Orthopedic Surgery in Tunisia
Lumbar Disk Herniation

Sometimes called a slipped or ruptured disk, a herniated disk most often occurs in your lower back. It is one of the most common causes of low back pain, as well as leg pain (sciatica).

Between 60 and 80 percent of people will experience low back pain at some point in their lives. A high percentage of people will have low back pain caused by a herniated disk. Although a herniated disk can sometimes be very painful, most people feel much better with just a few months of nonsurgical treatment.

 

Causes

In many cases, a herniated disk is related to the natural aging of your spine. In children and young adults, disks have a high water content. As we get older, our disks begin to dry out and weaken. The disks begin to shrink and the spaces between the vertebrae get narrower. This normal aging process is called disk degeneration.

In addition to the gradual wear and tear that comes with aging, other factors can increase the likelihood of a herniated disk. Knowing what puts you at risk for a herniated disk can help you prevent further problems.

  • Gender. Men between the ages of 30 and 50 are most likely to have a herniated disk.
  • Improper lifting. Using your back muscles to lift heavy objects, instead of your legs, can cause a herniated disk. Twisting while you lift can also make your back vulnerable. Lifting with your legs, not your back, can protect your spine.
  • Weight. Being overweight puts added stress on the disks in your lower back.
  • Repetitive activities that strain your spine. Many jobs are physically demanding. Some require constant lifting, pulling, bending, or twisting. Using safe lifting and movement techniques can help protect your back.
  • Frequent driving. Staying seated for long periods, plus the vibration from the car engine, can put pressure on your spine and disks.
  • Sedentary lifestyle. Regular exercise is important in preventing many medical conditions, including a herniated disk.
  • Smoking. It is believed that smoking lessens oxygen supply to the disk and causes more rapid degeneration.

Treatment

In the majority of cases, a herniated lumbar disk will slowly improve within 6 to 8 weeks. By 3 to 4 months, most patients are free of symptoms.

Nonsurgical Treatment

Unless there are neurological deficits — muscle weakness, difficulty walking — or cauda equina syndrome, conservative care is the first course of treatment. It is not clear, however, that nonsurgical care is any better than letting the condition resolve on its own.

Common nonsurgical measures include:

  • Rest: Usually 1-2 days of bed rest will calm severe back pain. Do not stay off your feet for longer, though. Take rest breaks throughout the day, but avoid sitting for long periods of time. Make all your movements slow and controlled. Change your daily activities so that you avoid movements that can cause further pain, especially bending forward and lifting.
  • Anti-inflammatory medications: Medicines like ibuprofen or naproxen may relieve pain.
  • Physical therapy: Specific exercises can strengthen your lower back and abdominal muscles.
  • Epidural steroid injection: In this procedure, steroids are injected into your back to reduce local inflammation. Of the above measures, only epidural injections have been proven effective at reducing symptoms. There is good evidence that epidural injections can be successful in 42-56% of patients who have not been helped by 6 weeks or more of other nonsurgical care. Overall, the most effective nonsurgical care for lumbar herniated disk includes observation and an epidural steroid injection for short-term pain relief.

Surgical Treatment

A small percentage of patients with lumbar disk herniations require surgery. This includes the urgent surgeries for people with neurological deficits or cauda equina syndrome.

Surgery for lumbar herniated disk is controversial. Research shows that patients 2 years post-surgery have the same results as patients treated nonsurgically. Patients with significant sciatica who have surgery, however, have better and more rapid pain relief. Surgery resolves symptoms faster for those with motor weakness or numbness, as well.

  • Procedure. The most common surgical procedure for a herniated disk in the lower back is a lumbar microdiskectomy. Microdisketomy involves removing the herniated part of the disk and any fragments that are putting pressure on the spinal nerve.
  • Rehabilitation. Most patients do not require formal physical therapy after surgery. A simple walking program 30 minutes each day, along with flexibility exercises for the back and legs, can be done as a home program.

The surgery for lumbar herniated

Orthopedic surgery in Tunisia - lumbar disc
Before the surgery for lumbar herniated
Orthopedic surgery in Tunisia - lumbar disc
After the surgery for lumbar herniated

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