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It is a simple interventional treatment method that we apply in cases where pain is prominent and does not respond to drug treatments in both lower back and neck hernias. There are around 3000 applications in our records. In this method, which can be applied by almost every anesthesiologist, only the neck region requires further training. It is a method that has been used in Turkey for decades. It is among the daily routines of anesthesiologists, especially those dealing with Algology (science of pain).
We have pads, which we call discs, located between our vertebrae. These are formations that act as shock absorbers that absorb the weight of the body in movements such as lifting, moving, bending and jumping. For any reason, for example, this may occur as a result of traumatic events such as a traffic accident, fall, impact, or as a result of simpler non-traumatic events such as stress or chronic constipation, these pads lose their elasticity and the process we call hernia begins.
Frequent reoccurrence of neck or lower back stiffness are early signs that something is not going right in our body. In other words, if our lower back or neck stiffness recurs frequently, it is necessary to pay attention, these are the leading symptoms. Later, our pain begins to appear and over time it starts to not respond even to painkillers. It even becomes such that we even lose sleep from the pain. Why? The hernia has now become more prominent and the event we call inflammation in the nerve tissue has begun to occur.
There is a jelly-like nucleus in the discs between our vertebrae. Nucleus protrudes beyond the disc and begins to press on the nerves. It can be in the form of bubbles. The microcirculation of the nerves under pressure is inhibited and the nerve begins to swell and give symptoms in the form of pain. At the same time, substances that cause pain begin to be released from our discs. This causes numbness and tingling, and then every movement becomes painful. While neck hernias cause pain and numbness and tingling that hits the head, neck, shoulders, shoulder blades, arms and armpits and fingers, herniated discs cause pain and numbness and tingling that hits the lower back, hips, calves and toes. Loss of strength, thinning of arms or legs are symptoms of advanced hernia. Urinary and stool incontinence and balance and gait disturbances are very serious signs and require immediate surgical operation.
With MRI. Yes, it's that simple. The most important diagnostic tool for lower back or neck hernia is MRI. When it comes to hernia, we should keep in mind that not every hernia we see in MRI require intervention, in other words, it is extremely wrong to plan a treatment because there was a hernia in the MRI film. Otherwise, you will have operated on the films, but the patients cannot get rid of their pain and complaints. In other words, a very careful examination guides the treatment.
If there is no response to painkillers and muscle relaxants or FTR treatments in back and neck hernias, it is useful to consult an algology specialist. Here, Injection treatments (Epidural steroid or cortisone) is a method we prefer for hernias, which we call bulging or protrusion in MR images. It eliminates the nerve swelling that we have explained above and prevents the release of substances that cause pain from the discs. It has an efficiency rate of 50-80%. It is a therapeutic method. Patients are relieved of pain and numbness in their arms or feet. They return to their normal daily lives. They start to see the benefits about 3-4 days after this injection. It can be applied 3 times a year. It is an intervention that should be applied in operating room conditions and by experienced physicians. Methods of delivery around the nerve of the target hernia using scopy (transforaminal steroid injections) are very popular applications. Since cortisone is given to a completely closed area here, very little of it participates in the systemic circulation and disperses throughout the body. In other words, the side effects of cortisone treatments are not seen in this method. Patients with stomach problems, high blood pressure or diabetes should be monitored more carefully. This treatment is not applied to patients taking blood thinners. Blood thinners such as aspirin should be stopped 1 week before this application. Physicians make some tests before this application.
