Herniated disc epidural: Epidural Steroid Injections for Pain Related to Herniated Disc – The Center for Musculoskeletal Disorders
Epidural Steroid Injections for Pain Related to Herniated Disc – The Center for Musculoskeletal Disorders
12 Jun Epidural Steroid Injections for Pain Related to Herniated Disc
Posted at 14:54h
Epidural injections, considered intermediate treatments, can result in relief when other therapy measures have not provided a solution for herniated discs.
A herniated disc, also known as a slipped disc or ruptured disc, often irritates nearby nerves, which can result in pain, numbness or weakness in an arm or leg. Inflammation in the surrounding area, caused by the compression of the nerve root, is the cause of pain going down one’s leg. This is called radiculopathy, or sciatica. Sciatica is often a burning, searing pain that is extremely disabling for patients.
The area surrounding the spinal nerves is the epidural space. The purpose of injecting anti-inflammatory medicine into the epidural space is to stop or at least improve the nerve inflammation, and thus, the source of pain.
There are two types of epidural injections currently in use. The first, an intralaminar epidural injection, involves steroid medication being placed just under the bone in back of the spine. There is also the transforaminal epidural steroid injection (TESI), in which the needle is placed into a more specific area where the nerve root is actually being pinched as it exits the spine.
Epidural steroid injections have been available for many years, but in a large-scale review published in the journal Pain Medicine and featured in a National Institutes of Health (NIH) review*, the significant benefits of such injections for the treatment of herniated discs were confirmed.
The review found that epidural steroid injections were effective for each of the following:
- reducing pain
- restoring function
- reducing the need for other health care
- avoiding surgery
The large-scale review was taken from material in 39 publications that published multiple studies involving hundreds of patients who were successfully treated with epidural steroid injections for disc-herniation related pain.
Epidural injections are an excellent treatment to try and avoid surgery with a low-risk profile. This is especially true for less severe disc herniations. Dr. Steven Horowitz is expert in providing these injections, and will individually assess each patient. In addition, he will counsel patients on how to return to normal activities following these injections.
Epidural Nerve Block Injections: Purpose, Procedure, Results
You may have heard of the epidural — the pain-relieving shot that some pregnant women get when they’re giving birth. But it has other uses, too.
It’s an injection that goes into your “epidural space,” which is right outside of the membrane that protects your spinal cord. Doctors use epidural injections to relieve pain during and after surgery, as well as managing chronic pain.
This procedure isn’t right for every case. But if it’s an option, it requires a lower dose of medicine and as a result has fewer side effects. Epidurals may even give you longer-lasting pain relief while helping you stay more alert and mobile.
Epidural Nerve Blocks
This one of the most common uses of an epidural. It’s a type of anesthesia that doctors may give you during surgery to numb your spinal nerves and prevent pain signals from traveling to your brain. It usually begins to work in only 10 to 20 minutes.
You’d get a nerve block through a small, flexible tube, called a catheter, that goes near your spine at the small of your back and delivers the medicine nonstop, so you feel no pain during your surgery.
An epidural targets the nerves that carry pain signals. So you’re still able to feel touch and pressure. In fact, even though you will not feel pain in the lower portion of your body, you may still be able to walk around with some help. For these reasons, doctors usually recommend the use of an epidural nerve block when a woman chooses to get anesthesia during childbirth.
Side effects include a drop in blood pressure, trouble urinating, and headache. Rare complications include bleeding in the epidural space, nerve damage, and infection.
Some epidural injections are done with different medications, including steroids, to reduce pain and inflammation in your back, neck, arms, or legs.
Your doctor will use an X-ray with a special dye to insert the needle in the right spot. They will choose a location along your spine from the bottom of your neck to your tailbone that is closest to the nerve causing your pain.
Conditions that can be treated by an epidural injection include:
The procedure can take as little as 15 minutes and the numbing part of the shot may start to work fairly quickly. (The steroid part, which lasts longer, should start to work in 2 to 5 days.) The amount of time your pain relief lasts is different for each person. This type of injection doesn’t always bring pain relief. But if it does, the benefits can last up to a few months.
Doctors may also use epidural injections to find the source of your pain. In this case, the injection will target a specific nerve. If it helps your pain, your doctor will know they’ve found the right nerve.
A common side effect is that you may feel more pain until the medicine begins to work. Rarer side effects include bleeding, temporary numbness or weakness, infection, headache, or nerve damage.
Who Shouldn’t Get an Epidural?
There are a number of conditions that may make it risky for you get an epidural:
Depending on your situation, your doctor might look for another type of pain relief for you, or you might need to wait until a better time for the procedure.
Epidural Injection | Epidural Pain Treatment for Sciatica and Herniated Disc
The doctor will review your medical history before injection. Patients problem areas will be studied to see where the best placement for injection site is. Patients should discuss any medications that they are currently taking with their doctor for a more seamless treatment.
The treatment is a nonsurgical alternative to help body pain that involves an injection done by a doctor. The treatment may last anywhere from 15 to 45 minutes followed by a short recovery period after injection. The injection works most effectively when placed close to the pain. Local anesthesia will be administered to numb the area. The patient will be awake during the injection. The needle will be injected into the epidural space into the inflamed nerve root. The doctor will use an image guiding system like fluoroscopy or computed tomography to place the needle into target area of pain. The medication will then distributed into the targeted area.
After the treatment, most patients will be able to walk right out of the procedure room. Our doctors recommend that you stay a specified amount of time after the treatment to ensure a safe recovery. Patients should have a ride home after treatment. Soreness may occur, but this can be easily fixed with ice and medication. After treatment, most patients can go about their usual activities, but avoid lifting objects 25 lbs. or over. There are no restrictions to the patient’s diet after treatment is implemented. Patients may experience drowsiness, numbness, or tingling in injection area. These symptoms are all considered normal after the injection and will fade with rest. Our doctors will schedule a follow-up appointment to check on your progress and chat about any questions or concerns you might have.
The epidural injection has immediate results for all patients. This treatment is not a permanent cure for your conditions, but an important source of pain relief. Patients will experience varied pain relief. Pain relief can be anywhere from semi to permanent relief. The results may even deter future use of painkillers and surgical procedures down the road. If pain persists, patients may receive a few more injections to fully benefit from the epidural treatment. This treatment can be coupled with physical therapy to build up strength and maintain a healthy lifestyle.
What Doctors Want Patients to Know About Epidural Steroid Injections – NWA Interventional Pain Rogers Arkansas
You’ve tried everything, but medications and physical therapy aren’t enough to alleviate your back pain.
If you’re dealing with persistent nerve pain in your spine, your doctor may recommend an epidural steroid injection to treat your pain. Here’s what you need to know about this treatment option and how you can prepare for your procedure.
What Is an Epidural Steroid Injection?
An epidural steroid injection is a treatment for chronic back pain. A shot of cortisone is injected into the outermost section of the spinal column, the epidural space.
Cortisone is a type of steroid that occurs naturally in the human body, typically as part of our brain’s chemical response to stress. When the adrenal gland releases it, cortisone suppresses the immune system, dimming inflammation and, in turn, our perception of pain.
