In medical service, Bank pain is one of the most common symptom to treat by physicians. Patients with back pain may experience differently than one another. They always wonder whether they should go to see the doctor for this pain or it will dissolve with time. It will be easy to take a decision if the composition of back and the common sources of pain are known. These information will lead towards proper treatment.
Back is composed by many structures such as muscle, ligaments, spine, disc that absorbing the load to spine, nerve and spinal cord. These basic structures play the key role as pain generators. Patients who have back muscle and ligament pain are characterized by the present of trigger points and pain normally occur during the movement of those affecting muscle. On the other hand, pain from disc has a distinct characteristic. It normally causes back pain, mostly during flexion, with sitting intolerance for a period. If the disc is ruptured, risk of nerve impingement increases. The symptoms of nerve impingement can be a combination of back pain and leg pain (usually unilateral), which would be discussed in this article.
Causes of disc rupture and herniation varies. Most common causes for disc rupture are heavy lifting, trauma or degeneration. Treatment of the herniation can range from medication such as NSAID or Gapapentin inhibitors with physiotherapy to surgery. In the recent years, the surgical treatment of such pathology is shifting from open surgery (still a standard treatment) to more minimally invasive surgery. Surgeons can now remove the herniated fragment using endoscope. This makes the incision smaller (less than 1 cm) and causes less damage to the surrounding soft tissue which leads to quicker recovery with less scarring. Patient can get discharge from hospital within 24 hours after the surgery.
Endoscopic disectomy which is also
known as PELD, is one of the best option for acute disc herniation without any signs and symptoms of spinal instability or disc calcification. The procedure is performed under local anesthesia with conscious sedation in most of the cases to communicate with patient during procedure which possibly increases the safety from accidentally damaging of the nerve. The approach of the procedure depends on the level of affecting disc and location of the fragments. Surgeons can use interlaminar, transforaminal or transiliac approach which are tailord to suit the individual pathology. After establishing the working portal, endoscope is inserted and surgeons can see the herniation or any disc pathology through the lens at the tip of the scope that is projected on the screen. At this point, surgeons can remove the pathology by using grasping forceps for obvious fragments or Ho-YAG laser for inflammatory tissues.
The result of the procedure depends on
many factors but overall result is comparable to standard treatment. Training and experience of the surgeon are also important for better outcome due to steep learning curve of the procedure.