'4' Principles for Back Health: Effective treatment for aged and chronic disc patients?
Nov 12, 2024
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Intervertebral disc herniation can usually be treated with conservative treatments such as medicine or physical therapy. However, if the pain continues to be severe enough to interfere with daily life or if there are symptoms of paralysis, surgical treatment is considered. Spinal surgery has been burdensome due to concerns over side effects or aftereffects in the past, but in recent years, bilateral spinal endoscopy has made safer and more accurate surgery possible. We will learn more about the symptoms and treatment of intervertebral disc herniation with Professor Son In-seok of orthopedic surgery at Gangdong Kyunghee University Hospital.
◇Movement with the 'Spine' Intervertebral Plate
The spine serves as a central axis of the body, not just a joint, for humans who walk upright as pillars of our body. As a pillar of the body, it connects the body and the head, maintains balance, and protects the spinal cord (nerve) from the brain. It consists of vertebrae, intervertebral disc, ligaments, and muscles, and has limited movement compared to other joints. To compensate for this, the intervertebral disk (disc), a cartilage tissue between the vertebrae, acts in combination to form the movement of the spine.
◇Disease caused by damage to the intervertebral disc fiber wheel
The intervertebral plate consists of the inner male nucleus and the outer fibrous ring.
The official name of the disease, commonly called the disc, is 'intervertebral meningiosis', which is a disease in which the inner meninges escape and compress the nerves as the fiber ring of the intervertebral disc is damaged. In the event of intervertebral disc herniation, the patient complains of radiating pain (mostly in one direction) that extends to the leg rather than back pain. In severe cases, it may result in decreased leg sensation or muscle strength. In general, the most common area of lumbar spine is the joint between lumbar vertebrae 4 and 5, and it is also common in the joint between lumbar vertebrae 5 and sacral 1, and between lumbar vertebrae 3 and 4.
◇ Treatment goals are pain relief and nerve compression removal
Human joints are partially regenerated, but they are generally more like consumables. The hip joint (intervertebral disc) also does not recover well once damaged. The nucleus that escaped from the intervertebral disc may also be absorbed with low probability, but the broken intervertebral disc does not recover to normal. Therefore, in general, the treatment of intervertebral meningiosis aims to relieve △pain and eliminate △nerve compression.
◇ Symptoms can be improved with conservative treatments such as drug, physical, and injection treatments
Most patients with intervertebral disc herniation perform conservative treatments such as medication, physical therapy, and injection therapy. By relieving pain and suppressing the secretion of inflammatory substances, it can calm swelling of surrounding tissues and improve nerve pressure.
Neuroplasty, commonly known as procedures, or intervertebral balloon plastic surgery can also be controlled through direct cleaning of the lesion and temporary space expansion. However, if the pressure is so severe that such treatment does not improve, surgical treatment is performed to remove the underlying lesion.
◇ Less burdensome surgery 'Bilateral spinal endoscopy'
Intervertebral disc herniation surgery is performed when nerve paralysis is severe, and daily life is impossible due to severe pain. The surgical method is to remove the nucleus that is pressing against the nerve. In the past, after general anesthesia, the skin was incised, and a part of the spine (the appendix) covering the joint was excised, and the escaped nucleus was removed. The burden on the patient was high due to bleeding and anesthetic side effects caused by large incision. Recently, many bilateral spinal endoscopy have been performed to reduce the burden on this.
◇ Minimize surgical complications such as infection, bleeding, and pain with minimal incision
Two-way spinal endoscopy is a surgery performed by making two minimum 1cm incision windows at the surgical site, inserting a high-definition endoscope on one side and a surgical tool on the other. Minimized incision reduces damage to normal tissue to the minimum, and the lesion area can be accurately checked and operated through a monitor, minimizing surgical complications such as infection, bleeding, and pain, and shortening the recovery period. Depending on the situation, surgery can be performed without general anesthesia, which is also useful for elderly patients with internal diseases or chronic diseases.
◇ Postoperative care is also very important
Patients with intervertebral disc herniation should not be relieved that the treatment has been completed and the pain has disappeared. This is because the management of the waist after surgery is more important. Once damaged, intervertebral plates are highly likely to recur, and degenerative changes progress faster than healthy people, which can lead to diseases such as stenosis or spinal anterior dislocation in the future. Misguided lifestyle habits and postures can make this progression even faster.
※Four principles for waist health
- They live a life of height such as chairs and beds rather than floor life. The posture of bending the waist and squatting does not help the waist.
-Avoid sitting or standing in one position for a long time. Keeping it in the same position for more than an hour puts a burden on your back.
-I walk on the flat for more than an hour a day. Walking exercises strengthen the standing muscles of the spine, maintaining the fullness of the spine and reducing the pressure on the intervertebral disc.
-Weight loss and smoking cessation. Tobacco reduces water in the water nucleus, causing loss of elasticity and damage to the intervertebral disc. Excessive weight also increases the pressure on the intervertebral disc, causing damage.
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