Naturally-occurring cortisone is short-acting. Artificial cortisone, like that delivered in an epidural steroid injection, is designed to last for much longer–anywhere from a few weeks to months.
How Does It Work?
The immune system is basically our body’s built-in defense system. It’s designed to fight against invaders, from bacteria to unknown viruses. So if you’re injured or something in your body isn’t working, your immune system is the first one on the scene, so to speak.
The immune system’s first response is inflammation. The goal is to kill off as much bacteria as it can around the damaged site before it needs to call in reinforcements.
Of course, your body isn’t meant to stay in a state of inflammation for an extended period of time–it’s a temporary measure until your immune system has moved on. So if the inflammation goes on for an extended period of time, it causes pain.
When cortisone is released by the adrenal gland, it has the opposite effect–it suppresses the immune system in a targeted area, reducing inflammation and thus reducing the associated pain.
When you get an epidural steroid injection, you’re taking advantage of naturally-occurring processes in the body. But instead of waiting for the cortisone to release on its own, your doctor is giving you a concentrated dose of artificial cortisone to hold the pain at bay for an extended period of time.
What Is it Used For?
Epidural steroid injections contains cortisone that acts as an anti-inflammatory agent. It creates an overall pain-relieving effect for an extended period.
This type of treatment is typically recommended for nerve pain in the spine, including:
What Are the Risks of Epidural Injections?
Generally, epidurals do not cause any ill effects. However, there are occasionally complications.
When side effects do arise, a few common ones include:
- Sleeping problems
- Steroid flush, or a rise in body temperature and flushing in the face and chest for several days
- Water retention
- Menstrual changes
- Increased hunger for a short peroid of time
Another common risk is the accidental puncture of the dura mater, the tissue surrounding the spinal cord. When this happens, spinal fluid leaks out of the spinal cord, creating a spinal headache.
As the name implies, it’s an extremely intense headache that gets worse when you stand or sit and lessens when you lie down. The pain can range from a dull, mild throbbing to an incapacitating pain similar to a migraine.
These headaches typically get worse before they get better. The good news is that they don’t tend to last longer than a few days.
What to Expect
If you and your doctor decide that the procedure is the right option for you, it’s important to understand what you should expect.
Before the procedure, your doctor will speak with you about your medical history, any current medications, allergies, and potential risks associated with the injection. If you are pregnant, nursing, or plan to be pregnant in the near future, make sure to tell your doctor.
The doctor will also review any pre-operation preparations necessary.
You won’t be able to drive after the procedure, so you should arrange for someone to drive with you and drive you back. Wear comfortable clothing and bring something along to occupy your time while you wait.
The skin around the injection site will be cleaned with an antiseptic and the doctor will inject a local anesthetic to numb the skin and deeper tissues or may spray a “cold spray” on your skin to numb prior placing the needle.
You will lie down on an X-ray table. The procedure will cause some discomfort. With a local anesthetic, you’ll feel a strong pressure, but you shouldn’t feel much pain.
Using fluoroscopy (a form of live X-ray) as guidance, your doctor will insert the needle and direct it toward the epidural space. Then, he will slowly release the cortisone and numbing medication.
The full benefit of the steroids will take a few days to take effect but shouldn’t take longer than five to seven days. Keep in mind that every patient is different.
If your symptoms are unchanged after a week, your doctor will investigate other potential sources of your pain. If the pain lessens but only for a short time, your doctor may suggest additional injections.
Do You Need Epidural Steroid Injections?
If you believe an epidural steroid injection might be the right choice to treat your back pain, we can help you.
NWA Interventional Pain is a comprehensive pain clinic offering solutions to your chronic pain. We individually tailor your treatment plan to ensure that we treat your pain in the manner that is best for you.
If you’d like to speak with us about your treatment options, use our contact page to get in touch.
Lumbar Epidural Injection
What Is the Spine’s Epidural Space?
The membrane that covers the spinal cord and nerve roots in the spine is called the dura mater, a protective type of tissue. The space surrounding the dura mater is the epidural space. Nerves travel through the epidural space to the back and into the legs. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contract in some way with the bony structure of the spine.
Illustration shows many spinal structures including, the third and fourth lumbar (low back) vertebrae, spinal cord, subarachnoid space, and epidural space. Photo Source: 123RF.com.
What Is an Epidural Spinal Injection, and How May It Help Reduce Back or Leg Pain?
A spinal epidural injection places anti-inflammatory medicine into a specific region of the spine’s epidural space. The medication helps decrease inflammation of the nerve roots, hopefully reducing the pain in the back or legs. The epidural injection may help the injury heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of pain is healing.
What Happens During a Spinal Epidural Injection Procedure?
An intravenous line (IV) is started so that relaxation medication can be given. The patient is placed lying on their side on the x-ray table and positioned in such a way that the physician can best visualize the low back using x-ray guidance (sometimes called fluoroscopy).
An image of fluoroscopy (real time x-ray) shows what the doctor saw while performing a low back procedure, such as a spinal injection. Photo Source: SpineUniverse.com.
The skin on the patient’s back is scrubbed using 2 types of sterile scrub (soap). Next, the physician injects a numbing medication into the skin area where the epidural injection will be administered (eg, L3-L4). This medicine stings for several seconds. After the numbing medicine has been given time to be effective, the physician directs a small needle, using x-ray guidance into the spine’s epidural space. A small amount of contrast (dye) is injected to ensure the needle is properly positioned in the epidural space. A mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected.
Pictured is a patient laying face down on their stomach on the treatment table. Pillows help keep the patient comfortable. In the background, is the monitor the physician will view to precisely guide needle placement during the injection procedure. Photo Source: Shutterstock.
What Happens After a Lumbar Epidural Injection?
The patient is returned to the recovery area where they are monitored by medical staff for 30-60 minutes. Prior to discharge, the patient is asked to record their levels of pain relief during the next week using a post-injection evaluation sheet (“pain diary”).
A follow-up appointment will be made for a repeat injection pain block, if indicated.
Depending on the patient’s level of pain relief, another injection may be administered in 2 weeks. The patient’s back or legs may feel weak or numb for a few hours. This is to be expected, but it does not always happen.
General Pre- and Post-injection Instructions for Lumbar Epidural Injections
A few hours before the procedure, the patient may be allowed to eat a light meal. If the patient has type 1 diabetes, they must not change their normal eating pattern prior to the procedure. Patients may take their routine medications (eg, high blood pressure, diabetic medications).
Patients should not take pain medications or anti-inflammatory medications the day of their procedure. Patients should be in pain prior to this procedure, so it’s important not to take medications relieve or lessen pain. These medicines can be restarted after the procedure, if they are needed.
If a patient is on coumadin (blood thinner) or glucophage (Metformin, a diabetes medicine), they must notify their treating physician so the timing of these medications can be explained.
In general, the patient is asked to be at the outpatient facility one hour prior to the procedure and can expect to be at that facility approximately 2-3 hours. A driver must accompany the patient and be responsible for getting them home. No driving is allowed the day of the procedure. Patients may return to their normal activities the day after the procedure, including returning to work.
