NOT EVERY BACK PAIN IS A HERNIATED DISC. - KISS. DR. HUSEYIN CANAZ

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Low back, neck and back pain are among the most common reasons for consulting a doctor. Chronic spine pains and underlying pathologies cause worldwide loss of work, job changes and disability retirement. Chronic low back pain can occur in the person for various reasons. Although hernia is the most known and feared cause of low back pain in the society, it is only one of the underlying pathologies. Other causes include fibromyalgia, rheumatic diseases, scoliosis and other deformities, facet joint disorders, age-related degenerative changes in the spine, osteoporotic collapse fractures.

Today, the purpose of treating low back, neck and back pain is to reduce pain by maintaining anatomical integrity and mobility, and to return the patient to daily life as soon as possible.

The main treatment methods are:

• Physical therapy and rehabilitation
Analgesic, anti-inflammatory, muscle relaxant drug treatments
• Minimally invasive interventions (facet joint blockage, facet joint radiofrequency ablation, epidural injection, nucleoplasty)
Vertebroplasty
• These are herniated disc and neck hernia operations.

Minimally Invasive Methods Without Surgery Can Be Used For The Treatment Of Low Back Pain.

Minimally invasive interventions are increasingly used in Europe and North America for patients who do not have advanced pressure on the nerve roots to the spinal cord and legs, and do not need a herniated or neck hernia operation.

The benefits of minimally invasive interventions include the fact that the anatomical integrity of the muscle structures around the spine and spine is not disrupted, the rest period after the procedure is very short, the use of long-term medication, the need for physical therapy and rehabilitation, the patient's return to work, daily and social life in a short time. Although the risks and complication rates of minimally invasive procedures are very low compared to surgical treatments, they are not completely risk free methods. Infection, nerve damage, bleeding are the main problems that can be seen and in order to avoid them, they should be applied by experienced neurosurgeons and algologists in centers with adequate equipment.
Minimally Invasive Treatment Methods Performed Without Surgery

Facet Joint Injection (Blockage):

The joints on both sides of the adjacent vertebrae that give the spine a movement feature are called facet joints. As a result of arthrosis, inflammation, trauma or heavy physical activity, the structure of these joints may be disrupted and chronic pain may occur due to this. The table that is followed by the painful movements of leaning or turning the waist back, right, left or left is called facet syndrome. Having low back pain when standing up or turning in bed after sitting for a long time is typical for this syndrome.

During the injection, a mixture of steroids and local analgesics is injected around the medial nerve, which senses the sensation of pain in the facet joint.

It is observed that the pain decreases significantly in the periods ranging from 2 to 6 months after the intervention.

Facet injection is not applied to patients with active systemic infection, local infection at the injection site, suspected pregnancy or pregnancy, bleeding disorder or using blood thinning medication.

Facet joint injection is an application with low side effects and risks. However, there are risks of nerve injury, hematoma development, and infection development. In addition, due to the systemic effects of the injected steroid, water retention in the body and impaired blood sugar regulation in diabetic patients can be observed temporarily.

Facet Joint Radiofrequency Ablation:

It is the process of burning the medial nerve endings using radiofrequency, which is responsible for the sensation of the facet joint in patients with disrupted structure of the facet joints and chronic pain associated with it. After the procedure, the patient's pain begins to decrease immediately, but it may take 1-2 weeks to see the optimum effect. The effect of the procedure continues on average 8-12 months in beneficial patients.

Facet joint radiofrequency ablation is not applied to patients with active systemic infection, local infection at the injection site, suspected pregnancy or pregnancy, bleeding disorder or using blood thinning medication.

The frequency and risk rates of this procedure are very low. Rarely observed side effects are burning, hypersensitivity or numbness in the entrance area. These are temporary effects and usually disappear within 2-3 days. In addition, infection, bleeding and nerve damage are among the possible risks.

Nucleoplasty:

It is the process of shrinking the disc material that begins to hernia using radiofrequency ablation method in patients with long-term back pain due to disc protrusion (beginning of the herniated disc). It can be used for the treatment of patients who do not respond to medical treatment for 6 weeks or more and who have low hernia hernia onset at MR imaging less than 33% of the spinal canal.

Success rates after nucleoplasty vary between 50-80% in different series.

The nucleoplasty method is not an alternative for herniated disc surgery. Spinal pathologies such as extruded and sequestrated hernias, herniations exceeding 33% of the spinal canal, loss of more than 50% of the height of the disc, spinal canal stenosis, spinalylosthesis in the waist bones constitute a contraindication for the nucleoplasty procedure. In addition, it should not be done in cases where the patient has systemic infection and affects blood clotting.

The main risks of nucleoplasty are infection, bleeding and nerve damage.

Epidural Steroid Injection

It is the process of injecting the steroid and local analgesia by reaching the epidural space (the outer part of the spinal cord) with a needle. It is aimed to relieve pain by reducing inflammation and edema in the nerve roots in patients with disc herniation, spinal canal narrowing or slipping in the waist bones. Epidural steroid injection is not an intervention for the treatment of the above mentioned pathologies, it is a method used only for pain control.

Epidural steroid injections are not administered to patients with active systemic infection, local infection at the injection site, suspected pregnancy or pregnancy, bleeding disorder or using blood thinning medication.

Although it has a low side effects and low risk, there are risks of nerve injury, hematoma development, infection development, intracranial hypotension due to cerebrospinal fistula. In addition, due to the systemic effects of the injected steroid, water retention in the body and impaired blood sugar regulation in diabetic patients can be observed temporarily.

Kiss. Dr. Huseyin Canaz
Brain and Nerve Surgery
Medilife Bağcılar Hospital