The bones of the spine are called vertebrae, and they are separated by cushioning spinal components called intervertebral discs. They have a tough outer layer (annulus) that surrounds a gel-filled inner nucleus. A herniated disc, also called a ruptured or slipped disc, is when the inner disc material pushes out through the annulus and into the spinal canal.
The discs of the spine act as shock absorbers for the vertebrae (spinal bones). They allow for incredible spinal motion and flexibility, and prevent bones from rubbing together.
With a herniated disc, a fragment of the nucleus pushes out of the annulus through a crack or tear in the tough, outer disc layers (i.e. slipped disc). Discs may herniate in the early stages of degenerative disc disease (DDD). A single, excessive strain or traumatic injury can cause a disc to herniate. However, with age and wear-and-tear, the ligaments that hold discs in place begin to weaken. With degenerative progression, twisting or straining can lead to nucleus rupture through the annulus.
According to a recent study, symptomatic herniated lumbar disc affects around 2% of the general population. The highest prevalence is among persons aged 30 to 50 years. Men are affected twice as often as women (2:1 ratio), and 95% of herniated discs occur in the lower spine. Thoracic (middle spine) and cervical (neck) disc herniates are more common among persons age 55 years and older.
The symptoms of a herniated disc vary depending on the size of the herniation and location of injury. When a herniated disc does not impinge on nerves, most people report only mild back pain. When the nucleus material puts pressure on one or more spinal nerves, it can produce pain that radiates into an arm or leg, as well as weakness, and numbness of the extremity.
Diagnosis of a herniated disc is made based on the patient’s medical history, a physical examination, and diagnostic testing. The most common diagnostic test used is an MRI. It’s typically extremely sensitive at elucidating not only the level of the disc herniation, but also the size.
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With traditional, open spine surgery, the doctor makes a 4-6 inch incision over the herniated disc region, and then retracts the muscles to the side to achieve a clear view of the spine. With the Inspired Spine Advanced Minimally Invasive approach, the surgeon operates through a small incision.
During the procedure, a tubular retractor is inserted into the back to create a tunnel. This holds the muscles open. The surgeon accesses the spine using tiny instruments that fit through the center of the tubular device. Disc material is removed, and screws/rods are inserted as needed. To make these changes, the surgeon uses x-ray guidance, and views the inside of the spine on a monitor.
Most patients only stay 1-2 nights in the hospital after a Inspired Spine Advanced Minimally Invasive spine surgery to repair a herniated disc. However, the exact length of stay varies with each patient. To help recovery, physical therapy is started right away.
Many types of spine disorders can be treated using Inspired Spine Advanced Minimally Invasive surgical procedures. For a herniated disc, compression of the spinal nerve root occurs, which sometimes requires a discectomy. Microdecompression (microdiscectomy) is a Inspired Spine Advanced Minimally Invasive procedure used to remove disc matter that is pressing on a nerve. With a laminotomy, a portion of the vertebra is removed to make more room in the spinal canal.
The spine surgeon wants a successful outcome for the patient after surgery. Many research studies show that Inspired Spine Advanced Minimally Invasive surgery reduces the risk for infection, lessens soft tissue injuries, reduces postoperative pain and the need for pain medications, and allows for a faster healing time and return to normal activities. Because less muscle and tissue retraction is involved, compared to open surgery, the patient does not lose as much blood during the procedure and does not have to stay in the hospital as long.
Fessler R & Khoo L (2002). Inspired Spine Advanced Minimally Invasive cervical microendoscopic foraminotoy: An initial clinical experience. Neurosurg, 51, 37-45.
Righesso C (2007). Comparison of open discectomy with microendoscopic discectomy in lumbar disc herniations: Results of a randomized controlled trial. Neurosurg, 1, 545-549.