SpineUniverse News/Research Comment:
Current Evidence on the Effectiveness of Epidural Steroid Injections
Epidural steroid injections are a common non-surgical treatment for several spinal disorders, and research is continuously refining the medical community’s understanding of this treatment. The more clinicians know about these injections, the better equipped they are to improve patient care and treatment outcomes.
A wealth of recent research exists on epidural steroid injections, but we’d like to highlight 2 specific studies that may be of interest to our readers.
The first study, which was published in 2015, focused on the effectiveness of epidural steroid injections on lumbar spinal stenosis symptoms (spinal stenosis affecting the low back is a common cause of back and leg pain).
The study’s authors compared 2 types of injections: The first contained corticosteroid plus lidocaine, and the second contained only lidocaine. The authors discovered that corticosteroid injections did not provide significant benefit over the lidocaine-only injections. The results questioned the effectiveness of a corticosteroid on symptom relief.
“These results suggest that although certain patient characteristics are associated with greater likelihood of good outcomes following either type of epidural injection for lumbar spinal stenosis symptoms (and possibly of good outcomes regardless of any treatment), there are no currently identified characteristics that predict a differential benefit from corticosteroid,” said Judith Turner, PhD, Professor of Psychiatry and Behavioral Sciences and Rehabilitation Medicine at the University of Washington, Seattle, WA.
The second study, which was published in 2014, questioned whether epidural steroid injections are effective at delaying or preventing spine surgery. While the authors found that the injections provide a short-term benefit—they may prevent the need for surgery for up to a year—the effectiveness isn’t long-term.
“Epidural steroid injections may provide a small surgery-sparing effect in the short term compared with control injections and reduce the need for surgery in some patients who would otherwise proceed to surgery,” the authors wrote.
So, while the injections may prevent or delay surgery, it’s more of a limited benefit than widely thought.
We note these studies not to discourage you from undergoing epidural steroid injections, but rather to help foster well-rounded discussions with your doctor. These injections have been shown to provide excellent pain relief in many patients (particularly those who have had symptoms for less than 3 months, not had a previous spine surgery, are younger than 60 years, and don’t smoke). However, epidural steroid injections are not magic bullets. Before starting injection therapy, talk to your doctor about the specific risks and benefits for you.
Commentary by Gerard Malanga, MD
Epidural Injections can be a very helpful adjunct in rehabilitation of patient’s the spine pain that radiates into an arm or leg or in the thoracic spine around the chest or trunk. They work by placing cortisone (a potent anti-inflammatory medication) close to an inflamed nerve. This allows the patient to be fully able to regain full motion and increase the muscular support of the spine critical in the recovery and prevention of future episodes. They are generally not indicated in spine pain that does NOT radiate from an irritated spinal nerve. Most patients actually respond to just 1-2 injections; therefore, they should not be routinely performed in a “series of three”.
In my experience, 60 % of patients require only one injection and only 10-20 % will require 3 injections. Certainly, if there is little or no pain relief after trying 2 injections, it is unlikely that the third injection will be of benefit. In addition, most patients can be treated with a local anesthetic without the need for sedation which requires an IV and a longer recovery immediately after the procedure.
Commentary by Leonardo Kapural, MD, PhD
Epidural glucocorticoid injections are commonly given to relieve pain and improve mobility without surgery, buying time for healing to occur or as an attempt to avoid surgery after other conservative approaches failed. Those injections have a good theoretical rationale, but they do not help every patient. Who then should receive an epidural glucocorticoid injection and how many? For leg pain greater than the back pain, guidelines from a respected source (Abram SE. Treatment of Lumbosacral Radiculopathy with Epidural Steroids. Anesthesiology. 1999:12(91):1937) suggest that patients who had full pain relief from the first epidural injection should not receive another one but to be re-evaluated in 4 weeks and followed thereafter.
Those patients who still have some residual pain after the first injection should receive a second and third injection and patients who did not get any benefit from the first injection should not receive another one. Patient selection is very important in deciding on the type of injections patients should receive. Transforaminal injections (different approach to the epidural space) may produce longer pain relief and may also predict whether a patient might benefit from surgery or not (for details, see McLain RF, Kapural L, Mekhail NA. Epidural steroid therapy for back and leg pain: mechanisms of action and efficacy. Spine. 2005;5(2):191-201). For patients with the diagnosis of lumbar canal stenosis, improvement after such injections may be longer lasting than it was initially thought.
Commentary by Steven Richeimer, MD
Epidural injections can be done at any level of the spine: cervical (neck), thoracic (mid-back), lumbar (low back), and sacral (tailbone area). The thoracic epidural may be a valuable tool in the treatment of mid-back and chest wall pains. These problems might be caused by disc problems, arthritis of the spine, or even shingles.
Epidural Steroid Injections for Pain
An epidural steroid injection is an injection of local anesthetic and steroid into the epidural space. The epidural space is a space located within the spine, just outside of the sac containing spinal fluid.
The goal of an epidural steroid injection is to provide pain relief by reducing the inflammation (swelling) of the nerve roots as they exit the spine. An epidural steroid injection will not correct the preexisting medical problem (such as spinal stenosis, herniated or bulging disc, arthritis, etc.) causing the pain, but it may improve the level of pain.
It is not unusual for someone to need more than one injection to get long-term benefit. The injections are done in a series of three injections about a month apart if needed. If the pain is significantly improved, no further injection is needed unless the pain begins to come back.
What can I expect on my first visit?
Your first visit is an initial evaluation. This appointment consists of reviewing your medical history, medications, x-rays, treatments already tried, and any other pertinent information and records. A physical exam will be performed. A plan of care will be formulated. If an epidural steroid injection is found to be appropriate it will be scheduled as soon as possible. Injections can only be done on the first visit if precertification arrangements have been made with your insurer to allow both an initial visit and a procedure on the same day.
What are the risks of the procedure?
The main risk, occurring in about one in 100 patients, is the risk of a dural puncture. (This rate is higher in patients who have had previous back surgery.) A dural puncture occurs when the needle is unintentionally advanced one layer beyond the epidural space and punctures the membrane that surrounds spinal fluid.
If this occurs, there is a risk of developing a spinal headache, which may be severe and may last for days. There is a procedure (epidural blood patch) that can treat the headache if it occurs and does not improve sufficiently in 48 hours.
Other risks are rare and include bleeding, infection, nerve injury and allergic reaction to the medication.
Some short-term side effects may occur. If local anesthetic spreads to nearby nerves, you may have weakness or numbness that can last for one to two hours. If this happens you will have to stay in the Pain Management Center until this resolves.
You may have increased pain for a few days after the injection. People with diabetes may have short-term elevation of blood sugars. People prone to fluid retention may have increased fluid retention for one to two weeks.
The procedure cannot be performed if you have an active infection, flu, cold, fever, very high blood pressure or if you are on blood thinners. For your safety, please make your doctor aware of any of these conditions.
Will the injection hurt?
Most people say the stinging/burning of the numbing medicine is the most uncomfortable part of the procedure, although every person’s response to any procedure is individual.
What happens during the actual procedure?
After you sign a consent form and your blood pressure is checked, the procedure will be performed while you are in a sitting position. For procedures in the neck, an intravenous is started.
