Three Generations of Surgery for Disc HerniationFamilies have first, second, and third generations with grandparents, parents, and children. Usually, 50 or 60 years passes from the first to the third generations. In the medical world, new treatment methods are the "first generation." As doctors improve the treatment and better methods are found, a "second generation" is born.
Unlike families, changes in medical treatment can take place quickly. Often, the move from first to second generation or from second to third generation happens over a period of just a few years. This has been true in the treatment of low back pain caused by a herniated disc pressing against a spinal nerve.
Open back surgeryÂ involving hemi-laminectomy was first described in 1934. In this operation, the doctor cut open the back muscles to take out a small piece of the backbone. This was done to remove disc pressure off the spinal nerve. There were many complications with this type of surgery when used to treatÂ disc herniations.
Since that time, doctors have looked for ways to avoid opening the back with a large incision to do surgery. The second generation called minimally invasive surgery was "born." Doctors began using a small incision to pass a slender instrument inside the body to work on the disc. A variety of methods using this idea were quickly developed. However, there were still too many problems, mainly because the doctor could not see inside the body while doing the surgery.
The third generation came along with the birth of fiberoptics. Fiberoptics is the ability to see inside the body using a rigid or flexible tube with a light and eyepiece on the end. Fiberoptics has given doctors a way to see inside the body to guide them during this type of back surgery. This has brought about a wide range of new methods to operate on the spine. Each method has its good and bad points. The surgeon must decide patient by patient which method is best.
Hallett H. Mathews, MD, and Brenda H. Long, MS, RN. Minimally Invasive Techniques for the Treatment of Intervertebral Disk Herniation. In Journal of the American Academy of Orthopaedic Surgeons. March/April 2002. Vol. 10. No. 2. Pp. 80-85.
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