Lumbar Disc Herniation
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We will provide information on the surgical methods for disc herniation, the length of hospital stay, and whether the procedures are covered by insurance.
椎間板ヘルニア
What is Lumbar Disc Herniation?
Intervertebral discs are situated between the vertebrae of the spine (lumbar vertebrae) and function as cushions that absorb shocks applied to the torso (Figure 1).
When excessive force is exerted on these discs or their elasticity decreases with age, cracks can form, causing the contents of the disc to be pushed out and protrude. This condition is called a disc herniation (Figure 2).
When excessive force is exerted on these discs or their elasticity decreases with age, cracks can form, causing the contents of the disc to be pushed out and protrude. This condition is called a disc herniation (Figure 2).
Symptoms
When a disc protrudes backward toward the spinal canal and compresses the nerves, it can cause not only lower back pain but also pain in the lower limbs. As the condition progresses, it may become difficult to exert strength in the lower limbs, leading to motor dysfunctions such as stumbling easily. Additionally, if the hernia compresses the nerves severely and damages the cauda equina (a bundle of nerves), it can result in urinary or bowel dysfunction. Symptoms like pain and numbness often intensify when bending forward or sitting in a chair.
There are also special types of hernias where the disc protrudes laterally. Therefore, early diagnosis and treatment of disc herniation are crucial. If lower limb pain does not improve despite appropriate treatment, if paralysis of the lower limbs progresses, or if urinary and bowel dysfunctions develop, surgery may be necessary.
There are also special types of hernias where the disc protrudes laterally. Therefore, early diagnosis and treatment of disc herniation are crucial. If lower limb pain does not improve despite appropriate treatment, if paralysis of the lower limbs progresses, or if urinary and bowel dysfunctions develop, surgery may be necessary.
Treatment Methods
Herniated discs can sometimes naturally resolve on their own, so surgery is not always necessary. However, large hernias that lead to a loss of leg muscle strength, resulting in conditions such as foot drop, or those causing urinary dysfunction, are absolute indications for surgery. For pain and numbness, the initial treatment typically involves oral medications or nerve blocks. If pain is severe or there is an urgent need to return to work or social activities, surgery may be considered as a relative indication. Recently, Hernicoa, a treatment that falls between surgery and nerve blocks, has become available under insurance coverage.
Surgical Methods
Intradiscal Enzyme Injection Therapy (Hernicore)
This treatment involves using X-ray fluoroscopy in the operating room to guide a needle, inserted under local anesthesia, to inject an enzyme (chymopapain) into the intervertebral disc. The enzyme works within the disc to reduce the pressure of the herniation and alleviate nerve compression. The effectiveness of this treatment is reported to be around 70%. Because of the rare possibility of drug allergies (anaphylaxis), a one-night hospital stay is required. Additionally, this treatment can only be performed once.MED: Endoscopic Discectomy
This surgical method involves inserting an endoscope through a 16mm diameter tube and using a high-definition monitor to visualize and remove the herniated disc. This technique has been implemented at our facility since its opening.FELD: Full Endoscopic Discectomy
This is an endoscopic surgical method that allows for even smaller incisions using an 8mm diameter endoscope. The herniated disc is removed while water is continuously flushed through the endoscope’s tip. This technique has been used at our facility since 2020 (see diagram below).Note: Depending on the type of hernia (such as giant hernias or cases with stenosis), endoscopic surgery may not be suitable, and a hernia removal through a small incision may be performed instead.
