What are the causes of a slipped disc? Is a removal necessary in every case?THE LATEST DEVELOPEMENTS WITH THE L.I.S.A. LASER IN DR.HOOGALND´S AND DRS. ZEEGERS´S DEPARTMENT
Slipped discs are a very common complaint. Their main causes are:- natural, inherent weakness of the disc-tissue
- sudden rotation of the upper body
- heavy lifting/shifting
- lack of exercise and permanent sitting may cause the back-part of the disc to be squeezed by a durable, erratic force: resulting in weakness of the back-part of the disc that, in turn, can result in tears and bulges.
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Slipped disc / hernia |
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Poor muscle-condition can multiply the risk of a slipped disc. We speak of a slipped disc, when the ventral protective-annulus of the disc tears and bulges. This causes the soft tissue to leak out and aggravate or jam the nerve resulting in severe pain. This pain can radiate into the buttocks, legs or feet. In some cases a slipped disc can recede with intake of pain-medication combined with two weeks of rest, during which the patient should avoid bending, lifting and shifting. Subsequently the patient should be advised to undergo physiotherapy, including strengthening exercises for the abdomen- and back-muscles. However, if the condition does not improve after two weeks of rest and the patient notices numbness and a certain muscle-weakness, a detailed examination and diagnosis would be advisable. In such case an endoscopic removal of the hernia could mean the best and least invasive solution. |
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What does the treatment consist of?
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Probe remove tissue |
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The endoscopic removal of a hernia is a cohesive, percutaneous operative treatment. Ectopic or leaked-out tissue is removed, thus leaving the empinched nerve freed. The procedure is performed under local anaesthesia in a sterile, up-to-date operating-room with anaesthetic stand-by and causes less pain than a dental treatment. Small cannulas with increasing diameter up to 7 mm are conducted as far as the hernia is located. The hernia is visualized with a special “spinescope” and removed by means of small instruments, designed by Dr. Hoogland. Leftover tissue is shrunk by means of a laser. In some cases, an enzyme is used to reduce/shrink the nucleus (core of the disc) to release pressure off the protective annulus for the subsequent healing-process.
The adjacent, fossil cover plate of the vertebral body is then abraded and refreshed with special instruments. This promotes the revitalisation of the disc, the growth of a buoyant, stabile protective annulus and improves the blood circulation of the disc.
Because this technique does not require open surgery, there are little or no complications, pain or scarring. In the majority of the cases, patients can leave the clinic one day after the procedure. Younger patients can be treated on an out-patient basis. |
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Before the treatment |
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Magnetic resonance image before the treatment: the disc visibly lost a lot of its height and its shock absorbing skills. |
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Three months after the endoscopic removal |
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Check-up image three months after the endoscopic removal: the hernia has been removed, the disc visibly recovered and gained back height and shock absorbing skills. |
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3D animation of the endoscopic nucleotomy
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3D animation of the endoscopic nucleotomy |
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The 3D animation of the endoscopic removal of a hernia is intended to make the procedure comprehensible, even for non-medicals. The impinched nerve causes the typical pain, loss of sensation or/and loss of function. The unique, lateral approach and special instruments, designed by Dr. Hoogland, enables gentle removal of a hernia under local anaesthesia. At the end of every procedure a freed nerve is made visible.
What are the advantages of the endoscopic procedure?
- The endoscopic procedure conserves tissue
- Better healing of the ripped disc
- No mentionable scarring
- Procedure performed under safe and comfortable local anaesthesia
- Patient can walk pain-free two hours after the procedure
- Patient can return home one day after the procedure
- Patient can return rapidly to his everyday life
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Recovery and a new life for the discAfter the degenerated, leaked out portion of the disc-tissue has been removed, the adjacent vertebral body is abraded and refreshed by means of special instruments. Disc-tissue grows back in height during a period of 3 – 5 weeks! This healing can be demonstrated 3 months after the operation by means of MRI scans. |
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Herniated Disc |
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Herniated disc compresses the nerve |
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Hernia is removed endoscopically |
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After removal of the protruded hernia, the base of the vertebra is abraded |
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A healthy blood-supply is restored |
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The protective annulus of the disc recovers within 6 weeks after the operation |
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"Endoscopic" is not always "endoscopic"The most fundamental difference and advantage of our method, compared to other, so called, endoscopic methods, is the safe lateral approach which conserves nerves and the Ligamentum Flavum. This L.I.S.A.* laser helped technique has been perfected in Dr.Hoogland’s department and is only offered there. The patient is positioned comfortably on his side. In other cases, surgeons approach the hernia over the risky, dorsal approach (from the back-side). This approach always sacrifices the Ligamentum Flavum – the crucial nerve-protective ligament of the spine - furthermore, in order to reach the hernia, nerves have to be pulled aside, which means taking the high risk of injuring a nerve into account. This method would be too painful for a local anaesthesia, hence have to be performed under full anaesthesia.
* The L.I.S.A. laser uses the so-called ‘side-fire-technique’, enabling the surgeon to remove tissue under an angle of 90°. Thus the risk of nerve damaging is illiminated, contrary to the old ‘straight forward’ method.
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Which post-operative care and rehabilitation will be required after the endoscopic nucleotomy?The patient will be examined by a physician one day after the operation. Furthermore, a physiotherapist will advise the patient about the post-operative rehabilitation. Physiotherapy can be initiated one week after the treatment. The patient is advised to wear a protective corset (manufactured one day prior the operation to fit the patients physiognomy) for the first two weeks after the treatment. This corset allows the patient to actively participate in every- day-life activities. Six weeks after the operation the patient can return to his normal fitness-routine. After three months the patient should, if possible, return to our center for another post-operative check-up. |
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