Low back pain and lumbar disc
Questions and answers with Dr. Masoud Asghari Nosari, neurosurgeon, about low back pain and lumbar disc:
Q: Mr. Doctor, please summarize in what areas you can help patients as a neurosurgeon?
Neurosurgery includes a variety of brain tumor surgeries, endoscopic brain surgeries and related diseases, as well as spinal surgeries. Treatment of various diseases of the lumbar disc, neck, spinal fractures and other such cases is also in our field of knowledge. Depending on the type of university, all partners take different courses. At the center where I studied, I completed all of these courses, including cerebral endoscopy, pediatric neurosurgery, cranial base surgery, cerebral endoscopy, and almost all of the courses that are routinely taught.
Question: Tell us about lumbar disc surgery, its symptoms and treatment methods. What problems do patients usually face when they come to you?
Answer: In general, lumbar disc is one of the most common diseases in the field of neurosurgery. It can be said that a very large percentage of people in the society do not suffer from lumbar disc disease but from diseases related to the spine. Due to the sedentary and sedentary lifestyle we have now, these diseases are also spreading. Sitting at a desk, inactivity, and lack of daily mobility increase spinal problems. The main symptoms of these diseases appear as back pain. In a wide range of diseases, we have these symptoms, and eventually they may manifest themselves as pain that spreads to the legs.
But the important thing is that the back pain of many of these patients is caused by spasms; Is caused by congestion; It is caused by activities that they do during the day and these activities may damage the spine. In other words, the main cause of pain is not the lumbar disc. After the examinations and examinations that are done, we may suspect a lumbar disc, and in that case, we will perform additional examinations.
In general, the main symptoms of lumbar disc herniation are low back pain and pain that spreads to the legs. Back pain, which is one of the most common diseases in society today, but lumbar disc has a completely different category. We should not say that someone who has back pain has a lumbar disc. Lumbar disc herniation has its own symptoms and is usually associated with back pain that spreads pain to the legs. It is also characterized by numbness of the toes, tingling in the feet, diffuse pain, and the like. At first examination, we must suspect that the patient has lumbar disc herniation, and then our diagnostic tests begin with simple photographs and graphs; Finally, we request an MRI to examine the condition of the discs, spinal cord, and spine so that we can diagnose the lumbar disc.
QUESTION: There are a lot of common questions about lumbar disc herniation, and there are some vague points that are very important for public information. Can you explain this?
Answer: Well, the disease that has a lumbar disc and this disc has been diagnosed, according to the type of disc protrusion, is divided into different categories.
If the patient’s lumbar disc is in an acute condition, the patient will need immediate surgery and no delay is allowed; These include debilitating pain for the patient, spinal cord injuries, for example, reduced strength of the patient’s lower limbs, or urinary disorders. These are some of the things that will have irreversible consequences if something happens. We need to categorize the rest to determine the appropriate treatment.
By no means do I want to convey that I recommend for the mother to be inactive. Many of these patients can control their disease by changing their lifestyle, losing weight and exercising, physiotherapy, swimming pool and hydrotherapy and the like.
The important thing is that the protruding lumbar disc can never be put back in place. This is a recurring question that many people ask, and the answer is no, it does not happen to the individual. The patient can live in such a way that the symptoms of the disease do not increase and his spinal cord is not damaged.
One of the most important lifestyle changes is weight loss, especially in women. Due to the fact that women, depending on their lifestyle, are usually less active than men, as a result, the weakness that occurs in the back muscles, causes more for women. If our spine has strong muscles, it will strengthen and reduce the pressure on the spine, which will prevent the disc from protruding. Therefore, going to the pool, regular hydrotherapy, physiotherapy and weight loss will be very effective.
These are just some of the goal setting shareware that you can use. We also prescribe a variety of medications available to patients, including anti-inflammatory drugs, analgesics, and the like. In addition, the recommended procedures and re-visit after a few weeks include the treatment process. During this time we monitor the patient. If the patient’s symptoms have improved or are improving, treatment is effective and we recommend continued treatment. However, if the symptoms of the disease are aggravated and the patient is incapacitated, so that the patient’s working, working and living conditions are affected, he is a candidate for surgery.
Of course, it should be noted that these treatments include simple disks; That is, simple spinal discs in patients who do not have a problem with the structure of the spine, as well as patients with spinal slippage and similar diseases (which includes a wide range of diseases).
In the case of lumbar disc herniation, the surgical procedure currently used worldwide and performed by us is microscopic surgery. In this way, we make a very small incision in the skin exactly where the lumbar disc is. Prior to operation, specify the exact location of the disk with the device.
Also, according to the experimental methods used by surgeons, a small skin incision can be made and, with the help of a microscope, the exact area where the disc is located can be inserted without any damage to the surrounding tissues and without affecting the muscles, to empty the disc. Then the patient’s recovery, ie recovery and hospitalization, takes a maximum of one day, and the patient must walk to the ward and perform his personal and daily activities. If he is good, God willing, he can be released after one day.
There is this concern and many patients also say that in the past the patient slept at home for a long time or was hospitalized and needed care; How about now? Current surgical procedures do not recommend hospitalization for more than one day, although for simple discs. Of course, there are special cares for patients that must be followed and change their lifestyle. If he has been doing things so far that have led to lumbar disc herniation, he should change his lifestyle.
