Wednesday, May 26, 2010
Bono's Back Surgery
U2 front-man, Bono, suffered a herniated lumbar disc and underwent surgery to remove the extruded disc fragment, according to his German neurosurgeons. This is a common operation but is not done emergently unless nerves in the spine are severely compressed leading to either profound muscle weakness such as a complete foot drop or abrupt bladder and bowel dysfunction accompanied by weakness and numbness in both legs. The later is know as cauda equina syndrome. When one of these two conditions occurs, emergent surgery is recommended to prevent permanent nerve damage. A full recovery is generally expected. When the primary symptom is pain and mild weakness of a muscle as well as some numbness is present, then non-surgical treatment is generally initiated first. This is the more common scenario and with time, the herniated disc generally shrinks and can be resorbed, resulting in resolution of symptoms without surgery. When symptoms do not resolve or when the situation is emergent, than a procedure called a discectomy is performed. This can be done via a "standard" laminectomy in which an approximately three inch incisicion is made in the center of the lower back, muscle is stripped off the spine, a portion of the spine know as the lamina is removed to enter the spine and then the disc fragment is removed. This can also be performed via a microdiscectomy in which the incision is smaller and the amount of bone removal is less and a microscope is used to visualize the inside of the spinal canal and the disc fragment. The procedure I prefer is even less invasive, what is refered to as an endoscopic microdiscectomy. With this technique a two centimeter (less than half inch) incision is made and a tube is passed to the spine without needing to dissect muscle off the spine. A few slivers of lamina are removed, if any, and the spinal canal is able to be visualized through the tube using high-power magnification. The fragment is then visualized and removed. The operation is performed under general anesthesia and the patient is able to go home the same day. Patients are walking the same day, begin therapy within a week and can resume the majority of their normal life-style activities within four to six weeks. The surgery is highly effective in resolving the symptoms and has a success rate of over 95%. A herniated disc can reherniate and this occurs between 10 and 20% of the time. Learning proper back care and maintaining good core muscle strength helps reduce the incidence of reherniation. This is the link to the video of this type of operation: http://www.youtube.com/watch?v=YV_EZgnCwTs.