Intervention for lumbar disc herniation
The spine (or spine) consists of stacked vertebrae, separated by risks. In the middle of the spine passes the spinal canal, containing the spinal cord, which terminates at the height of the second lumbar vertebra (L2). Beyond, the canal contains only a set of nerve fibers, called « ponytail ». These nerve fibers leave the spinal canal in the form of « roots » through openings (foramen or mating holes) located laterally at the height of the intervertebral discs.
A normal intervertebral disc is a flattened structure uniting the 2 vertebrae and acting as a shock absorber. It consists of a gelatinous central nucleus (nucleus) and a
fibrous annulus (annulus).
The disc degeneration often begins, after a phase of symptomatic dehydration, by cracks, tears of the fibrous ring.
The nucleus can then, along these cracks, migrate in the thickness of the ring and cause lumbar pain, acute or chronic.
If it moves even further through the ring, the nucleus can project to the posterior surface of the disc, forming a HERNIE DISCALE. This hernia can, through a
complete rupture of the annulus, migrate into the vertebral canal laterally, or upwards, or downwards, and even exclude itself while leaving the disc
This disc herniation can compress, « jam », one or more nerve roots near the disc. It is the cause of the symptoms: « sciatica » when the pain sits
behind the thigh, or « cruralgia » when the pain sits in front of the thigh. It has variable pain in the lower limb, tingling sensation or tingling (paraesthesia), sensations of disturbance of sensitivity (dysesthesia), up to anesthesia, motor disorders (loss of muscle strength) or partial or complete paralysis of part of the lower limb).
Evolution & conservative treatments:
Most (80 to 90%) sciatic herniated disc heals with medical treatment including relative rest, anti-inflammatory (possibly corticosteroids), muscle relaxants, and analgesics. This medical treatment may take 6 to 8 weeks to be effective. Lumbar infiltrations of corticosteroids may be proposed in a second step if the initial medical treatment does not lead to sufficient relief.
Surgical intervention is desirable for sciatica by herniated disc only:
– if the medical treatment, implemented appropriately (anti-inflammatory, analgesic,
muscle relaxants, possibly infiltration, corset), and for the necessary time (4 to 8 weeks)
is insufficient to relieve pain.
– if there is a situation of urgency: motor deficit (paralyzing sciatica), intolerable pain
not relieved by morphine (hyperalgic sciatica), syndrome of the « ponytail
» resulting in perineal disorders, sphincteric, especially urinary . A disc herniation
discovered on CT or MRI, and giving no symptoms, should not lead to an
intervention. The main element leading to propose an intervention, apart
from the emergency situations described above, is the patient’s intolerance to pain.
Expected goals & benefits
The purpose of the intervention is to release (« loosen ») the compressed nerve root, and to remove
sciatic pain; this goal is achieved in about 85% of cases.
It is never possible to ensure that the sensory or motor disorders will completely disappear
: the nerve root may have been compressed too much or too long and have been damaged.
The intervention does not « reset the disc »; lesions of disc degeneration will persist,
and a more or less important part of the lumbar pain will persist after the intervention.
No intervention puts the body back to « new ». No results are ever
100% guaranteed .
What intervention (s)?
It aims to release the nerve root of compression and is usually performed under
general anesthesia. The surgeon accesses the disc by a short incision (3 to 4 cm),
laterally separating the root (s); it removes the herniated disc, empties the center of the disc, to prevent
a free fragment is mobilized and causes a recurrence of compression. The disc is
never completely removed. The release of the root sometimes requires a complementary release gesture
(« nibbling ») if bone elements contribute to the compression of the root. It is
sometimes necessary, when the situation of the hernia imposes it, to remove a part of the vertebra
(foraminotomy, arthrectomy, laminectomy) to properly release the compressed root (s).
A transfusion is usually not necessary.
Surgical procedures always leave cicatricial, superficial and deep scars.
The consequences of the intervention
The consequences of the procedure are not painful, well controlled by the analgesic treatment.
Sciatic pain disappears either after waking or after a few days; paralysis requires
at least several days to recover; Sensitivity disorders often require several
weeks to regress. A complete recovery of sensory or motor disorders is
never certain. The rising is possible from the evening or the day after the intervention. If a drain has
been placed, it will be removed the next day or two days after the intervention. The return home is
possible after 1 to 4 days. Walking is recommended.
Avoid the car for 3 weeks. The work stoppage is – according to the professions – from 4 weeks
to 3 months, sometimes more.
Any intervention involves risks, the surgeon will inform you during the consultation.