The patient should not bend his back too much; He must use his knees to bend and straighten; Do not lift heavy loads; Do not engage in strenuous activities and harmful and destructive sports that are common among men, such as bodybuilding or prolonged driving. By observing these cases, he can easily return to his normal and normal life within a few days.
Question: Another important question that is asked is whether you use an artificial disc in lumbar disc surgery?
No, not as common as it sounds. In lumbar disc surgery, we cut the protruding part of the disc and lift it to release the nerve fiber. But if we want to use platinum-assisted spine fixation in spine surgery; Because this fixation occurs from the back of the vertebrae, we use several techniques to completely empty the disc, and an artificial disc is used for the upper and lower vertebrae. It is a so-called 360-degree fixation, meaning that both the back and the front of the spine are fixed to each other, at which point we can use an artificial disc to make the spine stronger.
Two of the most common diseases of the spine are neck, cervical disc and cervical spinal canal stenosis. These two diseases can have different symptoms as well as different treatments.
Patients with cervical disc herniation usually present with pain in the neck and arms. Depending on the type of nerve root involved, the pain may extend from the arm and elbow to the fingers, most commonly in the fingers.
This pain may be so debilitating that the person is no longer able to lift any object. However, in the advanced stage of the disease, these symptoms appear. There are also groups of cervical discs that occur in an accident due to trauma, and their conditions are different from common spinal diseases.
Patients who present with cervical disc must first undergo non-surgical courses. It should be noted that no neurosurgeon will initially consider surgery on these patients except in emergencies. That is, if a person presents with debilitating pain, anesthesia, and a sudden decrease in hand strength, then he or she becomes a candidate for emergency surgery.
In other cases, the patient should be treated and supported after performing diagnostic tests and procedures such as plain imaging, MRI, and EMG NCN (nerve and muscle tape). The patient must change his lifestyle, for example, no longer lift heavy loads as before; Do not put pressure on your neck and hands; Do not bend and straighten the neck too much; Take medications such as anti-inflammatory drugs, supportive therapies such as swimming pools and hydrotherapy, and other things that are recommended.
The important thing about the neck disc is that in the neck, unlike the waist, we do not bear much weight; As a result, weight loss in these people is not very effective.
Most of the symptoms of these patients are such that pain spreads to the upper limbs and arms. Subsequently, the person suffers from tingling and numbness of the fingers, and after changing the sensation and cooling of the fingertips, eventually finds a decrease in muscle strength and force, which is seen in the advanced stages of the disease. If a person presents at a stage where there is pain, the response to treatment is much better than at a stage where the strength of the hand is reduced.
Cervical disc surgery is also one of the main questions of the clients. Many questions are asked due to the sensitivity in the neck as well as concerns about this surgical procedure.
This surgical procedure is microscopic and is performed from the anterior front of the neck. The incision in the neck crease is transverse so that its place in the neck is not clear after the operation. In this method, after the incision is made, the whole disc is emptied from the front with the help of a microscope. The spinal canal is then released; The nerve roots of the neck are then released, and since the entire disc is drained, we use a cage or cervical disc between the upper and lower vertebrae to fuse or fix the upper and lower vertebrae together. Depending on the cervical discs, there may be one, two, and sometimes 3 to 4 cervical discs.
The length of hospital stay, like lumbar disc surgery, is one to two days, but patients must follow an important point after surgery. Since one of the vertebrae is fixed to the upper vertebra, do not bend and straighten the neck as before to avoid pressure on the upper and lower discs of the surgical site. Of course, their normal lives are not disrupted and they can resume the normal work they used to do. However, they should be more careful about their health and the way they do their daily activities.
Another condition that is usually ambiguous is cervical spinal stenosis. The symptoms of this disease, unlike the cervical disc, may not be in the hands and neck itself. This means that a person may have a spinal stenosis of the neck but not have a problem with his arms or feel pain in the neck.
The disease can sometimes manifest itself as movement symptoms. Patients may have difficulty walking; They may even empty their knees when walking; Decreased lower limb strength; Their arms may also be weak. As a result, many of these patients, when they have spinal stenosis, say to themselves, “Well, my neck does not hurt!”
It is true that these patients may not be in pain, but other symptoms should be considered. The disease usually occurs at older ages; In people, due to the pressure that enters the spinal cord from the back, the esophagus may also have a neck disc, but the maximum amount of pressure from the back is for the spinal cord. The parts that need to have a flexible tissue to protect the spinal cord tighten, take on a bony shape; In this case, pressure is applied to the spinal cord from behind and, so to speak, the spinal cord is narrowed. This pressure causes symptoms.
The surgical method of these patients is also different from cervical disc surgery. Because the pressure is on the spinal cord, our diagnostic and therapeutic approach also differs.
Since pressure is applied to the spinal cord from the back, surgery must be performed from the same area. An important issue in these patients is their age, which is older than the age of the neck disc. As a result, their length of hospital stay or postoperative care may also vary.
In this method, depending on the type of disease, the background of the person, and perhaps some degree of instability of the cervical spine that exists, before the operation, examinations are performed on the movements of the cervical spine in a bent forward or backward position. These examinations are performed to determine if it is necessary to fix the patient’s neck spine from behind with platinum during this surgery.
If necessary, fixation is performed during the operation, and if necessary, the same routine neck spinal stenosis surgery is performed for the patient. All of these patients must get out of bed in the morning after surgery. We help patients move, walk and start working in the ward. The sooner the patient returns to normal activities, the more effective it will be in improving the underlying disease and its context.