The back or neck is then cleansed with an antiseptic soap. A sterile drape is placed. The skin is anesthetized (numbed) with a local anesthetic. This is felt as a stinging or burning sensation. The needle is then advanced into the epidural space. Pressure is the usual sensation. If you feel pain more local anesthetic will be used.
Once the needle is in the epidural space, the medication is infused and the procedure is complete. Your skin will be cleansed and a bandage will be applied. The bandage can be removed on the next morning. Your blood pressure will be checked, and you will be able to leave with your ride after the doctor authorizes your discharge.
How will I feel after the injection?
Most people do not feel any different immediately after the injection, although the pain may be temporarily improved or worsened. The steroid takes two to three days to start to have an effect in most people, and it peaks in about two weeks. Therefore, it may be a while before you feel a change in your pain.
Some local tenderness may be experienced for a couple of days after the injection. Using an ice pack three to four times a day will help this. You may take your usual pain medications as well after the injection.
Will I have any restrictions on the day of the procedure?
You may not drive for the remainder of the day after your procedure. An adult must be present to drive you home or to go with you in a taxi or on public transportation. For your safety, the procedure will be cancelled if you do not have a responsible adult with you.
No heat is to be used in the injected areas for the remainder of the day. You should not take a tub bath, hot shower, or soak in water (such as a pool or hot tub) for the remainder of the day.
You may eat, drink and take your medications as usual on the day of the procedure (both before and after) unless told otherwise by your doctor.
For what reasons should I call the Center for Pain Medicine after the injection?
If you experience severe back pain, new numbness or weakness of your legs, loss of control of your bladder or bowels, or signs of infection in the area of the injection, you should call the Center for Pain Medicine at 617.732.9060.
Epidural Steroid Injections Can Help Relieve Your Pain After a Herniated Disc.: Advanced Pain Management Center: Interventional Pain Management Physician
Treating Herniated Nucleus Pulposus with Epidural Steroid Injections
Intervertebral discs are cushions between each pair of vertebrae in your spine that provide shock absorption. The outer ring of the disc is made up of strong fibers known as the annular fibers or simply annulus. The middle of the intervertebral disc is known as the nucleus pulposus and is characterized by its soft and gelatinous center and serves as the main source of shock absorption for the adjacent vertebrae. When a tear occurs in the annular ring of the disc, the nucleus pulposus (soft gelatinous center) can protrude out into the spinal canal. This is known as a herniated disc and is a very common and painful disorder. The protrusion typically puts pressure on nerve roots of the spine and in some cases the spinal cord. The affected region of the spine is typically the cervical and lumbar region, although thoracic can occur. At Advanced Pain Management Center, Dr. Fiks utilizes epidural steroid injections to treat the inflammation that occurs with herniated discs.
What causes a Herniated Nucleus Pulposus?
Most herniated discs are caused by repeated wear and tear and trauma. Discs heal from injury by forming scar tissue, which is weaker than normal tissue. A traumatic event such as a fall from a level of elevation can put tremendous pressure onto your vertebrae and discs which can cause a fracture and/or rupture. As people tend to age, the annular rings around their discs wear out, making them more susceptible to rupture from everyday activities that require lifting or bending.
Herniated discs often lead to immense pain that if left unchecked can radiate to other parts of the body. If you have any of the following symptoms contact your doctor immediately.
- Back pain
- Pain or numbness running down the back of the leg (sciatica)
- Pain that runs down into the arm or leg
- Neck pain
Once a herniated disc is diagnosed via an MRI, it is up to the physician to decide what the next step is. Typically, physical rehabilitation combined with injections is the first line of treatment after diagnosis. Dr. Fiks works with cases where the patient is experiencing extreme radiculopathy (pain due to compressed or inflamed nerves) and recommends epidural steroid Injections. Epidural steroid injections work by providing powerful anti-inflammatory action in the area, reducing swelling of the nerve and may sometimes lead to the herniated disk reducing in size and even returning to its original anatomical position. This can significantly reduce the amount of pain and allow the patient to increase activities and facilitate rehabilitation.
If you are suffering from a herniated disc, please do not hesitate to contact Advanced Pain Management Center and set up a consultation. To learn more, book an appointment with Advanced Pain Management Center today.
Vladimir Fiks, MD
Medical Director Advanced Pain Management Center and Cedar Hills Surgery Center
90,000 Injection therapy for chronic back pain and sciatic pain: Ratz epidural catheter
Key information: Ratz epidural catheter
- Indications for Rat epidural catheterization: Chronic nerve pain and sciatica herniated disc, radiculopathy (disease of the spinal nerve roots), endoscopic examination of the epidural space
- Hospital stay: 2 days, 3 nights (4 injections)
- Rehabilitation: Weight limit: 1 week -10 kg, 4 – 20 kg, physiotherapy
- Anesthesia: Local anesthesia only
- Mobilization: 1 hour after surgery
- Showering is possible: 1 day after surgery
- Duration of incapacity for work:
- Classes with active vi Sports ladies: Swimming or running 3 weeks after surgery
- Literature on epidural catheter therapy
What is Ratz epidural catheterization?
The image above shows the lower edge of the spinal column.A probe is used to guide the tube through natural openings into the epidural space (inside the spinal canal). Under X-ray control, she is sent to the pain center for safety. Medicines and pain relievers are injected directly into the source of pain from within. © Viewmedica
The Ratz Epidural Catheter is an injection (or series of injections) into the spine to treat chronic back pain. The injection is done four times within two days in a hospital.
Often this pain occurs due to the formation of scar tissue after surgery, herniated disc and sciatic nerve diseases.
This injection treatment achieves rapid and effective relief of chronic pain and discomfort in the lumbar spine without open surgery.
The medical community still considers the innovative Ratz treatment to be experimental.The established principles of epidural adhesiolysis, enzymatic scar therapy and osmotic pressure reduction are the subject of scientific research and debate.
Rat epidural catheterization is an effective method for relieving low back pain and sciatic pain.
Indications for epidural catheterization according to the Rat method
Reduction of the size of a herniated disc with an epidural catheter according to the Rat method
Epidural endoscopy is an effective method for treating early herniated discs.If the location of the hernia is acceptable, the hernia can be quickly reduced in size by infusing a 10% saline solution in the immediate vicinity of the hernia. The shrinking and shrinking speeds up the natural healing process that would otherwise take several months. Epidural catheterization in our clinic is an effective alternative to endoscopic or microsurgical removal of “fresh” hernias. After a thorough diagnosis, we will provide you with detailed information about the possibilities of an effective individual treatment of a herniated disc.
There are several diseases that cause severe sciatic pain radiating to the leg or even to the foot. One of the most important causes of hernia of the lumbar spine. In such cases, Ratz epidural catheterization can help reduce pain without spinal surgery. The main advantage is the absence of soft tissue injuries: epidural catheterization according to the Rat method is a reliable method that does not affect the sensitive area of the spinal cord.
A special probe is inserted into the spinal canal only through the skin and natural incisions at the base of the spine.
Examination of the epidural space of the spinal cord using endoscopic diagnostics
Using the epidural catheter according to the Rat method, not only high-quality treatment can be carried out, but also accurate diagnosis. In this case, the probe can be used to control instruments, including endoscopic cameras with a diameter of several millimeters within the epidural space of the lumbar spine, in order to visually investigate the causes of back pain.This diagnostic method gives an accurate idea of the location of painful inflammation, intervertebral hernia, stenosis of the spinal canal with pinched nerves.
