To provide an insight into our surgical techniques, the procedure for two standard operations for herniated discs in the cervical and lumbar spine is described in the following. To simplify things, the height and number of segments affected do not play a role here.
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Standard procedure for herniated discs
Surgical treatment of herniated discs on the lumbar spine is performed microsurgically. As a rule, access is made from the dorsal side with the patient in the prone position. After a skin incision of approximately two to three cm has been made, the individual tissue layers are gradually exposed and the herniated disc is visualised under the surgical microscope with the necessary depth of field. It is important here to differentiate precisely between segmental nerve and herniated disc, and also between muscle insertions, joint structures and vessels. Furthermore, using a surgical microscope helps to avoid injuries to the dura mater. Only after all relevant structures have been prepared and the anatomical conditions have been clearly visualised, is/are the herniated disc or constricting intraspinal bony structures removed; the latter are removed using special microsurgical fraises or forceps. The aim, in any case, is to gently relieve the affected nerve roots without provoking any instabilities caused by surgery. After the microsurgical decompression measures have been checked, the surgical site is gradually closed.
We also operate microsurgically on the cervical spine. Access is made with the patient in the supine position ventrolaterally on the right or left, depending on the affected side. When it comes to using a microsurgical technique to protect surrounding structures, the criteria for the lumbar spine also apply here. The difference, however, is that we use either a cage in the affected disc segment or also disc prostheses in younger patients. This leads to stabilisation of the affected motion segments and prevents post-operative instabilities. After the position of the implants has been checked, the wound is closed in a similar way to the lumbar spine. The skin suture is subcutaneous, that is, cosmetic.
The minimally invasive surgical technique enables fast mobilisation of the patient. On the day of the operation, the patient is motivated to get up independently and shown suitable movements sequences to perform. The muscle-strengthening post-operative care and structured therapy plan starts on the following day.
The clinic stay usually ends after three to five days.