Features surgery for endoscopic removal of hernias of the spine
Endoscopy is a method of visualization and operative technique, which is based on the introduction into the human organism with therapeutic or diagnostic purpose special optical devices, mechanical and electronic instrumentation.
The History of endoscopy dates back to 1806, when a German scientist and doctor Philip Bozzini for the first time presented the public with a primitive prototype of the endoscopic tube. Naturally, over the years this multi-faceted prototype and repeatedly improved according to the development of scientific and technological progress and modern trends in medicine. The crown of his development is a complex instrument with a wide range of opportunities and technological solutions used in modern hospitals for endoscopic removal of the herniated disc.
Endoscopic surgery – what it is
At the moment the essence of endoscopic surgery in accordance with the principles of minimizing the volume and the morbidity of surgical intervention, to perform the operation with utmost care to the patient while maintaining the necessary efficacy and scope of this manipulation.
The advantages of endoscopy include:
- minimum (1.5 cm) surgical access;
- significant reduction of trauma to surrounding tissues;
- reduction of intraoperative blood loss and duration of surgery;
- improving the quality of operations (reducing the risks and rate of complications);
- a decrease in the intensity of postoperative pain;
- increased the pace of rehabilitation after surgery.
so, for the treatment of herniated disc uses advanced minimally invasive technique of endoscopy. The operation is performed by different methods, but one of the most common is the transforaminal sequestrectomy.
Clarify the terminology: the removal of herniated spine is made through the hole through which the cord are nerve roots. Under the control of electronic-optical Converter (TUBE) is inserted a needle out of the channel, then it was a guide, enter the tube of the endoscope through which the removed portion of the disc, decompression and sequestration, compressing the nerve root and causing pain. In the future the intervertebral disc is adequately performs its shock-absorbing function and at the expense of the elimination of sequestration disappears radicular neurological syndrome, manifested a sharp radiating pain.
Indications and contraindications to the technique
surgical technique Transforaminal endoscopic removal of herniated discs is indicated for:
- sequestered foraminal or posterior-lateral hernia;
- root (radicular) neurologic syndrome in the form of severe radiating pain;
- applicable long-term ineffectiveness of conservative treatment.
However, we should not forget about the contraindications when applying this operation is not possible:
- obstruction (stenosis) of the spinal canal;
- median (midline) hernia of intervertebral disk;
- the presence of local or generalized infectious process;
- the presence of cancer (tumors).
the Procedure for treatment and rehabilitation
The Patient visits the clinic, outpatient examined, their overall analyses, magnetic resonance imaging, consultation with an anesthesiologist. After the operation, in the absence of any complications, in satisfactory condition, the patient is discharged to outpatient treatment in 2-3 days.
Among medical appointments – reception antiedematous, antibacterial drugs for 5 days, nonsteroidal anti-inflammatory tablet for 10 days. In the major recommendations on early postoperative recovery period include:
- 1 month to exclude physiotherapy, in addition to magneto - and laser therapy;
- 1 month of wearing semi-rigid corset the prohibition of shibuyabashi body to the extreme amplitudes;
- 1 month not do any physical exertion (hard work, a swimming pool, sports, etc.);
- is not limited to normal physical activity – walking, daily routine, sedentary job, a short drive away.
It is noted that failure to adhere to these recommendations on the rehabilitation period significantly reduces the effectiveness of minimally invasive interventions, and sometimes exacerbate the previous symptomatology.
Though relieved, the patient feels almost immediately for a full evaluation of the effect of treatment waiting period of two months after the operation. By this time at the level of the problematic segment is normalized intradiscalthe pressure and end the processes of recovery of the fibrous ring.
Among the complications, which may result from endoscopic surgery to remove herniated discs, possible are:
- recurrence in the late postoperative period (re-occurrence of the same pathology in the same location);
- hematoma at the site of intervention (does not require additional treatment, but fraught with pain for several weeks)
- infection (rare)
- trauma to the nerves or Dura mater (belonged rather to the error of the surgeon, than to the complication);
- scar-adhesions epidurit (development of proliferative zone of aseptic inflammation and the replacement of soft connective tissue hard fibrous with parallel changes in the properties of collagen, forming a fibrous scar, resulting in increased density and decreased elasticity);
- instability of the operated segments in the area (due to a partial, albeit minimal, resection of the disc);
- degenerative stenosis of the spinal canal (provoked by intra-operative trauma);
Several of the most prominent is the so-called "syndrome of the operated spine" – periodic or long-term pain in the lower back or extremities, after successful anatomical perspective for surgical interventions on the spine. Among his reasons:
- internal destruction of the disk;
- synovial cyst
- spondylolisthesis (disease manifested in displacement of one vertebra forward or backward in relation to others);
- pseudomeningocele (separation of the spine from the spinal cord with isolated effusion and accumulation in this place of cerebrospinal fluid);
- intermittent claudication (paresthesia in the legs, intermittent walking and driving to stay)
- pseudoarthrosis (sometimes you can find the name "neurotron" – false joint formed in abnormal location);
- radiculopathy (the second name – sciatica, indicating a fairly General term for a set of symptoms characteristic of the inflamed or clamped root of the spinal cord);
- facet syndrome (pain associated with osteoarthritis of the joint, radiating along the nerves emerging from the problematic zones of the intervertebral joint;
- arachnoiditis (serous inflammation of the arachnoid membrane of the spinal cord).
However, despite this impressive list of possible complications, mankind is unable to abandon operative minimally invasive arthroscopic intervention with a herniated disc for two reasons. As the rate of the above complications is small and in most cases they can be fought effectively; for many patients this surgery is the only alternative to get rid of continuously accompanying a life of pain.