Terminology for Epidural Catheterization by the Rat Method
The Rat Catheter was invented in 1982 by the American anesthesiologist Prof. Dr. Gabor Racz. A catheter is a special medical device through which a probe is inserted into a body cavity. Neurolysis is the relief of any pressure on the nerve.Caudal means closer to the tail or to the posterior end of the body. Epidural means inside the central nervous system, the constituent element of which is the spinal cord. There are no blood vessels inside this cavity.
When catheterization according to the Rat method is indicated ”
- Acute pain in case of intervertebral disc protrusion or herniation.
- Acute chronic pain from irritation of nerve roots
- Post-nucleotomy syndrome – pain after surgery
- Postoperative scarring or fibrosis
- Irritation of nerve roots from mechanical impact
- Hypertrophy of tissues surrounding the spinal cord 8 or bone arthrosis 9000 Determine if Raz Epidural Catheter Treatment is Right for You?
Rat epidural catheterization is an established treatment for radiculopathy due to nerve root lesions or chronic back pain.© Viewmedica.com
This treatment is only suitable for acute chronic pain. To carry it out, the patient must have had a negative experience of conservative treatment of back pain for at least three months.
In some cases, a Ratz epidural catheter can also help after a successful microsurgical nerve decompression, which may result in painful postoperative scars or irritations in the immediate vicinity of the spinal cord.
An MRI scan will confirm or deny the presence of nerve root irritation. For safety reasons, infiltration should be performed at least six weeks after the last epidural injection.
How is the epidural catheterization according to the Rat method
Generally, Ratz epidural catheterization is performed under local anesthesia. The patient lies on his stomach. In this way, the risks of general anesthesia can be avoided. The catheter remains in the spinal canal for two days, during which four medications are injected.During this time, the patient can move normally and not feel pain. The flexible catheter is equipped with a microscopic probe, which assists in the precise release and repair of the nerve roots. Under local anesthesia, it is guided to the desired site through the free space that surrounds the spinal canal. Through a thin catheter inserted into the spinal canal under X-ray control, special medicinal solutions are delivered to the affected nerve root, which have a resorbing, anti-inflammatory and anti-edema effect.
As a result, tissue contraction occurs, which compresses the nerve root. Thus, the load on the root is reduced and the main cause of pain is eliminated.
Rehabilitation after an epidural catheter according to the Rat method
- Avoid heavy loads (maximum 10 kg) for one week
- A maximum of 20 kg is allowed for four weeks.
- Avoid sports, especially those affecting the spine, for three months (ex.golf)
From right to left: 1. Introduction of the catheter into the problem area. 2. Use of infiltration and medication. 3. Dehydrated and compressed disc as a result of infiltration with 10% saline solution.
The procedure takes 30-60 minutes. Within an hour, the patient can get up. However, the hospital stay lasts for several more days. During this time, four more similar procedures are carried out for the administration of medications. This is essential for maximum results.If additional scar tissue needs to be removed, an additional injection may be needed after a few months.
Advantages of the Ratz Epidural Catheter
When does your spine specialist need to choose an alternative treatment?
- Tumors and neoplasms
- Vertebral fracture
- Stenosis of the spinal canal
- Urinary tract dysfunction, sexual dysfunction
- Noticeable methods of neurological symptoms (numbness, paralysis, endoscopic failure of forces) Information You can get treatment by contacting us.
An epidural catheter according to the Rat method is a procedure during which the hernia itself is reduced and thus the pressure on the nerve roots is reduced. The catheter has a special shape and material that facilitate its advancement without damaging its surrounding tissues, which minimizes the risk of complications. This method is suitable in cases of unsuccessful microsurgical treatment (open spine surgery). Depending on the circumstances, by introducing various chemically active substances, we achieve an osmotic effect and relieve irritation of the nerve fiber.
The area surrounding the spine is quite sensitive due to the high density of its nerve tissue.
Scarring from open back surgery can lead to chronic inflammation and loss of function, resulting in new problems. In such cases, the formed scars can be removed by additional exposure to enzymes, which accelerates the healing of the tissues of the spinal cord and affected nerve roots.
Possibilities and limits of epidural catheterization according to the Rat method
Capabilities: With the help of an epidural catheter according to the Rat method, it is possible to cure intervertebral hernia, as well as other diseases of the spine, when physiotherapy and open surgery did not bring the desired result.
Borders: Such complex structural damage as, for example, degeneration of the spinal disc with bone spurs (osteophyte), stenosis of the spinal canal, spondylolisthesis, degenerated discs, etc. require minimally invasive (endoscopic) intervention. If you need information about effective minimally invasive treatment, please contact us.
Recommendations for minimally invasive treatment
In the presence of a herniated disc, chronic pain and loss of nerve function often occur.
Complications and side effects of Rat epidural catheterization
Good hygiene is critical to preventing complications after Rat epidural catheterization.
These problems can be remedied by injecting 10% saline during Racz epidural catheterization. This method helps to eliminate fluid from the hernia, thereby reducing the volume and pressure on the surrounding nerve tissue. In addition, this procedure has a decongestant effect of painful inflammation of the nerve roots.It is worth noting that there is strong clinical evidence that the Ratz epidural catheter is an effective treatment for radiculopathy due to nerve root damage or chronic back pain.
Epidural catheterization according to the Rat method
This method is used in patients who are not satisfied with a single caudal injection. It consists in bringing a thin catheter to the problematic part of the spine, followed by the introduction of anti-inflammatory and analgesic drugs through the catheter for several days.This maximizes the effect and does not require repeating injections daily.
Ratz epidural catheterization in many cases avoids herniated disc surgery. The procedure will also help those who experience complications after spinal surgery, and in this case it has almost no alternative. According to statistics, the operation can get rid of pain in 85% of cases.
The main effects of the procedure are: destruction of adhesions in the epidural space and reduction of stenosis (narrowing) of the spinal canal resulting from prolonged inflammation or surgery on the spine.
Indications for epidural catheterization according to the Rat method:
- Acute or chronic pain in any pathology of the intervertebral disc
- Post-nucleotomy syndrome (pain after spinal surgery)
After thorough sterilization of the skin, local anesthesia is performed, for which a small amount of local anesthetic is injected intradermally and subcutaneously. The catheter is guided to the spinal nerve roots under real-time X-ray control for patient safety.The medication is then delivered through the catheter to the spinal roots. The entire procedure usually takes 30-40 minutes. On the following days, the administration of drugs through the catheter is repeated to achieve maximum results.
Many patients can get back on their feet within an hour after the procedure. You can return to work that does not require physical effort in two weeks, and you can gradually start active sports in a month.
Many patients fear spinal surgery due to the risk of possible complications.Caudal epidural injections are considered an adequate and safe treatment for many patients. Along with the correct technique, manipulation risks are reduced if needle insertion is controlled using fluoroscopy (X-ray).
90,000 Spine treatment
Osteochondrosis of the spine. Herniated discs.
