In the first three months of onset, we operate on disc prolapses causing severe incontrollable pain (Sciatica) and/or associated with neurological deficit, and of course in cases of huge prolapses with impending features of ‘Cauda Equina’ syndrome.
After the first three months; we operate, in addition to the above, on cases with pain interfering significantly with life style and not settling on conservative treatment.
Conservative management is indicated in absence of neurological deficit and in certain cases associated with co-morbidity. The old fashion treatment of bed rest, wood board, floor bed etc. is non-effective and out of question.
Pain control: usually by using balanced analgesia techniques which means using different pain killers with different mechanism of action including simple pain killers, non-steroidal anti-inflammatory, morphine, etc.
Muscle relaxants: used to alleviate the vicious circle of pain and spasm, and facilitate active physical therapy and rehabilitation, I am a great fan of Valium as muscle relaxant as it make wonders with patient with acute pain.
Physiotherapy and Lumbar disc prolapse: physiotherapy role is to facilitate return to usual activities and mobilize the spine in safe way. It may include manual techniques, dry needling, and traction depending on the case. In the market there is advocate of special traction devices and magnetic devices, we do not support these methods as it is not supported by any objective research and we consider it ineffective without any randomised controlled trial. Osteopath and chiropractor involvement is reasonable but they do not have magic hands when compared to physiotherapist.
Epidural injection: epidural injection is a great, simple and safe method to treat lumbar disc prolapses with 50% chance of success, its mechanism of action is to reduce pain to a tolerable limit and reduce the inflammation around the nerves in the spinal canal. It can be repeated up to three times and can simply cure you.
The cases estimated to require surgery are only 7% of the total cases, in which conservative treatment failed and in presence of neurological deficit. There are many techniques for lumbar discectomy surgery. All techniques share the same philosophy of removing the pressure on the nerves without damaging the spine and the surrounding soft tissue. Patient selection, surgeon preference, and advanced instruments availability are the key of successful outcome.
In this respect, I will explain some of the available techniques and its advantages and disadvantages for public understanding. please click on the links below to read more.
There is nothing called Laser Discectomy in spinal surgery, some surgeons use laser probe and coagulate the disc space after finishing the micro discectomy procedure but this has no scientific proven advantage and it is possibly used or designed for marketing and propaganda purposes.
Complication of Lumbar Micro Discectomy:
The complication risk is 2-3 %, complication are usually minor and reversible including minor weakness, sensory disturbance, haemorrhage, infection, Dural tear and CSF leak. The major complication of paralysis and inability to function including Cauda Equina syndrome are theoretical in our current era and in experienced hands.
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