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What is spinal hernia?

A bulge in the intervertebral disc

Spinal disc herniation is a bulge in an intervertebral disc. This bulge presses on a sciatic nerve, thus causing pain in a patient’s leg, which may or may not be accompanied by symptoms of neuropathy (numbness or loss of strength).

Normal back

Normal person

Patient suffering from spinal hernia

Patient suffering from spinal hernia

Hernia operations are among the procedures most frequently carried out by neurosurgeons. Out of nearly 11,000 hernia operations performed in the Netherlands each year, over 9,000 are carried out by neurosurgeons.

The cause of backache is unclear

What happens even more often is that neurosurgeons will see patients suffering from backache. In many cases, it will be unclear at first whether a patient’s backache is caused by a hernia. Doctors used to assume that this was the case. However, these days, it is generally believed that degeneration of an intervertebral disc may contribute to the onset of backache.

Some hernias do not present with pain symptoms. A hernia typically presents with pain radiating down one leg, since the hernia causing the pain is generally to one side of the spine. However, hernias do occur in the middle of the spine, which may cause pain radiating down both legs.

Causes of a spinal hernia

Degeneration of an intervertebral disc

Degeneration of an intervertebral disc is a normal process that occurs in all of us to some extent. Heavy work involving frequent bending over and lifting of heavy objects may put a person at an increased risk of developing backache, but will not cause a hernia. Hernias occur in equal measure in people performing manual labour and in people who have office jobs. What is notable is that smokers require spinal hernia surgery much more often than non-smokers, and that surgeries performed on smokers tend to be less successful than those performed on non-smokers. Persons with jobs involving a lot of sitting, e.g. drivers and office workers, are especially prone to hernias.

A hernia can affect anyone

If an intervertebral disc degenerates, it may start bulging, or alternatively, its outer ring may tear, thus causing pieces of the soft core to be pressed through this tear, towards the spinal canal. Generally speaking, the ring will tear in its weakest spot, which happens to be the spot where the sciatic nerve branches off the spinal canal. A hernia can affect anyone, and we do not know why some people are affected while others are not. However, it is known that some families are more prone to hernias than others.

Symptoms of a spinal hernia

Generally preceded by backache

Generally speaking, the onset of a hernia is preceded by backache. The great majority of patients will have experienced lumbago. However, a spinal hernia does not just affect the back, but radiates down a leg and may present with numbness or pins and needles. The pain affects the area served by the sciatic nerve, on which the hernia is pressing. Pressure on this nerve may also result in a loss of strength in a leg or foot muscle.

Paralysis or a tingle

Nerves serve a dual function: they serve the muscles, but also an area of skin. Each nerve serves its own muscle and area of skin. Affected nerves may cause paralysis of one or multiple muscles, numbness or tingling. Since coughing, sneezing or straining causes the pressure in the spinal canal, and therefore the pressure exerted on the sciatic nerve, to increase, the pain radiating down the leg may temporarily become more intense. We can often tell from a patient’s description of his leg ache and of the nature of any loss of strength that may have occurred which nerve has been affected.

Diagnosis of a spinal hernia

Neurological examination and medical imaging

Following the neurological examination, we perform a medical imaging procedure to determine whether the pain in a patient’s leg is indeed caused by a bulging intervertebral disc. Generally, an MRI scan of the spine is the type of medical imaging procedure performed when a doctor suspects a spinal hernia.

At our clinics, MRI scans can either be performed at once or soon after the patient’s intake interview. MRI scans have the advantage of being able to create an image from three directions, and to render the intervertebral disc itself visible, in a manner which tells us more about the extent of its degeneration.

Diagnosis of a spinal hernia

Diagnosis of a spinal hernia

MRI of the spine

MRI of the spine

Surgery of a spinal hernia

Not every hernia requires surgery

Some 70 to 80% of all hernias heal of their own accord, following rest and physiotherapy. In other words, patients must not rush into surgery. On the other hand, the recovery process may take longer if a patient waits too long before undergoing surgery. Generally speaking, surgeons will wait at least six weeks before operating on a patient (unless there is an indication for emergency surgery), but will want to perform surgery within 6 months of the onset of the pain (if the pain lasts that long).

Surgery of a spinal hernia

Surgery of a spinal hernia

So what happens when I undergo surgery?

