Rehabilitation after removal of the intervertebral hernia

According to statistics, the most common hernia of the lumbar spine, and least often - the thoracic. Despite the fact that surgical intervention is not always required for the treatment of this pathology, many operations are still performed. That is why it is necessary to know about the process of rehabilitation in the postoperative period.
Today, degenerative-dystrophic diseases of the spine are one of the main causes of pain in patients.
The basis of osteochondrosis is a decrease in the fluid content in the intervertebral disc, a decrease in its thickness and the involvement of bone, muscle and nervous tissues in the pathological process.
As the disease progresses, the annulus fibrosus surrounding the nucleus pulposus of the disc ruptures. Then part of the nucleus comes out, forming the so-called hernia (node) of the intervertebral disc.
Surgery eliminates the cause of the patient's symptoms, leading him to the doctor. However, the eradication of these signs does not solve all problems. It is necessary to eliminate the consequences of the underlying disease. That's what rehabilitation is about. It is important to return the patient to an active household and work life.
The postoperative period is divided into the following stages:

• 1-14 days - early postoperative period.
• 14-32 weeks - late postoperative period.
• From 2 months after surgery and later - a delayed postoperative period.

After surgery, it is necessary to perform physiotherapy exercises that will help strengthen the muscle corset and avoid recurrence of the disease.

General principles of the rehabilitation process

• During the postoperative period, it is important to be under the comprehensive supervision of a surgeon, neurologist, rehabilitation specialist, as well as other highly specialized specialists according to indications.
• A herniated disc causes severe discomfort to the patient due to severe pain and limited mobility. After surgery, a person feels helpless and driven into certain limits (compliance with the rules, schedule of examinations by specialists, taking medication, etc.), therefore, the development of a depressive state is possible. In this situation, you can not do without the help of a psychotherapist.
• After the operation, it is necessary to use a special corset. This will be an excellent prevention of the recurrence of the disease.
• Appointment of physiotherapy exercises, massage and physiotherapy.
• Gymnastics is carried out from the first day after the operation. A set of therapeutic exercises is selected individually and performed under the guidance of an instructor or doctor.
• The main principles of physiotherapy exercises in the postoperative period are regularity and a gradual increase in load.
• It is contraindicated to lift more than 2-3 kg with one hand after surgery for 3 months.
• It is necessary to limit prolonged sitting for 3 months after surgery.
• Outdoor games with sharp ballistic movements should be excluded.
• It is recommended to give up alcohol and smoking for the entire period of rehabilitation.

Cervical disc herniation

After the operation, the main emphasis in gymnastics is breathing exercises.
In the first stage of rehabilitation, it is necessary to limit the turns and tilts of the head.
After the permission of the attending physician, you can take a half-sitting position with the obligatory putting on of the Shants collar. During this period, exercises on the upper shoulder girdle are added to breathing exercises. Hands should not be raised above shoulder level. When performing a shoulder rotation, the palms should be lowered and pressed to the body.
At the next stage, leg movements are added to the set of exercises.
You can stop using the orthosis (Schanz collar) only after a control X-ray examination.

Thoracic disc herniation

After surgery, gymnastics is aimed at preventing complications from the internal organs. The first step is breathing exercises.
In the absence of contraindications, the patient is allowed to roll over on his stomach almost immediately after the operation. You can perform exercises in this position in a few days.
After obtaining permission from the attending physician, it is necessary to get up and walk, but be sure to put on a fixing orthosis.
A week after the operation, static exercises can be added to the complex of therapeutic exercises, that is, holding a certain muscle in a contracted state for several seconds.
Movements are gradually introduced in a standing position, as well as with resistance, weights and additional equipment.
Any exercises must be performed with a professional instructor and under the supervision of an exercise therapy doctor or a rehabilitation therapist.

Disc herniation of the lumbar spine

It is necessary to abandon the sitting position for a period of 3 to 6 months. Driving a car is contraindicated for the first 3 months after surgery. As a passenger in a car, you can only ride in a semi-sitting or lying position.
It is necessary to use a fixing orthosis.
You can start walking in the absence of contraindications from the first day after the operation.
Rest in the supine position should be 20-30 minutes several times a day.
After the operation, high-amplitude movements, as well as twisting of the spine and tilts, are absolutely contraindicated for 1-2 months.
In the early days, it is necessary to perform gymnastics in a supine position, paying attention to the correct rhythm of breathing. All movements must be done slowly. The number of repetitions increases gradually. Gymnastics is performed daily. During classes, pain should not be caused, i.e., the range of motion should be up to pain.