Schematic anatomy of the spine
Our spine consists of three segments and 32 vertebrae: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral and 3 coccygeal vertebrae.When viewed from the side, these segments form three natural curves.
Herniated disc is a pathological condition when a part of the nucleus pulposus of the intervertebral disc is pushed to its outer edge, towards the spinal canal. This puts pressure on the nerves and lining of the spinal cord. The spinal nerves are very sensitive to even slight pressure, which can lead to pain, numbness, and weakness in one or both legs.
Herniated disc (cross-sectional side view).
Intervertebral discs are soft, elastic spacers between the hard bones (vertebrae) that make up the vertebral column. The spinal canal is the hollow space in the middle of the spine that contains the spinal cord, from which the nerve roots extend. The discs between the vertebrae allow the spine to flex and act as shock absorbers.
Almost everyone experiences low back pain at least once in their life. This pain can range from mild to severe.Pain can be short-lived or long-term.
Pain may be slow onset or sudden, and may be intermittent or persistent. In most cases, back pain will go away on its own within a few weeks.
As we age, our spines, in the area of the vertebral bodies, grow with us. Aging causes degenerative-dystrophic changes in the spine. These changes may start in the middle of our 30s or even earlier, especially if we overdo our activities.
Spinal injections for acute pain relief
Epidural injection is used to treat pain that begins in the spine and radiates to an arm or leg, and often occurs when a nerve is inflamed or compressed (“pinched nerve”).
Local anesthetics and glucocorticosteroids (cortisone for example) are used for epidural injections. This reduces inflammatory changes and reduces or eliminates pain.
These injections are often used to treat underwear syndrome caused by degenerative-dystrophic changes in the intervertebral joints or trauma to this area.
Sacroiliac joint injection
Problems in the sacroiliac joints are usually characterized by pain in the lower back, buttocks, and back of the thighs.
Minimally invasive spine surgery
Spine surgery has traditionally been performed as “open surgery”, which meant opening the operated area with a long incision, 20-25 cm, allowing the surgeon to view and access anatomical structures.In recent years, technological advances have allowed patients to be treated with a new technique that does not involve a long incision, thus avoiding significant damage to the muscles surrounding the spine. In most cases, this results in less pain after surgery and faster recovery. Spine surgery is usually only recommended when a period of non-surgical treatment, such as medication and physical therapy, has not relieved the painful symptoms associated with the spinal problem.In addition, surgery is only considered when your doctor can determine the exact source of the pain, such as a herniated disc or spinal stenosis.
Minimally invasive surgery has been used more widely for procedures such as decompression and fusion since the late twentieth century. Decompression surgery relieves the increased pressure on the spinal nerves by removing the problematic part of the bone or herniated disc. Fusion surgery consists in the operative fusion of painful vertebrae so that they heal into a single hard bone after the operation.
In minimally invasive surgery, doctors use special instruments to access the spine through small incisions with minimal damage to muscles and other anatomical structures. The technique helps the surgeon see only where needed, using smaller incisions, less interoperative bleeding, and a shorter hospital stay for the patient.
The diagram shows the general principles of minimally invasive spine surgery.The microsurgical instrument is used for spinal surgery through a tubular retractor. Removal of a herniated disc. The screw is placed in the bone using a retractor.
Neurosurgical Department – City Hospital No. 41, Yekaterinburg
Treatment in the general ward (1 k / d) 3 300 Examination in the general ward (1-5 k / d) 28 500 Treatment in a 2-bed ward (1 k / d) 3 600 Examination in a 2-bed ward (1-5 k / d) 34 500 Treatment in a single room (1 room) 4 700 Examination in a single room (1-5 k / d) 41,000 Preoperative examination and treatment (1 c / d) 6,000 Anesthesiology-resuscitation and intensive care Daily observation of a resuscitation patient on mechanical ventilation (1 b / d) 16 500 Daily observation of a resuscitation patient without mechanical ventilation (1 c / d) 12,000 Daily observation of the patient in the intensive care unit (therapeutic, cardiological, neurological department) (1 c / d) 6 500 Daily observation of the patient in the intensive care unit (surgical, otorhinolaryngological, traumatological and orthopedic, urological, proctological, gynecological, neurosurgical, oncological, endocrinological, cardiovascular and plastic surgery departments) (1 c / d) 11,000 Operations 6 category of complexity 22 500 Removal of lipomas of various localization. Decompression of the median, ulnar, radial, peroneal, tibial nerves. Isolation of the nerve in the carpal tunnel. 7 category of complexity 27 500 Postoperative wound revision within 3 weeks after surgery Removal of neuromas of various localization. Decompressive craniotomy. Removal of a brain cyst. 8 category of complexity 33 500 Neurolysis and suture of peripheral nerves. Suturing the nerve using microsurgical techniques. 9 category of complexity 44 500 Closed external drainage of subdural hematoma. Removal of epidural hematoma of the brain. Removal of tumors of the skull bones with plastic defect. Plasty of the defect of the cranial vault. Ventriculo-peritoneal shunting. Removal of a herniated disc at the lumbar level in one segment – microdiscectomy. 10 category of complexity 55 500 Removal of a herniated disc in 2 segments at the lumbar level. Neurolysis and suture of one, two and three nerves. Thorkildsen’s operation. Lumbo-peritoneal shunting. Cystoperitoneal shunting. Syringomyelic cyst – emptying and draining. Ventriculocisternostomy. Laminoplasty. 11 category of complexity 66 500 Removal of herniated disc at the lumbar level using the METRx system. Fixation of the C2 tooth with a screw. Removal of brain hematoma. Dissection of adhesions and decompression of the nerve plexus trunks. Biopsy of intramedullary tumors. Intracerebral tumor biopsy *. 12 category of complexity 88 500 Transpedicular fixation at the lumbar level (4 screws and 1 cage). Herniated disc at the cervical level – discectomy (1-2 discs) and removal of the hernia (hernias), anterior fusion with a plate and cage (1-2 cages). Tumor (fracture) of 1-2 vertebrae at the cervical level – resection of the vertebral body (s), anterior fusion with a plate and cage (MESH mesh, telescopic cages). Tumor (fracture) of 1-2 vertebrae at the lumbar and thoracic levels – resection of the vertebral body (s), anterior fusion with a cage (MESH mesh, telescopic cages). Microsurgical removal of neoplasms of the spinal cord. Removal of neoplasms of the spinal cord membranes using microsurgical techniques. Meningeoma (convexital, parasagittal, falx-) – removal of the tumor *. Microsurgical removal of brain neoplasms *. Transpedicular fixation and transforaminal interbody fusion with a cage at the lumbar level (4-6 screws and 1-2 cages). Removal of brain metastases *. 