Intervertebral Disc Herniation: Overview & Treatment
Introduction
The spine is made up of small bony segments called vertebrae. These vertebrae are categorized into cervical or neck vertebrae, thoracic (upper back), lumbar (lower back) and sacrum. A cylindrical bundle of nerve fibers called the spinal cord passes through the entire vertebral column and branches out to the various parts of our body.
Cushioning discs present between the vertebrae act as shock absorbers that redistribute the forces acting on your vertebrae when you walk, run, bend or twist.
These intervertebral discs are made up of two types of cartilage: the inner pulpy cartilage known as nucleus pulposus, which is surrounded by concentric layers of fibrous cartilage known as annulus fibrosis. When this cartilage in the center of the disc protrudes through small tears in the hard-outer covering of the disc, the nerves passing through the spinal cord can become compressed or pinched, causing severe pain and deformity.
This is known as disc herniation.
Minimally Invasive Microdiscectomy or METRx Discectomy
Minimally Invasive Microdiscectomy or METRx Discectomy uses microscopic or endoscopic techniques to access and remove this herniated disc, and relieve pressure on the compressed nerves.
Disease Overview
Aging – As you age, gradual wear and tear occurs to the spinal discs, causing them to lose water content. This makes them more susceptible to rupturing or tearing.
Heavy Lifting or Minor Trauma – Any heavy lifting or minor trauma can cause disc herniation.
Most disc herniation occurs in the lumbar spine, causing debilitating pain in your buttocks, thigh and calf areas. Herniated discs in the cervical spine cause pain in the shoulder and arm.
Other symptoms associated with a herniated disc include numbness and tingling, or weakness in the region served by the pinched nerve. Symptoms of disc herniation can be alleviated by surgically releasing the herniated disc through a surgical procedure called a Minimally Invasive Microdiscectomy.
Indications
METRx is indicated in most commonly for disc herniation. However, it can also be used for:
- Laminotomy: partial excision of the thin bony plate of the vertebra;
- Medial Facetectomy: removal of the facet joint that guides the movement of spinal bones;
- Foraminotomy: expanding a foramina or bony opening to allow clearance of nerves;
- Nerve Root Retraction.
Surgical Procedures
Minimally Invasive Microdiscectomy or METRx Discectomy is usually performed on an outpatient basis under spinal or general anesthesia. You will be lying on your stomach during the procedure.
The Neurosurgeon will use live-action X-ray called Fluoroscopy, to accurately visualize your spine and locate your herniated disc. Under the guidance of the fluoroscope, your surgeon will insert a small needle called a guide wire through the skin and muscles in your back to the diseased area.
The needle is withdrawn and a half-inch skin incision is made over the area to be treated and dilators are inserted sequentially. The dilators create a tunnel, leading to the affected disc by splitting the back muscles instead of cutting them. Retractors are used to hold the tunnel open, and a microscope and special surgical instruments are inserted.
Viewing through the microscope, your surgeon trims and removes the diseased disc using special cutting instruments. After completion, the retractors are removed and the muscle fibers joined back together. A small strip of adhesive bandage is applied over the incision site at the completion of the procedure.
Post-operative Care
You will be prescribed pain medications to relieve immediate postoperative pain. Cold packs may be applied as instructed for pain relief.
Your Doctor will educate patient on gentle stretching, strengthening and conditioning exercises to be performed during the postoperative period.
Advantages and Disadvantages
METRx Discectomy is performed using a minimally invasive muscle splitting technique. The muscles are separated along their natural divisions, and not cut or removed to access the underlying spine.
This causes very little damage to the soft tissues and reduces postoperative pain, and wound healing problems and hastens recovery.
Risks and Complications
Some of the potential risks associated with the METRx system, include the need for transitioning to an open procedure, damage to the surrounding nerves and soft tissues, infection and blood loss.
Summary
METRx discectomy is a minimally invasive procedure to treat a herniated disc.
Because the back muscles are not cut, but instead are separated, the postoperative period results in a faster recovery and early return to your normal everyday activities when compared to traditional open surgery.
