Tell us about the surgical treatment of intervertebral disc extrusion / herniation (l5s1)? How was the operation, recovery?

Tell us about the surgical treatment of intervertebral disc extrusion / herniation (l5s1)? How was the operation, recovery?

Endoscopic Spine Surgery for L5 S1 Disc Prolapse -- PIVD

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answers (3)

Answer 1
January, 2021

Read carefully, this is IMPORTANT!

Types of surgery for vertebral hernia

  1. Discectomy.
  2. Microdiscectomy.
  3. Endoscopic discectomy.
  4. Percutaneous discectomy (nucleoplasty).

Open classical discectomy is performed under general anesthesia. The incision of the skin over the affected segment of the vertebral column is at least 7-9 cm. The muscles move widely, the yellow ligament is dissected, which covers the vertebral column from the outside. For better access, laminectomy is performed - removal of a part of the vertebral arch.

In addition to removing the disc, a partial excision of the vertebral spines is performed. In place of the removed disc, an immobile connective tissue connection of the vertebrae develops.

Sometimes, to stabilize the vertebrae, an implant (an artificial titanium or bone, taken from the crest of the patient) is placed on the site of the removed disc. For the same purpose, in case of instability of the spine area, it is possible to connect several vertebrae with metal plates.

Open discectomy lasts about 2 hours, then the patient is forced to lie on his back for 24 hours. Sitting is not allowed for 3 weeks.

Open dyscectomy is a fairly traumatic operation that requires a long period of recovery and rehabilitation. Currently, it is rarely used.

However, in some cases this is the only method of treatment (in cases of hernias of larger sizes, disc sequestration, narrowing of the spinal cord canal and some other complications). It is also believed that open dyscectomy is the most reliable method and gives the least number of relapses. In addition, this method does not require any expensive equipment and can be performed in any neurosurgical department.

Microdiscectomy . This is a less traumatic operation, performed with the help of special microsurgical instruments under ultrasound or X-ray control. The surgical incision in this case is small - 3-4 cm. The muscles are carefully moved away, a small area of ​​the yellow ligament is “bite out” and then a hernia or a part of the disc is immediately removed. the ligaments remain intact, therefore, the biomechanics of the vertebrae is practically not disturbed. This operation is performed most often.

Endoscopic discectomy . All stages and principles of the operation are the same. The difference is that the operation is performed through an even smaller incision (1.5-2 cm) with the help of a special endoscopic device. The surgeon conducts all manipulations under the visual control of the monitor.

Minimally invasive discectomies have many advantages:

  • The operation can be performed under epidural or even local anesthesia.
  • Long-term bed rest and long-term rehabilitation are not required.
  • Terms of inpatient treatment - 3-5 days. In some clinics, the operation is performed on an outpatient basis.
  • Employment is restored in 2 weeks.

Percutaneous discectomy (nucleoplast) is performed with small hernias without rupture of the fibrous ring (in 10-15% of all hernias). It is carried out on an outpatient basis under local anesthesia. A special cannula is introduced into the center of the disc under X-ray examination, through which an electrode with laser radiation or cold plasma is brought to the nucleus. They destroy part of the nucleus pulposus, reducing the size of the hernia and lowering the pressure inside the disc.

Video: lumbar discectomy and fixation of the vertebrae L4-S1

Preparing for surgery to remove the hiatus / strong>

To establish the diagnosis of an intervertebral hernia, determine its current size and localize, the spine MRI method is used.

Immediately before the operation, the patient undergoes

  1. General blood analysis.
  2. General urine analysis
  3. Coagulogram.
  4. Biochemical analysis.
  5. X-ray of the lungs.
  6. Research for markers of infectious diseases.
  7. See a therapist.

An operation was indicated against :

  • Acute infectious diseases.
  • Decompensated chronic diseases.
  • Pregnancy.
  • Disorders of the blood coagulation system.

For 8 hours before the operation, it is forbidden to eat or drink.

Postoperative period

After open dyscectomy, a strict bed rest is prescribed for at least for a day. The drainage is removed after a day. If necessary, anesthetic drugs and antibiotics are prescribed.

For 3 weeks, it is not allowed to sit, bend over, lift weights. It is recommended to walk in a special lumbar bed.

After microsurgical operations, it is possible to get up in a few hours, after a few days the patient returns to normal physical activity. However, lifting weights and bending the spine is still recommended to be limited within 4-6 weeks. At the same time it is recommended to take a break from driving a car. Women are not recommended to become pregnant for half a year after surgery.

Possible complications after surgery:

  1. Bleeding.
  2. Wound and spinal cord infections.
  3. Damage to the spinal cord membranes, with leakage of cerebrospinal fluid.
  4. Damage to the nerve root or spinal cord.
  5. Recurrent herniation of the intervertebral disc.

