Disc Herniation: Surgical Options and Recovery Insights

Herniated disc

Hello Doctor, last month I went to the hospital for an examination due to lower back pain and found out that I have multiple herniated discs, with the first, second, fourth, and fifth discs being the most severe (the fourth and fifth discs are completely herniated on the MRI, while the first and second discs have about one-third of the space remaining).

1.
What is the current success rate for surgery?
2.
The doctor recommended two options: one is the use of screws, and the other is the placement of a dynamic stabilizer.
Which one is better?
3.
Among these two options, which one allows for more flexibility in post-operative activities?
4.
Additionally, I would like to ask if having a Japanese-style room with only a memory foam mattress will worsen my condition as a severe herniated intervertebral disc (HIVD) patient? Also, is post-operative rest appropriate?
5.
In the future, should I be extremely cautious about all activities such as bending, lifting heavy objects, driving, and sitting, to avoid any slight improper posture, including exercise, to prevent recurrence?
6.
I consulted a neurosurgeon; is there a difference in how herniated intervertebral discs are treated by orthopedic versus neurosurgical specialists?
I apologize if I have repeated or offended in any way, and I greatly appreciate your attention and answers.

Liu Xiansheng, 30~39 year old female. Ask Date: 2020/03/23

Dr. Lai Zhaokang reply Neurosurgery

1.
Over 90% improvement is achievable, with a safety rate of over 99% (unless there are specific underlying conditions) (##but this depends on the surgical method you ultimately choose##).

2.
It is essential to review your imaging and symptoms.
The benefits of the product come with drawbacks.
There is no one-size-fits-all; it should be about what is most for you.
This requires an evaluation by a specialized spine physician with professional experience.

3.
Different materials are available: silicone, PEEK, titanium alloy...
It is important to choose the one for your needs.

4.
A lower-profile approach may not be ideal for lumbar spine care.

5.
Once the appropriate surgical method and product are selected, after three to four months of healing post-surgery, I will allow my patients to return to normal activities, but they should avoid heavy lifting to prevent recurrence.

6.
In Taiwan, lumbar spine surgeries are currently performed by neurosurgeons or orthopedic surgeons.
However, each specialty has its own focus, and each physician has varying levels of expertise and experience.
The intricacies of the procedure can differ significantly (similar to how different chefs prepare a dish like scrambled eggs with tomatoes, from selecting ingredients to cooking and serving, resulting in different tastes and digestibility).

7.
Choose a physician you feel you can trust.
Best wishes.
// Dr.
Lai Chao-Kang, Chief of Spine Neurosurgery.

Reply Date: 2020/03/23

More Info

Understanding disc herniation, particularly in the context of surgical options and recovery, is crucial for patients experiencing significant discomfort and functional limitations. Based on your situation, where you have multiple herniated discs, particularly at the L4-L5 and L1-L2 levels, let’s address your questions comprehensively.

1. Surgical Success Rates: The success rate for surgery related to disc herniation varies based on several factors, including the specific surgical procedure performed, the surgeon's experience, and the patient's overall health. Generally, discectomy, which is the surgical removal of the herniated portion of the disc, has a success rate of approximately 80-90% in relieving leg pain and improving function. However, the success rate can be lower for patients with multiple herniations or those who have had previous surgeries.

2. Surgical Options - Steel Pins vs. Dynamic Stabilizers: The choice between using steel pins (fusion surgery) and dynamic stabilizers (which allow for some movement) depends on the specific nature of your disc issues and your lifestyle needs. Fusion surgery provides stability but can limit mobility in the affected segment of the spine. Dynamic stabilization, on the other hand, aims to maintain some range of motion while providing support. The best option for you should be discussed with your surgeon, considering your activity level, age, and specific spinal condition.

3. Postoperative Activity: In terms of postoperative activity, dynamic stabilization typically allows for more flexibility compared to fusion. Patients with dynamic stabilizers may experience less stiffness and retain more functional movement, which can be beneficial for rehabilitation and daily activities. However, the exact outcomes can vary based on individual healing and adherence to rehabilitation protocols.

4. Living Environment and Recovery: Regarding your living situation, a memory foam mattress can provide better support and comfort, which is essential for recovery. However, if your room setup requires you to sit or lie in positions that exacerbate your pain, it may hinder your recovery. It’s crucial to create an environment that promotes proper posture and minimizes strain on your back. Post-surgery, adequate rest and gradual reintroduction of activities are vital for healing.

5. Activity Precautions: After surgery, it is essential to be cautious with movements that involve bending, lifting heavy objects, or prolonged sitting. These activities can increase the risk of re-injury or exacerbation of symptoms. Engaging in physical therapy and following your surgeon's guidelines for activity restrictions will be crucial in preventing recurrence.

6. Specialist Consultation: Consulting with a neurosurgeon versus an orthopedic surgeon can yield different perspectives on treatment. Neurosurgeons often focus on the nervous system and may have more experience with nerve-related issues, while orthopedic surgeons specialize in the musculoskeletal system. Both can effectively treat disc herniation, but your choice may depend on your specific symptoms and the recommendations of your primary care physician.

In conclusion, navigating the complexities of disc herniation and its treatment requires a collaborative approach with your healthcare team. It’s essential to weigh the benefits and risks of each surgical option, consider your lifestyle and recovery environment, and adhere to postoperative care guidelines to optimize your recovery. Always feel free to ask your healthcare provider any questions or express concerns you may have about your treatment plan. Your proactive engagement in your health care is vital for achieving the best possible outcomes.

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