What is a Disc Herniation?
A disc herniation occurs when the soft, gelatinous core (nucleus pulposus) of an intervertebral disc protrudes through tears in its outer fibrous ring (annulus fibrosus). This protrusion can press on nearby nerve roots or the spinal cord, leading to severe back pain, radiating pain, sensory disturbances, or even paralysis.
It most commonly affects the lumbar spine (lower back), followed by the cervical spine (neck). The thoracic spine (mid-back) is less frequently involved. Typical symptoms include:
- Localized or radiating pain (e.g., sciatica or brachialgia)
- Tingling, numbness, or a "pins and needles" sensation
- Muscle weakness or signs of paralysis
- Restriction of movement, protective posture, muscle spasms
Common causes include degenerative processes, improper or excessive loads, physical inactivity, obesity, or genetic predisposition.
Conservative treatment is the first step towards recovery
In most cases, herniated intervertebral discs are successfully treated without surgical intervention. Conservative treatment aims to relieve pain, reduce inflammation, restore mobility, and return to daily activities. Methods include:
- Medication treatment (for example, non-steroidal anti-inflammatory drugs, muscle relaxants, corticosteroids)
- Physical therapy (for example, manual therapy, medical exercise programs)
- Thermal and electrotherapy
- Back school, posture training, and movement therapy
- Image-guided injection therapies (for example, periradicular injections)
Under medical supervision and with consistent application, the disc can often stabilize. Symptoms often disappear within a few weeks.
When is Surgery Necessary?
Surgical intervention is considered when:
- Conservative treatment does not lead to an improvement in symptoms after several weeks
- Symptoms of paralysis appear or worsen
- Bladder or bowel dysfunction (cauda equina syndrome) is present – requiring urgent action
- Chronic pain persists despite therapy, significantly limiting daily life
Microsurgical Discectomy – Minimally Invasive, Precise, Tissue-Preserving
In surgical approaches, microdiscectomy is now considered the gold standard. This procedure involves the removal of herniated disc material through a small skin incision under an operating microscope, minimizing damage to surrounding tissues.
Advantages of the microsurgical technique:
- Small surgical access, usually 2–3 cm
- Preservation of muscles and soft tissues
- Use of modern microscopes and visualization methods
- Low risk of scarring and instability
- Short hospital stay, quick mobilization, and rehabilitation
The goal of the surgery is not only to relieve pain but also to decompress the affected nerve roots to prevent loss of function and avoid long-term damage.
Subsequent monitoring and long-term forecast
After successful conservative or surgical treatment, active patient participation is crucial. Back exercises, ergonomic behavior, muscle strengthening, and regular movement play significant roles in preventing recurrences.
In the long term, the prognosis for intervertebral disc herniations is favorable if they are detected in a timely manner, treated individually, and a healthy spinal culture is adopted.
