A disk begins to herniate when its jelly-like nucleus pushes against its outer ring due to wear and tear or a sudden injury. This pressure against the outer ring may cause lower back pain.
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If the pressure continues, the jelly-like nucleus may push all the way through disk's outer ring or cause the ring to bulge. This puts pressure on the spinal cord and nearby nerve roots. Not only is this a mechanical compression (squeezing) of the nerves, but the disk material also releases chemical irritants that contribute to nerve inflammation. When a nerve root is irritated, there may be pain, numbness, and weakness in one or both of your legs, a condition called sciatica.
In a herniated disk, the soft, jelly-like center of the disk can push all the way through the outer ring. (Side and cross-section views shown.)
Lumbar diskectomy, a surgical procedure to treat herniated disks in the lower back, is not required for most patients. Surgeons usually recommend spine surgery only when nonsurgical treatments have failed to relieve painful symptoms or for patients experiencing specific issues, such as:
- Persistent (constant) muscle weakness that affects daily functioning
- Difficulty walking due to pain, weakness, or impaired mobility
- Loss of bladder or bowel control, which can be a sign of severe nerve compression (the nerve is being squeezed or compacted) and requires immediate attention
The decision to proceed with lumbar diskectomy is carefully considered based on the severity of the symptoms and the individual patient's overall health and lifestyle.
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Surgery to remove the herniated disk was historically done through a large open incision. Microdiskectomy is a newer surgical procedure commonly used to treat a herniated disk in the spine. It is a minimally invasive technique, performed using a microscope, that aims to relieve pressure on the spinal nerve and ease symptoms.
Another newer surgical option for treating a single herniated disk is endoscopic diskectomy. This minimally invasive procedure involves the use of an endoscope, a thin tube with a camera, which allows the surgeon to visualize and access the affected area. This approach is similar to the arthroscopic approach commonly used in knee, hip, and shoulder surgery.
Endoscopic minimally invasive spine surgery.
Potential benefits of endoscopic diskectomy include:
- Smaller incisions
- Reduced scarring
- A shorter recovery time
In cases where there are disk herniations at multiple levels of the spine, an open procedure with a larger incision may be necessary.
For more information, please visit spinal rigid endoscope.
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