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Introduction
Back pain is one of the most common health problems and is a common reason why people visit a doctor in India. The pain can be short lived or can be a long term source of debilitating pain affecting our normal day to day activities. Disc herniation is a common cause of back pain. These can be diagnosed and effectively treated to give a pain free life
Anatomy
To understand backpain we need to know the anatomy of the spine. The back bone consists of 33 bones called vertebrae stacked on top of each other. In between the vertebra are intrervertebral discs, the other supporting structures being muscles and ligaments. Together, the vertebrae and the discs provide a protective tunnel (the spinal canal) to house the spinal cord and spinal nerves. These nerves run down the center of the vertebrae and exit to various parts of the body. These help to carry signals to and from brain to the other structures
Most herniated discs occur in the lumbar section of the spine .The lower back is called lumbar spine and is made up of five bones called the lumbar vertebrae. The lumbar spine bears most of the weight of the body. The vertebrae are separated by cushiony discs, which act as shock absorbers preventing the vertebrae from rubbing together. Each disc is made up of a tire-like outer band called the annulus fibrosus and a gel-like inner substance called the nucleus pulposus.
What are the causes of the herniated disc?
A herniated disc occurs when the gel-like center of a disc ruptures through a weak area in the tough outer wall, the disc material touches or compresses a spinal nerve causing back pain and leg pain. It can be due to improper lifting or spontaneously, aging also plays an important role
What are the Symptoms? Back pain may be associated with pain that radiates from your low back area, down one or both legs, this is called sciatica. Pain usually gets aggravated on activity such as bending and lifting. Pain maybe accompanied by numbness and tingling in your leg
How is the problem diagnosed? A doctor trained in spine problems usually performs a physical examination and tests include an MRI scan of the spine which helps to identify the problem.
What are the treatment options?
Based on the pathology treatment could be medical or surgical. Medical treatment is where the doctor prescribes medication and advices rest
When to go for Surgery?
Acute neurological deficits such as a dropped foot and Acute bowel and bladder involvement where there is loss of control of one’s bowel and bladder. Severe agonizing pain inspite of effective medical treatment. Remissions & recurrences inspite of effective medical treatment. Hindrance to day to day activity and earning “Livelihood.
What does the Surgery involve?
This procedure called OPEN discectomy involves a large incision on your back, dissecting muscles and removing a part of the bone to reach the spinal nerves which are moved aside to expose the herniated disc and the disc material is removed. Recent advances to open discectomy is a micro endoscopic discectomy
What is Microendoscopic discectomy (M.E.D)?
It is a key hole variant of discectomy where only a 1.5-2cm incision is taken and tunnel for the camera, an endoscope and instruments is made and under vision, the herniated disc is reached and removed. It is a surgical technique which requires proper training and in experienced hands gives the best results to the patient
What are the advantages of M.E.D?
Smaller incision, less damage to native structures, less complications, early mobilization on day 2 of surgery, smaller scar
What to expect post-surgery?
Early mobilization ,physiotherapy, proper posture and lifting techniques, proper diet and stress management all help in early recovery and early return to work
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