This article has been authored by Dr. Saurabh Rawall, who is a spine surgeon at Jaypee Hospital Noida. He has done his MBBS from AIIMS, New Delhi followed by MS Orthopaedics from AIIMS, New Delhi, India. To know more about Dr. Saurabh Rawal or book an appointment, please call 0120 – 412 2222
Increasing number of people are found to be suffering from slip disc or herniated disc. This can be caused due to aging, accidental trauma or injury, or lifting weights and excessive strain.
What is Disc Herniation?
This is a spinal disorder where the cushioning rubbery disc between spinal bones is damaged. This disc is the shock protector for the bones as it absorbs shocks and jerks the bones face in our routine activities like bending, walking, lifting and twisting.
The cushioning disc has two parts: the inner gelatinous soft core and the tough outer ring. Herniated or slipped disc arises when this gelatinous soft core protrudes through the outer ring. This happens when the outer ring is either injured or weak.
- The symptoms depend whether the location of disc herniation is in the low back, mid back or neck. Slip disc causes a debilitating pain and discomfort in movement because it tends to compress the spinal nerve in the affected area along with numbness or weakness of surrounding organs, arms or legs. Referred pain is also experienced along the course of that nerve.
- When the damage is in the neck a person may experience pain around the neck area and numbness, tingling, weakness, or pain in the shoulder, neck, arm, or hand. These symptoms would seem to intensify with increased motion of neck.
- If the lower back disc is affected, a person may experience pain originating from buttocks and moving down the back of each leg to the knee or below. Numbness, tingling or weakness in the buttocks, anus or genitals, back, legs, or feet or all of these organs can be felt. These symptoms are similar to Sciatica.
- The patient will also feel a sharp pain that might rise with movement, straining or coughing. There would be a certain difficulty in controlling bowel movements or bladder function
If you are experiencing any of these symptoms, it is an indication to see a specialist immediately.
The spine specialist will perform a thorough physical examination followed by neurological examination. This includes complete check-up of spine, never function testing, abdominal examination and screening.
The doctor may try to understand the history and ask for information on prior spine problems, lifestyle, any past injuries, duration of pain and existing symptoms.
Specialised imaging study is done after a few weeks of initial treatment and if it fails to give the desired relief. This includes magnetic resonance imaging (MRI) or myelogram. A contrast dye is injected in the spinal column and then traced to diagnose a deformed disk and the intensity of damages to specific nerves.
Sufficient rest or limited activity and anti-inflammatory medications form the first level treatment. Doctor will ask to restrict activities like lifting, bending, and straining for a short period.
Another therapeutic remedy would be to treat the injured area with ice packs initially and later switch to hot packs.
After the first few weeks, if the body responds positively to the treatment, the doctor may recommend physical therapy, exercise and massage. If these measures do not work, surgical repair can be considered.
About Keyhole Surgery
This is a breakthrough in minimal invasive surgery. The term ‘keyhole’ itself explains the size of the incision cut in the back. Keyhole surgery is performed through a cut just as big as a needle puncture or less than 1inch. In an open surgery, the surgeon makes an incision of at least 5 to 6 inches. Keyhole surgery is performed with an endoscope, a very high definition camera and exclusively designed surgical micro-tools and monitors for indirect viewing. The fragments of the prolapsed disc are slowly removed without any harm to the surrounding tissue. The patient is awake through the procedure and only local anaesthesia is administered.
The success rate of this procedure is around 96% and there are many advantages for the patients.
- Since it is not an open surgery, there is a lower risk of scarring, blood loss, blood clots being formed or infection.
- Keyhole surgery eliminates the danger of spinal fluid leaking and causes minimal injury to the spinal nerves.
- The muscle tissues around the affected area are carefully pushed aside. As the muscles in the back are not disrupted, recovery is quicker and less painful. In most cases the patient is able to move freely on the same day of the surgery. Discharge time for this could be 1-2 days maximum for a normal case.
- Moreover since the patient is awake, he or she is able to communicate in case of any discomfort or pain.
As the person comes out of local anaesthesia, there might be minimal pain and some discomfort, maybe for a couple of hours only. Keyhole surgery is a technological boon to the field of medical sciences. When conducted with precision, this surgery gives accurate outcomes and renders much shorter hospital time for the patient.
Cost of Surgery
The cost depends on the category of hospital, the location and the extent of pre-surgery procedures. Approximate cost of Keyhole surgery for herniated disc in India amounts between Rs 1,00,000 to Rs 3,50,000.
Taking the decision to undergo a spine surgery is very crucial and should be made on a well-informed basis. Talk to you doctor and understand about the methodology, recovery period and post-surgery care.