Unfortunately, according to statistics, the operation is effective only in 80-85% of cases. The reasons for the relapse of pain syndrome after surgery can be very different:

  • Incomplete removal of hernia with microsurgical technique.
  • The occurrence of a hernia in another disc due to increased load on it after removal of the adjacent disc.
  • The cause of the pain was not originally a herniated disc.

DeShould I or should I not do a disc herniation surgery?

If an acute picture of nerve root or spinal cord compression occurs, such a question, as a rule, is not worth it. In this case, the operation should be performed as early as possible in order to avoid irreversible changes.

Doubts may arise in the patient with prolonged pain syndrome. Of course, surgery is a risk and extreme. The overwhelming majority of patients are afraid of surgery and try to delay it as long as possible.

With a herniated disc with persistent pain syndrome, it is necessary to start conservative therapy. In 80% of cases the pain goes away. But the treatment must be carried out under the guidance of an experienced qualified doctor, preferably a vertebral spine, avoiding any "charlatan" methods.

If it took more than 1.5-2 months of treatment, not passed an operation is proposed.

What is important to know when deciding whether to agree or not?

  1. There are no clear uniform criteria for indications for surgical removal of a hernia. That is, the basic criterion will be the subjective perception of pain by each patient (“you can endure the pain - endure, if you can’t - operate”).
  2. It is better to consult with several doctors, preferably from different clinical schools. Summing up their opinions, we come to our own solution.
  3. If there are symptoms of nerve root compression (muscle weakness, numbness), the decision must be made within 6 months. It is believed that after this time the operation will no longer solve these problems.
  4. If you have doubts about the cost of the operation, you need to accept the fact that the cost of long-term conservative treatment can significantly exceed the cost of the operation.
  5. It is very important to find on the Internet the reviews of those people who have already undergone this operation, it is better to communicate with them in personal correspondence. Basically, the reviews of patients who have undergone removal of the intervertebral hernia are positive. Indeed, in 80-90% of cases, this operation is really effective.

The best reviews about minimally invasive methods: microdiscectomy, endoscopic discectomy or laser hernia removal. Such an operation on the spine turns out to be painless and not such a terrible procedure as it seemed. The pains go away within a few days, there is no need to observe bed rest, only some restrictions in the load on the spine are required.

Disability after discectomy

There is an opinion that after the operation on the spine, the person becomes disabled. This is not the case. After all, the operation to remove the disc herniation in most cases fulfills its goal - to cure the person and return him to the normal load.

The sick leave after removal of the hernia lasts up to 1.5-2 months. If the course is favorable, the patient returns to work.

If the work is associated with hard physical labor (taking thepains, work with a shovel, monotonous flexion-extension of the back), such patients can be granted a disability list up to 4 months, or a certificate for light labor is issued through the VK commission.

Only in the absence of the effect of the operation: in case of persisting pain syndrome, neurological dysfunctions.

Cost of the operation

Discectomy can be made free of charge by OMS by polys in any neurosurgical department. If desired, you can have surgery in a private clinic, choosing a doctor, agreeing on the method of surgery. The cost of operations to remove a herniated disc in different clinics ranges from 30 to 120 thousand rubles.

I strongly recommend that you familiarize yourself with the effective method of treating joints and spine that can be used at home. If interested, here's the link.

Answer 2
January, 2021




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Answer 3
January, 2021

From the observations of a neurosurgeon, most operations at the L5-S1 level end very well and the forecasts for rehabilitation are quite optimistic. This means that the patient after the operation can continue their usual lifestyle, which allows sports and travel. However, the condition of a person before the operation is very important as the initial data: if a disc herniation squeezed the roots of the spinal cord for a long time (at a given level of the cauda equina fiber), to such an extent that numbness of the limbs or dysfunction of pelvic functions lasted several months or even years, then the dead nervous the tissue, accordingly, will not recover, and after the operation, these symptoms will remain forever.

I would like to share a separate point about the complications associated directly with operations, during which, due to involuntary "jerking" of the patient, even under anesthesia, (after all, we are talking about an operation not only on the bones of the vertebrae, but also on delicate nerve sheaths), damage to the fibers and nerve trunks is possible.

In practice, such operations have become routine, have been performed for a very long time, domestic experience has been accumulated and foreign ones have been adopted, protocols for robots have been developed, intervertebral disc implants have been improved, and neurosurgeons are excellent at coping with muscle twitching of patients during operations.

Rehabilitation is quite long and tedious, here the social sphere will be more important to you than the very essence of the medical sphere, which is algorithmic.

For a complete picture of the answer to this question, I think it is necessary collect responses from patients themselves after surgery at the L5-S1 level of the spine.

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