At CPH Privathospital we can now remove your disc herniation using a new minimally invasive keyhole operation also called >> endoscopic lumbar disc herniation operation<<. Previously, muscle was detached and bone and ligament were removed to gain access to the herniation. Today we can perform a much smaller procedure, where the herniation is now removed by keyhole operation.

What is a disc herniation?

Do you have radiating pain in your lower back or pain in both legs? Then you may have a disc herniation in your lower back. A disc herniation occurs when the outer layers of a cartilage disc can no longer contain the soft nucleus that lies between the vertebrae. This causes the soft gel mass to bulge through the fibrous ring.

Your spine runs from the head to the pelvis and has a total of 24 vertebrae made of bone. Between these vertebrae are cartilage discs that function as shock-absorbing cushions between the vertebrae. In addition, they have a protective fibrous ring that encloses the elastic content. 

If the bulge is positioned unfavourably, it can press on and irritate the nerves that pass by your disc. And this can cause unpleasant pain. The herniation will often occur in the lower back, but you can also experience pain in the neck and – in rarer cases – thoracic vertebrae. You can often see the disc herniation by the elastic content bulging out in the back. 

Why do you get a disc herniation?

All people can get a disc herniation, but it is particularly people aged 30-50 who are affected. This is due to, among other things, wear and ageing. In addition, congenital disorders, physically demanding work or sudden overload – for example an accident – can also be the cause of a disc herniation.

In all cases, the fibrous ring in the disc becomes weakened, so the soft part can bulge towards the spinal canal. Over time, the fibrous ring becomes stiffer, and symptoms develop gradually. 

Do you experience anxiety or discomfort with your possible symptoms? At CPH Privathospital you are welcome to contact our experienced specialists. If our consultant (specialist doctor) suspects that you have a disc herniation, it can be confirmed by means of an MRI scan. During the preliminary examination, we will also ask you a number of questions and perform a clinical examination of you, so that together we can review the development of your symptoms.

Signs and symptoms of disc herniation in the lower back

Disc herniations come in several variants and can occur throughout the back. However, you will primarily experience a disc herniation in the lower back, which is usually completely harmless and painless. But there are also situations where it is far more serious. If you therefore experience symptoms of a disc herniation, you should contact your doctor immediately and have the cause of your back pain examined. 

Sometimes the herniation can irritate one of the nerves that run from the back to the legs. In that case, you experience pain that radiates from the lower back and further down into the buttock and leg. This causes severe discomfort in the legs because the nerve functions become weakened. In addition, you may experience reduced strength in the leg, numbness and lack of reflexes. Many describe this as “sciatica”, as nerve roots can be affected by a disc herniation in the lower back.

Another sign of disc herniation is if it occurs in the upper part of the spine. Here you may experience pain that radiates into the arm or in a band around the chest. The radiating pain is usually described as burning, tingling and stabbing sensations. 

Symptoms of disc herniation in the lower back

• Radiating pain to the leg, foot and / or toes.
• Sensory disturbances in the leg, foot and/ or toes
• Reduced strength of the leg muscles

The development of symptoms is often slow, where discomfort from the back and legs gets worse, but they can also occur suddenly. If you therefore experience one or more of the above pains, or if they do not disappear after a few weeks, you should contact your doctor immediately. The doctor will then assess whether you need an operation or perform an MRI scan to establish a diagnosis.

The preliminary examination

Before it is decided whether you should have an operation, you will come for a preliminary examination with our consultant (specialist doctor) in spine surgery. The doctor listens to your medical history and performs a clinical examination. It is necessary that you have an MRI scan performed before we can make a final diagnosis. When the scan has been performed, you discuss what treatment options are available, including operation and which type.

Preparation

The operation is performed under general anaesthesia, which means you must arrive fasting, so that your stomach is completely empty. This is important because the anaesthesia causes your muscles to relax, creating a risk that food in the stomach may flow back through the oesophagus and into the lungs.

Special rules may apply to you, for example if you are diabetic, a smoker, overweight, pregnant, receiving chronic pain treatment or have frequent acid reflux. The anaesthetist will review the rules with you before the operation.

The operation

With keyhole surgery, only the prolapse itself and any loose fragments from the disc nucleus are removed. The advantage is that with the endoscope one enters from the side and passes by the nerve and directly into the disc to remove the prolapse, rather than having to go through muscles, bones and the spinal canal.

The endoscopic surgical method is performed with a special endoscope under general anaesthesia, where through a very small incision in the skin (approx. 0.5 cm) the disc prolapse can be removed through the endoscope. The advantage of this method is that it is very gentle because only a very small channel is made through muscle and tendons. Less scar tissue is formed, which means less pain, and in this way the patient will retain their normal function and become pain-free more quickly and return to a normal state.

With surgery for disc prolapse, the symptoms in the leg/legs are relieved and approximately 90% of patients experience an improvement. However, there are also risks associated with the procedure, including bleeding, infection, damage to nerves and membranes, etc. The surgeon will review this with you in connection with planning the operation.

After the operation

Many patients can go home the same day they have been operated on. A few stay overnight until the next day.

It is important that you get out of bed immediately after the operation, but make sure to have a relative or nurse by your side, as you may be dizzy. Get up and stand several times during the day after you have been operated on.

When you are to go home from the hospital, it is important that you arrange for someone who can drive you home, as you must not get behind the wheel yourself. You must not drive a car yourself until you can react normally in any situation, and it is important that you have stopped taking strong pain-relieving medication.

You will be given pain-relieving tablets or a prescription for use in the first days after the operation. If there is a need to extend the medication, please contact your general practitioner.