Spinal twisting exercises, as well as running and jumping, are completely excluded.

Physiotherapy

2 weeks after the operation, electrotherapy (SMT, lidases), and ultrasound therapy, as well as hydrocortisone ultraphonophoresis, are prescribed. A course effect is carried out, consisting of daily sessions with a total number of up to 15.

A gentle massage of the limb on the side of the lesion is carried out already in the first days after surgical treatment in the presence of radicular syndrome, which is manifested by numbness, decreased reflexes and an increase in weakness of the limb.

Acupuncture

It is quite possible to introduce reflexotherapy into complex treatment a month after surgical treatment according to indications.

Operation complications

Like any other operation, surgical treatment of a hernia is associated with a certain risk of complications. Let's consider some of them.

Anesthesia:

• The trachea or esophagus may be damaged by the laryngoscope during intubation for anesthesia.
• Allergic reactions to anesthetic solutions.

Operation:

• Respiratory and cardiac arrest, uncontrolled drop in blood pressure.
• Rupture of the dural membrane of the spinal cord with liquor leakage (the cause of chronic headaches), infection of the cerebrospinal fluid with the development of meningitis, and also (with purulent meningitis) the formation of a fistula of the dural sac with a constant outflow of purulent masses with the appearance of abscesses in the surrounding tissues. Sepsis and death.
• Damage to the esophagus, trachea or vascular bundle in the cervical region.
• Recurrent nerve disorder. Its function is restored independently in 2-3 months after the operation.
• risk of nerve root injury.
• CSF infection (less than 1%).
• Transverse myelitis is the result of an unintentional surgical injury or infection of the spinal cord. Manifestations depend on the height of the lesion, so paresis, paralysis, and severe neurological disorders may occur.
• Damage to the Adamkevich artery in the case of anatomical features of its location in a patient during surgery in the L4-S1 area, where hernias are most often formed. The result is lower paralysis and incontinence.
• An epidural hematoma is formed due to damage to the vessel during the operation and the accumulation of blood in the epidural fatty tissue. With untimely measures taken for diagnosis and treatment, purulent periduritis occurs. After that, it can turn into cicatricial-adhesive epiduritis, which, depending on the localization of the process, manifests itself with various neurological symptoms: paresis, paralysis, pain syndrome, impaired sensory and motor function, incontinence, disorders of the urogenital area, etc.

Postoperative period:

• Toxic damage to the brain, kidneys, liver and heart.
• Osteomyelitis of the vertebral bodies is a purulent lesion of spongy tissue after surgery, spreading to nearby tissues with loss of support function by the vertebrae. As a result - the destruction (fracture) of the spine. In weakened patients, a generalization of the process with the development of sepsis is possible.
• Postoperative stenosis of the spinal canal due to the active growth of connective tissue in the surgical area. Connective tissue compresses the dural sac and slows down the flow of cerebrospinal fluid. Subsequently, this results in a complete cessation of its circulation, i.e., a condition requiring immediate repeated surgical intervention. In addition, the connective tissue directly compresses the spinal cord and its roots, which is also an indication for repeated surgical intervention.
• Recurrent disc herniation is a late complication of surgery. Re-formation of a hernia in the area of ​​the operation performed more than 1 year ago.
• Instability of the vertebra with the formation of spondylolisthesis. During the operation, it is necessary to remove the bone arches of the vertebrae, which reduces the supporting function of the spine. After surgery, such a vertebra may be displaced backward or forward relative to other vertebrae with trauma to the intervertebral disc with the formation of protrusion and hernia.

It is important to understand that a herniated disc and surgical treatment of this disease do not make a person disabled. With proper therapy and the implementation of all the recommendations of a multidisciplinary medical team, a return to the usual way of life occurs in a fairly short period.
However, it is necessary to know that surgery is not the only way to eliminate a herniated disc. There are methods of non-surgical treatment. So resorting to surgical intervention is only in cases where other types of therapy for some reason are not suitable for a particular patient.

TV channel "Russia-1", program "About the most important". Dr. Bubnovsky talks about exercises for spinal hernia: