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Fig. 1: Artists rendering of herniated disk
Fig. 2: CT scan showing herniated disk
Fig. 3: MRI showing herniated disk |
The lumbar intervertebral disk
is made up of a fibrous outer ring called the annulus and a gelatinous inner
portion called the nucleus (fig. 1). The disk acts as a cushion between the
vertebral bodies. When herniation occurs, the nucleus pushes through the
annulus of the disk producing pressure on the nerve root and/or cauda equina.
This is demonstrated on the CT scan (fig. 2), the MRI
(fig. 3) and the myelogram
(fig. 4). Nearly all patients complain of leg pain (sciatica) in the
distribution of one or more nerve roots. Some have back pain as well.
Frequently, patients can be treated conservatively with success. However,
when their ability to perform normal day to day functions is degraded for a
substantial period of time (4-6 weeks), or in the presence of progressing
neurological deficit (i.e. foot drop, loss of control of bowel and bladder,
cauda equina syndrome), lumbar microdiskectomy is the most effective
treatment. During microdiskectomy, the offending disk fragment and much of the loose nucleus are removed through a small, one to two inch incision (figs. 5-8). With success rates of around 90%, patients are able to return to work and full activity in an average of about 10 weeks. Our group has the most extensive experience in Western New York performing outpatient microdiskectomy. In the past 3 years, we have performed more than 1000 of these procedures successfully. Patients prefer this to overnight stay in the hospital. |
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Fig. 4: Myelogram showing herniated disk |
Fig. 5: The incision is small, one inch in
most cases |
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Fig. 6: Spine Exposed |
Fig. 7: Herniated disc material is removed |
Fig. 8: Disk removed and nerve root
decompressed |
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