Click the button below for some general information on operations performed by Dr Schröder.

More information on surgery

Risks of spinal hernia surgery

Potential post-operative complications

Like any other operation, spinal hernia operations carry a few risks. However, complications are highly unlikely to occur. After all, spinal hernia surgery is performed at our clinics many times a year.

Even so, we may encounter some neurological failure after the operation, which is generally caused by the surgeon’s having had to manipulate a nerve that had been compressed for a long time. Common risks also include inflammation of the wound or a wound that does not heal properly. Subsequent bleeding is a much more rare but problematic complication. The well-known cerebrospinal fluid leak is another, none too severe complication. A fluid leak is a tiny tear in the sac that holds the cerebrospinal fluid. When this happens during surgery, the leak will be sealed at once, and it will not have any lasting consequences. In very rare cases a tear may continue to leak after having been sealed. If this happens, the tear will have to be resealed at a later stage.

After surgery of a spinal hernia

Tips from a physiotherapist

Following the operation, the patient’s follow-up appointments will be with a physiotherapist, who will provide some useful tips to help the patient load his back and make a full recovery while the patient is still at our clinics. Typically, patients are able to walk again the day after their operation. They are free to go home, then, depending on the size of their wound.

Follow-up examination

Two weeks after the operation, we will ring the patient for a phone check-up during which we will discuss his or her current condition. Generally, the patient will be told on this occasion that s/he is allowed to resume normal activities and increase the load on his or her back. If the patient is already experiencing a clear improvement, no further steps will have to be taken at this point.

Resuming exercise and returning to work

Patients will be allowed to undergo supervised physiotherapy upon their discharge from the clinic if they are in a poor physical condition or afraid to resume movement. Embarking on an intensive back and abdominal muscle training programme soon after the operation is not recommended, as the back muscle will not have full pulling force for the first 3 to 6 months following surgery. The duration of the post-operative recovery period varies from patient to patient. Whether or not a patient will be allowed to return to work soon after his or her operation obviously depends on the nature of the person’s duties. Patients should always listen to their bodies and take a break when their bodies tell them they have had enough.

Patiënt testimonials

Many patients like to share their experiences with people who experience similar conditions, but have not yet had surgery.

Read some of the patient testimonials treated by Dr Schröder.

View all testimonials

Vorige
  • Treatment of a neck hernia

    03 August 2015

    A. van Raay's testimonial

    “Several neurosurgeons didn’t want to risk it. Dr Schröder immediately saw the nature of my problem, and a week later I went under the knife.”

    Read more

  • Treatment of a neck hernia

    23 July 2015

    Friso de Bruin's testimonial

    “I had an appointment with Mr Schröder on 29 June, and after having a good and clear conversation with him, an operation was scheduled for 8am on 2 July.”

    Read more

  • Treatment of a neck hernia

    16 June 2015

    Leo's testimonial

    “He provided excellent information on the procedure he was going to carry out and the risks I’d have to take into account. Partly because of this, I went into the operation with great confidence.”

    Read more

  • Treatment of a spinal hernia

    09 June 2015

    C.M. Boogaard-van der Kreeft's testimonial

    "Dr Schröder performed my operation. The operation went well. The pain in my hips and legs was gone at once."

    Read more

  • Treatment of a neck hernia

    27 May 2015

    B. Schrooders's testimonial

    “After undergoing ‘treatment’ at CWZ for nearly 10 months, and having tons of nerve blocks administered, I quit, requested my file and conducted a Google search. I ended up on Bergman Clinics.”

    Read more

Volgende

The neurosurgeon

Dr Schröder first registered as a certified neurosurgeon in 2001. From 1 October 2001 to March 2003, he served as a registrar at Haaglanden Medical Centre’s neurosurgery unit in The Hague. Afterwards, he worked at Amsterdam’s Slotervaart Hospital’s neurosurgery unit from March 2003 to October 2010.

Meet Dr Schröder

Dr Schröder's blog

Dr Schröder regularly publishes new articles on his blog. Read all about spinal hernia, neck hernia, spinal stenosis, neurosurgery and other related subjects.

View all blog posts

  • 13. On coincidence, bad luck and science

  • 12. Dozing off

  • 11. The Big Spinal Quiz for the articulate patient

  • 10. Sherlock Holmes and Dr Watson

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