history. Lumbar disc herniation is a major cause of back pain and sciatica. The surgical management of lumbar disc prolapse has evolved from exploratory laminectomy to percutaneous endoscopic discectomy. Mixter and Bar first published results of laminectomy and discectomy for lumbar disc prolapse. Yasargil and Caspar started the use of microscopes for posterior discectomy which limited the skin incision and lead to less muscle and epidural scarring. Patients had less postoperative pain, early rehabilitation, and early return to work. Due to these advantages, microdiscectomy became the gold standard in disc surgery. Hijikata (1975) independently experimented with mechanical nucleotomy via a 2.6-mm-od cannula that was inserted into the center of the intervertebral disc via a posterolateral access. He reported a satisfactory postoperative outcome in 64% of patients. Kambin and Schaffer (1988) used arthroscope for visualization and excision of the disc. Yeung developed rigid working channel endoscope for percutaneous endoscopic lumbar discectomy (PELD). The advantage of a percutaneous endoscopic discectomy is that the disc is approached posterolaterally through the triangle of Kambin without the need for bone or facet resection thus preserving spinal stability. There is less damage to muscular and ligamentous structures allowing for faster rehabilitation, shorter hospital stay, and earlier return to function. Although many studies have shown the efficacy of PELD with good clinical outcome, the percutaneous approach poses challenges to surgeons and the PELD, the learning curve is usually perceived to be steep. Major complications such as nerve root injury, dural tear, haematoma, visceral injury, vascular injury, and infection may occur, possibly resulting from lack of skilled surgical techniques during the learning period. The purpose of this study was to report the results of PELD by a single surgeon who had not been previously exposed to this procedure. www.drtamertekin.com

Patients' Questions About Lumbar Hernia Surgery​

  • Does lumbar hernia recur, that is, does it recur?

 ​  _cc781905-5cde-3194-bb3b-136badcf_cc781905-136badcf5cf58d_ _cc781905-5cde-3194-bb_cf311994_badc5cf31-94_badc5cf3194 -136bad5cf58d_ has a 5% recurrence rate. This rate is based on the patient's compliance with the doctor's recommendations.

falls further. It is essential not to do heavy work after the surgery.

  • Do fully closed endoscopic lumbar hernia surgeries repeat more frequently?

     _cc781905-5cde-3194-bb3b_136bad5cf58d There is the same probability of recurrence with microsurgery as with the surgeries performed So this rate is again 5%.

  • Does herniated disc surgery with microsurgery repeat?

      _cc781905-5cde-3194-bb3b-136bad5 can repeatf. This rate is 5%.

  • Can you be paralyzed in herniated disc surgery?

Technological devices such as       _cc781905-5cde-3194-bb3b58d_bada5cf 3194-bb3b-136bad5cf58d_helps surgeons a lot because it enlarges the surgical field. For that reason; In an operation performed by an experienced surgeon, the probability of developing a stroke is low.

  • Is hernia surgery an unsuccessful surgery?

      _cc781905-5cde-3194-bb3b58d_kesinf As long as you are careful and listen to your doctor's recommendations after a good surgery, you will not have any complaints for many years.

  • Will my pain and numbness continue after hernia surgery?

      _cc781905-5cde-3194-bb3b if the nerve continues to give pain relief after the pressure on the nerve, the pain continues, the pain is removed 58_bad5c This is called neuropathic pain. Pain and numbness may continue for 1-3 months after surgery. Patients should not worry about this. Medicines to reduce this pain will be given by your doctor.

  • How do I know if my lumbar hernia has recurred?

      _cc781905-5cde-3194-bb3b- _cc781905c drops dramatically. If; If the pain reoccurs as severely as before the surgery, your lumbar hernia may have recurred. In such a  case, it would be beneficial to re-examine your doctor.

  • Paralysis developed before her hernia surgery, what will happen now?

      _cc781905-5cde-3194-bb3b-1394-d Exercises recommended by your doctor and physical therapy must be done. The recovery process of the paralysis may be immediate in some patients, while it may take a period of 6 months in some patients. Therefore, it is recommended that patients who develop paralysis should not delay the operation too long.

Rules to be Followed by Those Who Have Back Hernia Surgery

  • Pain may be felt in the wound area after hernia surgery, but the general severe leg pain and low back pain are less than before the surgery.

  • Sitting for a long time is inconvenient at first. Weight should not be lifted, excessive bending forward and movements that will stretch the spine should be avoided in the first 1 month after surgery 

  • The wound area on the waist should be kept clean and dry. If you have redness, swelling, warmth and discharge in the wound area, call your doctor.

  • After 3 days, you can take a warm shower with waterproof dressing materials such as Tegaderm.

  • Use your painkillers according to the prescription given by your doctor.

  • At first, short walks can be made indoors. 

  • There is no harm in going up and down the stairs.

  • Use a European toilet for the toilet.

  • It would be appropriate to start sexual activity 2 weeks after the operation. Still, it's good to be careful. Back movements can increase your pain. It's okay to have a passive relationship.

  • Driving is allowed 2 months after back surgery. In particular, place a support behind your lower back while driving and traveling.

  • Cycling or swimming may be allowed after a few weeks. 

  • Usually desk workers can start light work after 2 weeks. Those who work in heavier jobs and those who have occupations that require heavy physical load can start work after 4-6 weeks.

  • If you are overweight according to your body mass index, try to lose weight by dieting.

Contact for detailed information and appointment requests Click the page .

full endoscopic lumbar discectomy
lumbar discectomy