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Lumbar Disc Prolapse Treatment

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A doctor analyzes the digital x-ray of a patient for lumbar disc prolapse treatment.

Minimally invasive (Tube Assisted) Lumbar Discectomy: An Overview

Conventional (open) spine surgery involves dissecting the spinal muscles from their attachments and retracting them in order to reach the spine. This causes injury (Denervation/ Ischemic) and affects post-op muscle function.

Minimally Invasive Spine Surgery (MISS) or Lumbar Discectomy is a type of technique wherein the entire spine surgery is done through small tubular retractors without disrupting the muscular attachments of the spine.

This procedure involves the removal of the herniated or prolapsed disc that is pressing on the nerve root, thereby providing relief from pain and discomfort. This surgery can be done as an open (conventional) technique or a minimally invasive (Key-hole; Muscle sparing) technique.

There are different types of minimally invasive techniques. When the discectomy is done using a Tube (Tubular retractor), it is referred to as ‘Tube Assisted Minimally Invasive Lumbar Discectomy.’ Irrespective of the Minimally Invasive nature of the surgery, consulting with a spine specialist can ensure that the primary goal (Nerve root decompression and disc fragment removal) is not compromised.

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When You Will Need a Minimally Invasive (Tube-Assisted) Lumbar Discectomy

Doctors at Spine 360 may recommend this surgery if you have:
Lumbar Disc prolapse (Disc Herniation/ Slip Disc), which does not respond to conservative therapy or symptoms in early courses that necessitate surgical intervention.
Weakness of leg or foot drop, progressive numbness
Bowel and bladder disturbance – Emergency surgery recommended
Severe debilitating pain preventing daily activity or walking
Recurrent episodes of pain after partial improvement
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Surgical Options at Spine 360

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Selective Nerve Root Block (SNRB)
A Selective Nerve Root Block, or SNRB, serves a dual purpose as a diagnostic and therapeutic procedure. It involves the precise administration of medication, usually an anaesthetic or a combination of anaesthetic and steroids, in proximity to an inflamed spinal nerve. The injection is directed at the intervertebral foramen, the bony opening between adjacent vertebrae, reducing inflammation and numbing pain signals transferred by the nerve.
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Transforaminal Epidural
The Transforaminal Epidural Block plays a crucial role in alleviating the inflammatory component of Lower Back Radicular Syndrome (LRS). This targeted therapeutic approach, guided by imaging, allows for precise medication delivery. This narrative review explores the multifaceted aspects of lumbar transforaminal epidural injections of steroids, shedding light on its therapeutic potential.
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Racz Procedure (Epidural Neurolysis)
The Racz Catheter Procedure, also known as Epidural Neurolysis, is employed to liberate entrapped nerves from scar tissue within the epidural space of the spine. This procedure facilitates the effective delivery of medications, such as cortisone, to the affected areas, thereby reducing pain stemming from scarring.
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Sacroiliac Joint Block
Pain originating from the sacroiliac (SI) joints can lead to discomfort in the lower back, buttocks, and leg. Typically, one SI joint is the source of pain, causing symptoms on one side of the lower body. Although it is less common for both SI joints to be painful simultaneously, this joint can be targeted with injections for both diagnostic and therapeutic purposes.
Pre-Surgical Care For Tube-Assisted Lumbar Discectomy
What to Expect During a Minimally-Invasive Lumbar Discectomy
Guidelines for Post-Surgical Care

Kindly follow the instructions given below to ensure your safety and optimum outcome of your surgery:

  • Consult your doctor to check your overall health and fitness for surgery.
  • Inform your doctor of the medications you are taking and ask if you should stop taking any of these medicines before surgery (such as blood thinners, etc).
  • Your doctor will review your condition with you and explain what all of your possible choices are, including medications, physical therapy, and other surgeries such as removal of the diseased disc, fusion, etc.
  • Do not eat or drink anything after dinner the night before the surgery (after 10 pm)
  • The surgery is performed under General anaesthesia (rarely regional anaesthesia) in a prone position (Face down position).
  • A small vertical incision (1.5-2 cms) is placed in the lower back, and a trans muscular tract is created by sequential dilatation with increasing size of dilators to finally use a 16 or 18-mm diameter tubular retractor.
  • The position and accuracy level are confirmed at this stage using a C-arm (Fluoroscopy/X-ray) image).
  • Using an operating microscope, a small portion of the overhanging bone and ligament is removed to reach the herniated portion of the disc.
  • The herniated portion of the disc is gently separated from the nerve root and removed, thus decompressing and relieving the nerve root of its compression. The healthy part of the disc is left intact.
  • After this, the tube is removed, and the skin wound is closed appropriately with absorbable sutures.
  • Patients' recovery rates vary, so post-operative stay may differ. Typically, individuals are discharged the following day.
  • A waterproof dressing will be applied on the wound, which is to be changed every alternate day (Will be taught before discharge)
  • Regular follow-up will be required - at 1 week, 6 weeks, and 6 months following surgery.
  • Prepare your home for life after surgery – place important things such as medication and personal hygiene items within easy reach.
  • Remove safety hazards, such as clutter on the floor that may cause you to trip or lose your balance.
  • Arrange someone to help you at home and around the house after surgery.

Deeper Insights About Lumbar Disc Prolapse Treatment

MISS has several benefits apart from the smaller/ cosmetic incisions. Due to fewer muscle injuries, there is reduced blood loss, faster recovery rates, and less post-operative pain. Also, the post-operative muscle function is better after MISS. Patients who undergo MISS require lesser analgesics than Conventional (open surgery).

In both procedures, the prolapsed portion of the disc is removed, and the nerve root decompresses adequately. The difference lies in the approach. While MIS uses a small incision and preserves muscular attachments, open surgery uses a relatively larger incision and disrupts muscle attachments. MIS reduces the collateral damage caused to the muscles and ligaments and aids in faster recovery and return to work/ normal activity. In addition, the risk of infection is lower in MIS than in open surgery. MIS results in cosmetically better scars than open surgery.

Similar to other surgical procedures, the Lumbar Discectomy carries the risk of infections, bleeding, blood clots, allergic reaction to the anaesthesia, and injury to the nerves. Depending on your recovery, it may provide short-term relief from your disc prolapse issue. However, at Spine 360, we ensure you are exposed to minimum risks during and after the procedure.

Yes. Our doctors will recommend post-surgical physiotherapy to strengthen your back muscles and prevent other injuries in the future.
Of course. Although the possibility of a recurring herniated disc is significant, you can prevent it by following your doctor’s advice and being cautious while walking, lifting, and exercising.
Generally, you may require a few weeks to recover from a Lumbar Discectomy. However, this recovery duration differs from patient to patient.
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