Lumbar Disc Herniation

What causes a lumbar disc herniation?

lumbar disc herniation los angeles, los angeles spine surgery, los angeles spine treatment, herniated disc los angelesThe natural curvature of the spine provides the skeleton with strength and stability. The curves act like a spring in a coil and distribute the mechanical stress as the body moves. Unfortunately, because the lumbar spine carries the bulk of the body's weight, it is more prone to injury. As discs age, they lose their water content and begin to degenerate. The annulus fibrosus (outer ring), may also be damaged through general wear and tear or by injury in which the nucleus, under extreme pressure, bulges out through the annulus fibrosus ring.

Can lumbar disc herniation be prevented?

Most lumbar disc herniations occur in 30- to 50-year-olds when we are physically active and busy, sometimes too busy to take care of ourselves. Confining our physical activity to what our bodies are prepared for is a key to preventing injuries. The answer to this dilemma is to prepare our bodies for what we want to do. Consistent and rational exercise, maintaining good body weight, good posture (especially holding the abdomen in) and good nutrition all support good back health. Dr. Regan's private practice offers information on preventing back pain along with exercises to help strengthen the back. Accident prevention involves assessing risks – is your body prepared for the activity you are about to do?

What surgical treatment options are there for lumbar disc herniation?

1. BAK Fusion Cages

medical illustration of a spine, with objects labeled as threaded fusion caps spine with device planted in between vertebra
A device called a "cage" is used to hold spinal grafts in place while the healing occurs.

The procedure is performed under general anesthesia. The doctor uses a fluoroscope (live-action xray) to help mark the areas to be fused and to aid assessment of the physiologic (normal) curve of the spine, disc height, and accurate placement of the cages. Then one-third to one-half of the articulating facets (the extensions on the vertebrae) are removed; this allows the cages to be inserted with minimal damage to the nerve roots. Using a microscope or other magnification, Dr. John Regan identifies the nerve roots in the epidural space. Then the disc material is removed. Using dilators of increasing diameters, the vertebral bodies are separated to obtain a satisfactory disc height. Threads are cut into the opposing vertebral surfaces using a bone tap. The cage is then screwed into this space and packed with the patient's own bone material.

2. ALIF (Anterior Lumbar Interbody Fusion)

In the ALIF procedure, an anterior approach to the spine (the incision is made in the abdominal area, in front) allows complete removal of an intervertebral disc. Once the disc is removed, the space is filled with bone (sometimes held in place by a cage or other device) to obtain a spinal fusion.

3. PLIF (Posterior Lumbar Interbody Fusion)

Posterior Lumbar Interbody Fusion (PLIF) is a surgical technique that involves removing an intervertebral disc and creating a spinal fusion in the lumbar spine through one incision in the back. The procedure involves making an incision in the midline of the back. After incising (cutting into) the middle of the layer of muscle and ligament that sits on either side of the spine, the attachments to the spinous process and lamina are freed. Using a special instrument that removes small bites of bone, the lamina is gradually removed until the doctor can see the nerves. The nerves are then gently moved slightly to expose the intervertebral disc.

Using various instruments, the disc is removed through the right and left sides of the spinal canal and the intervertebral space, which has been cleared, is then packed with bone graft and a bone block or cage implant. Instrumentation, such as pedicle screws, are used to provide support for the fused vertebrae. Additional bone graft may be placed to ensure a solid fusion.

4. TLIF (Transforamenal Lumbar Interbody Fusion)

Dr. Regan points out an area of interest at the lower part of the spine - the lumbar vertebrae, examining an X-ray imageTransforamenal Lumbar Interbody Fusion (TLIF) is a surgical technique that involves removing an intervertebral disc and creating a spinal fusion in the lumbar spine through one incision in the back. It is similar to a PLIF except that the disc removal is performed through an approach that is more lateral (to the side). In some cases only one side of the disc needs to be exposed (right or left) in order to perform the procedure.

The procedure involves incising (cutting) into the middle of the layer of muscle and ligament that sits on either side of the spine, and freeing the attachments to the spinous process and lamina. Using a special instrument that takes small bites off bone, the lamina is gradually removed to expose the nerves. Using various instruments, the disc is removed through the right and left sides of the spinal canal (although sometimes all this can be done through one side only) and the intervertebral space which has been cleared is then packed with bone graft and either a bone block or cage implant. Instrumentation, such as pedicle screws, is then placed in the vertebrae to secure it. Additional bone graft will often be placed across the transverse processes to ensure a solid fusion.

5. Intradiscal Electrothermal Therapy (IDET)

IDET therapy is a new and minimally invasive procedure for treating pain due to disc degeneration. The technique involves delivering controlled levels of thermal energy (heat) to a section of a degenerated disc through a fine wire. This heat causes contraction and thickening of the disc wall, resulting in contraction or closure of disc fissures (small tears).

6. Laminotomy

When the spinal canal becomes narrowed or the nerves compressed, a laminotomy can be performed to free up the space of the spinal canal by removing a portion of the lamina. The procedure involves making an incision into the layer of muscles and ligaments that sits on either side of the spine, and freeing up the attachments to the spinous process and lamina to expose the laminae to full view. Using a special instrument that removes little bites of bone, the lamina is gradually trimmed until sufficient bone is removed to free the compressed nerve This "unroofs" a portion of the spinal canal and resulting in enlargement of the space available for the nerves.

7. Laparoscopic Fusion

Many patients require spinal fusion surgery to stabilize the vertebrae and alleviate severe, chronic back pain. Traditionally, spinal fusion has been performed as open surgery, and while it has been associated with a low complication rate and pain relief for 90% of patients, many patients experienced back pain and fatigue as a result of muscle loss from the operation.medical illustration revealing the skeletal structure of a man, numerous surgical devices draw attention to an area of interest at the base of his spinemedical illustration revealing the skeletal structure of a man, numerous surgical devices draw attention to an area of interest at the base of his spine

In 1993, a minimally invasive way to perform spinal fusion surgery, called laparoscopic spinal fusion, was developed by Dr. Regan. By using endoscopes and special instrumentation, laparoscopic spinal fusion requires only a small incision in the back. There are numerous benefits including reduced hospital stay and recuperation time. Dr. Regan's patients undergoing laparoscopic surgery are hospitalized for just under 2 days, versus the 4 to 6 days required for patients undergoing open surgery.

8. Artificial Disc Replacement

Dr. Regan performs ADR procedures and previously preformed them as part of an Federal Drug Administration clinical trial. When performing artificial disc replacement (ADR), the doctor inserts a small prosthetic (artificial) disc comprising a polyethylene core that slides between two metal end plates.

The end plates are attached to the vertebral body with anchoring teeth built along the rim of the end plates. The prosthetic discs replace the injured discs, helping to relieve chronic back pain. The polyethylene core allows movement of the spine, unlike fusions which prevent normal movement.

close-up view of an artificial disc artificial disc placed in between two vertebrae

The disc is made of the same material used in artificial hips and knees.

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