The Different Surgical Treatments for a Herniated Disk

20th March 2020
You've surely heard more than once about someone who suffers from a herniated disk. What does it mean and how is this issue treated?

A herniated disk is a very common pathology. It’s something that can affect us all, especially as we become older. There are multiple ways to treat it, but if the less invasive techniques fail, there are also different surgical treatments for herniated disks that can solve the more serious cases.

What is a herniated disk?

In between each one of our vertebrae, there’s something called an intervertebral disk. It consists of a nucleus pulposus on the inside and a fibrous ring that surrounds it.

The role of this disk is to cushion the load that our column supports. On top of that, it also prevents the vertebrae from rubbing against each other; in turn, this allows our back to move fluently.

A herniated disk happens when the nucleus pulposus of the disk breaks the barrier of the fibrous ring. This causes it to move backward and compress the nerve roots that come out from between the vertebrae.

This may occur due to the progressive deterioration of the ring, which ends up giving in with the passage of time. However, it can also happen suddenly, when exerting too much effort with a bad posture. In this case, the ring is unable to withstand said effort and it gives in.

What movements can lead to a herniated disk?

To explain this, we have to take a look at how the nucleus pulposus works and understand the explanation in the previous paragraph. The nucleus pulposus slides in the opposite direction to the movement. This means that if we bend down to pick something up, the front part of the vertebrae gets closer, and the nucleus pulposus moves back to allow this movement.

A woman with back and neck pain due to a herniated disk

Knowing this, and taking into account that a hernia happens when the nucleus moves back quickly or suddenly, it’s easy to see that herniated disks occur mainly due to movements in which we flex our spine. In other words, it happens when we lean forward.

Secondly, for torsion reasons, rotating our column is also detrimental, although to a lesser extent. However, the worst movement is when we do both things at once, as this academic publication shows.

Flexing the column while rotating it combines compression and torsion forces. Both of them require a great effort from our back structure. Thus, we must be extra careful when picking up an object that isn’t directly in front of us, for example.

At this point, it’s important to mention another small detail: muscle strength is a decisive factor in this matter. Having toned paravertebral muscles can help to keep everything in place.

To fulfill this requirement, there are specific exercises that we can do of greater and lower intensity. However, simply walking and not spending too much time sitting down, already contributes a lot in this regard.

The most common surgical treatment

If you’ve had the misfortune of suffering from a herniated disk, it may heal with a few visits to the physical therapist and medication to reduce inflammation and relieve pain. However, depending on the severity of your case, surgery may also be necessary.

In most cases, doctors opt for a diskectomy, in which they remove the affected vertebral disk. There’s also the possibility of removing a ligament in the affected area. Another option is fixing the vertebrae that are above and below the problem disk.

A doctor checking the back of a patient to detect herniated disks

To date, there’s no better-proven technique to treat herniated disks than a simple diskectomy, which may even be a microdiscectomy. In this case, the patient only requires a very small incision, and the surgery is performed with an operating microscope. It has the added advantage of shorter rehabilitation periods.

Recovering after a herniated disk surgery will depend on your daily activities and how well we stick to the treatment and exercises indicated by the professionals. As soon as you’re released from the hospital, the physical therapist will prescribe a set of exercises.

The improvement will be gradual, but you should be able to walk normally and perform basic daily tasks around a month later. As you continue to strengthen your back and abdomen muscles, the discomfort will disappear, and you’ll be able to make greater efforts.

If your day to day requires lifting heavy loads or doing sports that cause great stress on the spine, recovery can take up to a year.

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  • Hernia discal lumbar: historia natural, papel de la exploración, timing de la cirugía, opciones de tratamiento y conflicto de intereses. Pedro DD; López AR; Salazar JM; Alonso VM. Neurocirugía (English Edition), Volume 28, Issue 3, May–June 2017, Pages 124-134.
  • Hernia discal lumbar, una visión terapéutica. Tabares NH; Díaz QJ; Tabares SH; Tabares SL. Revista Cubana de Ortopedia y Traumatología 2016; 30 (1).