13 category of complexity * 99 500 Transpedicular fixation at the lumbar, thoracic and cervical levels (6-12 screws, 2 or more cages). Tumor (fracture) of 1-2 vertebrae at the lumbar and thoracic levels – resection of the vertebral body (s), anterior and posterior fusion. Decompression of the spinal canal with implantation of a stabilizing system (4-6 screws, 1-2 cages). Pituitary adenoma – transcranial and / or transnasal removal. Clipping of the aneurysm neck of the cerebral arteries. Removal of the cerebral cavernous angioma *. Removal of a neoplasm of the cerebral hemispheres using microsurgical techniques *. Microsurgical removal of the neoplasm of the meninges of the brain with plastics of the dura mater and calvarium with auto- or artificial implants *. Removal of neoplasms of the cerebellum and IV ventricle using microsurgical techniques. Meningeoma tentorium of the cerebellum – decompressive trepanation and tumor removal. Microsurgical removal of neoplasms of the meninges of the brain with plastics of the dura mater with auto- or artificial implants *. Arnold-Chiari anomaly – decompression of the cranio-vertebral spine, partial resection of the cerebellar tonsils. Tumor (fracture) of three vertebrae at the cervical level – resection of the vertebral bodies, anterior and (or) posterior fusion. Tumor (fracture) of three vertebrae at the lumbar and thoracic levels – resection of the vertebral bodies, anterior and posterior fusion. Transoral removal of the odontoid process and occipitospondylodesis. Removal of a herniated disc using video endoscopic technologies. * With this type of intervention, it is possible to use MR navigation. Anesthetic aid Total intravenous anesthesia (up to 30 minutes) 6,000 Total intravenous anesthesia (over 30 minutes) 11,000 Spinal Anesthesia 9 500 Combined endotracheal anesthesia (duration up to 2 hours) 11 500 Combined endotracheal anesthesia (duration from 2 to 6 hours) 17 500 Combined endotracheal anesthesia (duration more than 6 hours or for thoracic and cardiac surgery) 22 500 Spinal Epidural Anesthesia 13 500 Atralgesia 4,000 Local anesthesia 1 150 Epidural Anesthesia 8,000 Pathological studies Pathological and anatomical examination of biopsy (operational) material of the 1st category of complexity * 1 050 Pathological and anatomical examination of biopsy (operational) material of the 2nd category of complexity * 1 300 Pathological and anatomical examination of biopsy (operational) material of the 3rd category of complexity * 1 600 Pathological and anatomical examination of biopsy (operational) material of the 4th category of complexity * 1 800 Pathological and anatomical examination of biopsy (operational) material of the 5th category of complexity * 2 100 The calculation is carried out as follows: preoperative examination (1 c / d) + the number of c / d in the selected category of the ward + the number of c / d stay in the intensive care unit + operation of the corresponding category of complexity + anesthesia + pathological and anatomical examination operating material
Herniated disc: surgery, cost of removal in Moscow
Surgery to remove an intervertebral hernia in MedicaMenta
Removal of a hernia of the spine is a necessary measure of assistance when conservative treatment has not yielded results or the condition is dangerous to health.
The operation can effectively cure the pathology, significantly improve the patient’s condition. After its implementation, many note progress in restoring the functions of the limbs, the return of sensitivity, the complete relief of pain, the normalization of the pelvic organs.
Treatment of intervertebral hernia (removal, operation)
WHAT WE ARE READY TO OFFER
Modern methods of therapy
We carry out conservative (medication, blockade, physiotherapy, etc.)) and surgical treatment of diseases of the spine. Our doctors practice the most modern therapies. A great deal of experience has been accumulated in endoscopic and microsurgical operations for spinal hernias … which operations we perform
Modern technologies make it possible to carry out operations for herniated discs without extensive incisions, with minimal trauma and precision accuracy, which significantly reduces the risk of complications and shortens the recovery period.
Application of the latest equipment
We guarantee the use of only modern, high-precision and high-tech equipment during the operation. The operating room “MedicaMente” is equipped with the best models of technology, which allows performing operations on the spine of any complexity.
European type hospital
Depending on the type of operation, you will stay in the hospital under round-the-clock medical supervision for an average of 1-3 days.Cozy rooms, friendly staff will make your treatment as pleasant as possible.
MedicaMent successfully performs spinal surgeries (including for intervertebral hernias) of varying degrees of complexity.
Would you like to ask a question about your case?
The neurosurgeon will answer you within 48 hours
Hernia of the lumbar spine
The lumbar spine is the most common type of localization of intervertebral hernias among the population.
Endoscopic removal of hernia
The peculiarity of the endoscopic method is that all surgical procedures are performed through a small puncture on the skin (7-8 mm). This minimally traumatizes the tissues, muscles and bone structures of the spine, reducing the risk of scar-adhesions and complications that may occur with other types of operations.
Main advantages of the method:
- Conducted without incision, through a puncture
- Minor muscle injury
- Short hospitalization (3-5 days)
- Minimum severity of postoperative pain
Minimally invasive removal of hernia
The operation is performed with a small incision 2-3 cm long.Work on the spinal roots and intervertebral disc is performed through a special port that isolates the surrounding tissue from instruments and the external environment. Thus, the risks of infectious complications are minimal, and wound healing occurs practically without scar formation.
Main advantages of the method:
- Performed through a 2-3 cm incision
- Muscles and ligaments are not cut, but gradually spread apart
- Short hospitalization (3-5 days)
- Minor blood loss
Minimally invasive method for removing tissue of an intervertebral hernia using a high-speed jet of water (saline).After the procedure, the compression of the nerve, which is often the cause of significant pain and weakness in the back and legs, is eliminated. The manipulation consists in reducing the intradiscal pressure and reducing the pressure of the hernia on the spinal root.
Main advantages of the method:
- Minimally invasive approach (manipulation is performed without incision, through a puncture)
- Performed under local anesthesia
- Does not require long-term hospitalization
- Low number of complications (less than 0.1%)
* The method of surgical intervention is determined by the neurosurgeon during consultation and after examination.
Hernia of the thoracic spine
Herniated discs of the thoracic spine are rare (less than 1 case per 400,000 population). Indications for surgery to remove a hernia of the thoracic spine are spinal cord compression, weakness in the lower extremities, or pain in the spine.
Endoscopic removal of hernia
Through 3, sometimes 4 small skin incisions on the lateral surface of the chest, access to the chest cavity is made.With the help of an endoscope, a herniated disc is removed. The incisions are closed with a cosmetic suture.
Main advantages of the method:
- Minimally invasive approach (manipulation is performed through a small incision)
- Minor blood loss
- Minimum risks of developing an adhesive process in the pleural cavity
- Absence of intercostal neuralgia in the postoperative period
* The method of surgical intervention is determined by the neurosurgeon during consultation and after examination.
Hernia of the cervical spine
Hernia of the cervical spine in terms of frequency of occurrence is in second place after lumbar hernia and without appropriate treatment can lead to the development of serious pathologies. It occurs when there is a violation of the structure of the disc located between the vertebrae. The operation is necessary in cases where degenerative changes in the spine lead to a serious deterioration in the quality of life.
Endoscopic removal of hernia
Safe puncture access to the intervertebral disc is performed and endoscopic removal of the hernia is performed.The technique is acceptable in young patients, if there is no stenosis of the spinal canal at the cervical level.
Main advantages of the method:
- Minimally invasive approach
- Maintaining normal mobility in the spine
- The rehabilitation period does not exceed 1-3 days
The operation is performed by removing the disc through a small incision in the front of the neck.The herniated intervertebral disc is removed and a bone plate is inserted between the vertebrae so that the space between the vertebrae grows together.
