Throughout life, the intervertebral discs, those gelatinous pads that separate the vertebrae of the spine, undergo a series of degenerative changes that can lead them to rupture. In many cases, this pain does not subside despite medication, exercise or physiotherapy and can become extremely limiting in your daily life. And in many cases we cannot prevent it either. It is part of the natural aging and wear process of our skeleton in most cases.
A lumbar disc herniation occurs when part of the intervertebral disc, usually the nucleus, moves out of place, forming a prominence that extends beyond the limits of the annulus fibrosus. "One of the changes that can occur is a rupture of the annulus fibrosus. When this occurs, said annulus has a window through which part of the content of the nucleus pulposus can migrate," explains the orthopedic spine surgeon at the Hospital El Pilar (Barcelona), doctor Ignacio Moya.
Thus, the conventional treatment of intervertebral disc herniations consists of rest, analgesic medication, rehabilitation, and, ultimately, surgery, as this expert recalls.
Specifically, it points out that traditional surgery, called microdiscectomy, consists of a procedure where an incision is made in the lumbar area, a dissection of the muscles, and a hole in the back of the vertebra, which allows the extraction of the hernia. and decompression of the affected nerve.
"However, this procedure involves general anesthesia, a wound that must subsequently be sutured and, generally, requires one or two nights of admission," says the specialist. “In addition, the muscle dissection that occurs on many occasions can lead to long-term low back pain that is very difficult to treat.”
Innovation in treatment: the laser
Precisely, the team of Dr. Moya, an orthopedic surgeon who specializes in spine at El Pilar Hospital, offers his patients a differential procedure in their field for the treatment of contained lumbar disc herniations: percutaneous decompression by intradiscal laser.
“It is a minimally invasive treatment that is included in a group of interventions called nucleoplasties. The intradiscal laser option offers very interesting advantages over conventional treatments due to the rapid recovery of patients, as it is performed in a minimally invasive way,” he highlights. "In addition, during this procedure there is hardly any aggression to the lumbar muscles, leaving them intact to act as a vital element in the recovery of a lumbar disc herniation."
This technique consists of making a small puncture in the skin that allows access to the herniated disc with a needle. A probe capable of emitting a laser is introduced through said needle, which, in turn, generates an increase in heat within the disc.
"By producing this heat, an evaporation of the liquid part of the disc occurs. This significantly reduces the pressure inside it and, in turn, the pressure it exerts on the nerve roots. In this way, a decompression of the said nerves," explains Dr. Ignacio Moya, who directs the only team that has performed these procedures since the beginning of 2023, having already treated a total of 21 patients, with very good results.
Advantages
In the opinion of this specialist from the El Pilar Hospital, the great advantage of this treatment is its very low aggressiveness: “It is not necessary to make incisions, since the probe is introduced through a small needle, and the procedure is much shorter.” .
Therefore, according to what he says, it can be performed under sedation, without the need for general anesthesia, and the patient can be discharged shortly after. He also highlights that recovery is much faster than with conventional surgery, intraoperative risks are drastically lower, and both return to work and sports occur “significantly faster.”
Ignacio Moya also indicates that, currently, there are different types of nucleoplasties, such as those performed by radiofrequency or using ethyl alcohol.
However, he does warn that those carried out with lasers have certain advantages. "The application of the laser is much more precise. It allows the team to control everything much more, unlike ethyl alcohol, which can leak out of the disc and end up producing chemical irritation of the lumbar roots, which can lead to symptoms of very limiting pain and difficult to solve. In this way we have a safer procedure that minimizes the risks."
Now, ultimately, Dr. Moya insists that these types of techniques should be carried out by specialists in the treatment of lumbar spine pathology and be used only in contained hernias, that is, in those in which no surgery has been performed. extruded a fragment of the disc into the channel.
