Pinched nerve, is a condition in which the nerve is compressed by the surrounding part. When you experience a pinched nerve, your body will send a signal in the form of pain
The most common symptom of a pinched nerve or HNP ( Herniated Nucleus Pulposus ) is pain. Mild cases of HNP often do not cause symptoms, but symptoms of severe pain can also appear. Pinched nerves or HNP most often occur in the lower back and neck.
PERCUTANEOUS ENDOSCOPIC LUMBA DISCECTOMY (PELD)
Almost everyone has experienced low back pain (LBP). This situation can certainly hinder daily activities and work productivity. It should be noted that 80% of LBP conditions are caused by problems in the lumbar muscles and can be treated conservatively/without surgery, which includes rest, medication, physiotherapy, acupuncture, etc. But of course we have to give a time limit for conservative therapy, if there is no improvement in pain within 6-8 weeks, other problems must be looked for besides muscle problems. Another cause of low back pain, especially in productive age, is a condition called HNP .
HNP ( Herniated Nucleus Pulposus ) is a condition in which the spinal discs protrude so that they can cause a pinched nerve . The most common locations for HNP to occur are the waist (lumbar), neck (cervical) and lastly the least common is the back (thoracic). Patient complaints can include tingling that radiates to the hands or feet, neck or waist pain, weakness/paralysis of the limbs, or difficulty holding bowel movements or urination.
80-85% of HNP cases can be treated without surgery, but 15-20% of them require surgery. The development of medical technology in almost all lines is currently leading to minimally invasive techniques . Likewise with surgical techniques in spinal cases such as HNP. Although the microdiscectomy surgical technique for HNP cases remains the gold standard , a technique is currently being developed called Percutaneous Endoscopic Lumbar Discectomy (PELD).
PELD is a pinched nerve surgery technique, which can be performed under local anesthesia, only requires an 8mm incision , can be done in one day care / without hospitalization, operating time is 20-40 minutes, there is no need to install implants and the bleeding caused is very minimal . The work is done with the help of a lens and a monitor, so that the nerves are clearly visible and injury can be avoided.
With an incision of only 8mm , the PELD technique provides several advantages, including that the patient will feel minimal postoperative pain, can immediately mobilize the road after surgery, so that the patient can return to activities or work more quickly.
Patients are often concerned about the risk of paralysis in spinal surgery including the lumbar region. It should be noted that the levels that are often affected by HNP in the lumbar region are the L45 and L5S1 levels. At the L45 and L5S1 level operations, there were no nerves that move the thigh and knee muscles, so theoretically it is almost impossible for paralysis of the lower half of the body to occur as is generally feared by patients. With proper indications and good working techniques, the PELD operation success rate can reach 98%.
PERCUTANEOUS ENDOSCOPIC CERVICAL DECOMPRESSION (PECD)
Our dependence on technology is unavoidable. The use of laptops or computers as a means to work is now very common. Especially by the millennial generation. Wrong neck position when using a laptop or computer can trigger pain in the nape or neck and tingling that radiates from the shoulders to the hands which can sometimes really interfere with daily activities.
One disease that is often experienced by workers who use laptops or computers is HNP ( Herniated Nucleus Pulposus ). This situation is a protrusion of the joint pads in the neck area which can cause pinching of the neck nerves. Symptoms that can be caused include pain in the nape or back of the head, pain in the shoulder blades, tingling that radiates from the neck to the hands, numbness in the hands, or even weakness in the shoulders, elbows or fingers. At a more advanced stage of pinching, complaints of myelopathy can be found, including balance disturbances, impaired coordination of fine movements (such as buttoning clothes, using a spoon, often dropping things), to paralysis.
In general, the treatment of cervical HNP includes conservative therapy (without surgery) or surgery. Conservative therapy must be attempted first for 4-6 weeks, because 80% of the symptoms of cervical HNP can be lost with conservative therapy which includes drugs, physiotherapy, acupuncture, injections, and improvement of working position. 20% of cervical HNP cases require surgery. Indications for surgery in cases of cervical HNP, among others, if conservative therapy has failed, the pain caused is so severe that it interferes with daily activities, upper limb weakness has occurred, and/or there are symptoms of myelopathy.
The choice of surgery for cervical HNP varies. Currently, with the development of medical technology, cervical HNP surgery can be performed using an endoscopic technique called Percutaneous Endoscopic Cervical Decompression (PECD) , which can be performed from the front of the neck (anterior) or from the back of the neck (posterior) depending on the location of the joint protrusion. This technique is a minimally invasive technique that only requires a small incision of about 6 mm , uses an endoscope in the form of a tube connected to a camera and monitor, so that the nerves can be seen very clearly, short operation time of about 30 minutes, can be done in one day care or without treatment hospitalization, and the time to return to activities again is very short.
Patients are often afraid of pinched nerve surgery because they fear that there will be a risk of paralysis. With PELD AND PECD operating techniques, these risks can be minimized.
Article written by dr. Harmantya Mahadipta, Sp.OT (K) Spine (Orthopedic Specialist and Traumatology Spine Consultant at EMC Tangerang Hospital). For further information and consultation schedule, contact: Ekha (0878 8989 0102) Call/SMS/WA.