Main advantages of the method:
- Minimally invasive approach
- There are no risks of recurrent disc herniation
- Short hospitalization (3-5 days)
- Minimum severity of postoperative pain
Safe percutaneous mini-access to the cervical spine is performed.Drilling of the intervertebral foramen, decompression of the spinal cord root and removal of the herniated disc of the cervical spine are performed.
Main advantages of the method:
- Minimally invasive approach
- Preservation of the intervertebral disc
- Presence of mobility in the cervical spine
- No risk of damage to the carotid artery, trachea and esophagus
* The method of surgical intervention is determined by the neurosurgeon during consultation and after examination.
Send us your MRI scans today!
The neurosurgeon will determine what kind of operation is needed in your case.
Intervertebral hernia Kharkiv | back hernia treatment
What is hernia ? This is the extrusion (protrusion) of the nucleus of the intervertebral disc into the spinal canal, as a result of which the integrity of the annulus fibrosus is disrupted.
Most often, herniated discs in the lumbosacral spine are diagnosed.Hernias of the cervical spine are less common, and hernias of the thoracic spine are the rarest. According to statistics:
• Hernias localized at the L5-S1 level in the lumbosacral region occur in 48% of cases;
90,044 • At the L4-L5 level – 46%;
• At other or several levels – in only 6% of cases.
The mildest condition is the protrusion of the nucleus of the intervertebral disc, in which there is no rupture of the annulus fibrosus, this is called protrusion.
Causes and signs of intervertebral hernias
The most common causes of intervertebral hernias are improper lifestyle, lack of prevention.What causes hernias in everyday life?
• Lifting weights, torsional loads (lifting weights with twisting), driving a car can also lead to deformation of the disc with subsequent herniation;
• With a sedentary lifestyle, the intervertebral disc does not receive nutrition, it dries up and loses moisture, becomes fragile. It can also be a hereditary increased risk factor;
• Protrusion of the disc is a physiological feature, with a mild manifestation, for example, in the morning a person has higher growth than in the evening after exertion and a working day.
Signs of a herniated disc are neurological disorders that occur due to compression of the spinal root. This is most often seen in people of working age. Before that, you can notice pain in the lumbar region, which occurs during physical exertion. To prevent exacerbations, we recommend adhering to an orthopedic regimen. (insert link to “10 Tips from Dr. Kostyuk)
Diagnosis of intervertebral hernia
Symptoms of an intervertebral hernia may not manifest themselves for several weeks, this may explain the spontaneous recovery, due to which remission occurs and there is no need for surgery.In other situations for diagnostics use:
1. MRI – magnetic resonance imaging;
2. MSCT – multislice computed tomography;
4. Invasive CT myelography.
If your condition has improved, but a hernia has been diagnosed, this may increase the risk of consequences in the form of formations like a radicular syndrome, for example, trauma and inflammation of the nerve roots of the spinal cord.
Surgical intervention is an extreme measure that is used when conservative methods of treatment have failed to improve the situation and relieve a person of pain.
Treatment of intervertebral hernia in Kharkov
Treatment of intervertebral hernia in Kharkov is carried out by a team of highly qualified specialists in the Clinic of Healthy Spine and Joints of Doctor Kostyuk. Conservative treatment consists of:
• Anti-inflammatory therapy;
• The use of anti-inflammatory drugs, both NSAIDs and hormonal;
• Muscle relaxants;
The aim is to reduce the inflammatory process at the site of hernia formation and reduce its impact on the root.Blockades also help to remove inflammation, we use:
1. Paravertebral blocks, which are introduced into the muscles that extend the trunk;
2. Epidural blockade – injections into the epidural canal, “under” the hernia.
At the same time, epidural blockade requires high qualifications and skills from the specialist who performs it, because the procedure is difficult from a medical point of view.
Resorption is the process of reducing the size of an intervertebral hernia.The immune cells that are produced during therapy recognize and destroy the foreign nucleus pulposus. This works in the case of inflammatory swelling, but with a newly formed hernia, it causes excessive pressure on the root in the period after an exacerbation.
During an acute period, it is necessary to stabilize the desired spine with an orthosis (orthopedic corset). After that, you will need rehabilitation according to the principle of treating osteochondrosis of the spine. By timely contacting the Clinic of Healthy Spine and Joints of Doctor Kostyuk, you will get rid of the pain syndrome and will be able to avoid surgery.
Microsurgery to remove a hernia of the spine
With the formation of an intervertebral hernia, the damaged disc compresses the nerve roots. This leads to severe pain and numbness in the limbs. Doctors prefer to treat this disorder with sparing conservative methods, but in difficult cases, surgery is often required.To normalize motor functions, the patient may be offered microsurgical removal of the hernia (microdiscectomy). Such operations are distinguished by minimal intervention in the body and a short (up to 1.5 months) rehabilitation period.
Indications for microdiscectomy. Advantages of method
Microsurgical removal of a hernia is possible in the presence of pathological formations in any part of the spine. Most often, hernias in the cervical and lumbar regions are treated in this way.The goal of neurosurgical surgery is to eliminate the pressure of the hernial protrusion on the nerve roots. This allows you to stop progressive pain, relieve swelling, and normalize motor functions. The risk of postoperative complications during microdiscectomy is minimal.
Other benefits of the treatment method include:
- High efficiency. In 95% of cases, it is possible to achieve a complete recovery of the body.
- Fast. The operation usually takes only 20-30 minutes. Long-term hospitalization is not required.
- Gentle pain relief. Epidural anesthesia is usually performed, which the body can tolerate more easily than general anesthesia.
How is microsurgical hernia removal performed?
For complaints of back pain, numbness of the limbs and decreased mobility, patients are prescribed laboratory tests and instrumental studies (CT, MRI, X-ray).If the diagnosis of “herniated disc” is confirmed, in unreleased cases, doctors first carry out conservative treatment. Microsurgical removal of the hernia is performed in the absence of positive results 4–6 weeks after the start of therapy.
For microsurgical removal of an intervertebral hernia, modern optical instruments and instruments for minimally invasive interventions are used.
The main stages of the operation:
- The patient is placed on his stomach or on his side.Anesthesia is performed.
- The doctor makes a small longitudinal incision (2-3 cm) in the area of the damaged disc.
- Under the control of a microscope, a dilator is inserted into the wound. The muscle fibers and the compressed nerve are gently pushed to the sides. The hernial mass is removed.
- The wound is sanitized, sutures and a sterile dressing are applied.
The return to the usual rhythm of life after microdiscectomy is faster than with major surgical interventions, but there are still some limitations.Within 1 month, you can not bend sharply, lift weights, sit for a long time. For a faster recovery, the patient is prescribed exercise therapy and physiotherapy procedures.
Painless microsurgical operations at the Central Clinical Hospital of the Russian Academy of Sciences
Intervertebral hernias are of different sizes and locations. The Central Clinical Hospital of the Russian Academy of Sciences treats all types of pathologies in any part of the spine. Neurosurgical operations require the highest skill of doctors. Our surgeons have sufficient experience and qualifications to perform such procedures.An individual treatment and rehabilitation program is developed for each patient.
You can find out about the cost of treatment in Moscow and make an appointment for a preliminary consultation online or by calling +7 (499) 400 47 33.