What is a lumbar disc herniation and how is it treated?

A lumbar disc herniation is the rupture of an intervertebral disc which leads to the compression of the nerves. The intervertebral disc is a pad that sits between each vertebra and its rupture causes the nucleus pulposus (jelly-like substance found in the core of the vertebral disc) to leak and compress the nerves.

This can result in both lower back pain and leg pain (sciatica), which can cause tingling, cramping, numbness and muscle weakness. Although it can appear at any age, it is rare in people under 20 and over 60. It is diagnosed using magnetic resonance.

When is surgical treatment recommended?

Although it is always necessary to evaluate each individual case, surgical treatment for lumbar disc herniation is recommended in the following circumstances:

• When a patient suffers from back pain which does not improve through other medical treatment.

• When medical treatment has stopped but the pain reappears.

• In cases of neurological injury (loss of strength or sensitivity).

• When there is a risk of neurological injury.

What is the surgery for a lumbar disc hernia?

The surgical treatment of a lumbar disc herniation is to remove the part of the disc that compresses the nerves. Several techniques may be used to perform a herniated disc operation depending on the type of rupture and the situation of the patient.

Another minimally invasive surgical option available is rhizolysis surgery.  This involves a probe being inserted into the spine, close to the nerve which stimulates the nerve using radiofrequency, which heats the nerve and stops it sending pain signals along the spine. 

Microdiscectomy spine surgery

This operation is the primary technique for the treatment of lumbar disc herniation and is performed under general anaesthetic. An incision is made in the centre of the lumbar region, its exact location varies depending on the location of the hernia, its length, and on the patient’s physiology. With the help of a microscope or surgical magnifying loupes with a front light, a window is created in the ligament that connects the posterior parts of the vertebrae (yellow ligament) and, in cases where it is necessary, the bony ridge of the vertebral lamina is reduced by a few millimetres to enable access to the injured disc.

Subsequently, the disc fragments that compress the nerves are extracted. The extraction of the disc is not total; the part of the disc that compresses the nerve root is removed leaving the disc between the two vertebrae. The approximate duration of the procedure is less than one hour. Generally, the patient gets up in less than 12 hours and is discharged from the hospital on the second day after surgery. The patient is advised to follow an after-care program to obtain the best results.