Surgery Godfather
Chapter 1136 - 909: Establishing Authority

Chapter 1136: Chapter 909: Establishing Authority

After his surgery, Yang Ping went to check on the Elderly Director, who was already able to walk around. Yang Ping conducted a physical examination and found that the muscle strength and sensation in both lower limbs were normal, indicating that there was no rebound edema after the nerve root was released from compression.

There are many causes of sciatic nerve pain, with lumbar disc herniation being the most common. Other causes include tumors in the vertebral canal or the sciatic nerve itself, compression of the sciatic nerve at the piriformis muscle, sciatic neuritis, herpes virus infection, and so on.

The Elderly Director had a neurinoma at lumbar 5 nerve root, which is mostly benign. The tumor removed during the surgery appeared to have a complete capsule, which also matched the characteristics of a benign tumor, but the final diagnosis still relied on pathology.

Because lumbar disc herniation is the most common cause of sciatic nerve pain, the Elderly Director didn’t pay attention and didn’t go to a better hospital for examinations, leading to a misdiagnosis.

"Where exactly is my lumbar disc herniated?"

With an MRI scan in his hands, the Elderly Director, unable to interpret it himself, had to ask Li Min.

Li Min pointed out, "You see here, there is indeed a mild herniation between lumbar 4/5 and lumbar 5/sacral 1 discs, but it’s very mild and wouldn’t cause symptoms. Look, now that the neurinoma has been resected, all symptoms have disappeared, so this lumbar disc herniation didn’t actually cause any symptoms."

’’So does that mean I also have lumbar disc herniation, just combined with a neurinoma?" the Elderly Director wondered to himself.

"You have lumbar disc herniation, but you don’t have lumbar disc herniation syndrome, those are two different things."

Li Min now had a very solid understanding of these common illnesses.

Lumbar disc herniation and lumbar disc herniation syndrome are two different concepts. Lumbar disc herniation is merely a radiological finding, not a disease. Patients can see the herniation in an MRI or CT scan, but without associated symptoms.

If there is disc herniation in radiology and the patient also has symptoms of back pain or leg pain, it is then called lumbar disc herniation syndrome, and it is considered a disease.

Lumbar disc herniation doesn’t need treatment, but lumbar disc herniation syndrome does. The symptoms of this condition can include back pain or leg pain, where leg pain usually manifests as radiating pain from the buttocks down the limbs, the extent of which depends on the severity of the condition.

Back pain is caused by the disc itself, triggered when the sinuvertebral nerve inside the lumbar disc gets irritated.

After the lumbar disc herniates, the annulus fibrosus ruptures and the nucleus pulposus protrudes, leading to local stress changes and an inflammatory response. Both mechanical pressure and inflammatory mediators stimulate the sinuvertebral nerves causing back pain.

Leg pain occurs when the spinal nerve root is compressed or stimulated, causing pain and numbness in the nerves that continue down the leg.

The common mention of lower back and leg pain refers to these symptoms.

There have been a few reports worldwide that the protruded nucleus pulposus of a herniated disc can be naturally absorbed by the body. This is medically feasible because once the nucleus pulposus strays from its normal location, the body treats it as a foreign substance to be cleared by immune cells.

However, these are just isolated reports and cannot be considered routine. Therefore, if lumbar disc herniation syndrome is diagnosed, it definitely requires treatment.

Conservative treatment should be tried first, as in most cases it occurs in episodes of attack and remission. It is not continuously problematic, especially in the early stages of the illness, where remission periods could be very long, even several years between episodes. In such cases, no surgery is necessary. During episodes, oral non-steroid anti-inflammatory and neurotrophic drugs for symptomatic treatment along with strength training of the back muscles during remission can stabilize the lumbar spine.

It should be clear that the target of treatment is the symptoms, not the protruded disc. The disc remains herniated even after symptoms disappear; it stays the way it is, and that’s fine. It is impossible to expect the disc to return to its original state.

If the symptoms are severe and persistent, and conservative treatment has been ineffective for over three months, impacting life and work, surgery may be considered. Surgeons should perform the smallest possible procedure, and if instability of the spinal segments is not an issue, they should ideally only remove the herniated nucleus pulposus and avoid segmental fixation with screws.

Young adults and middle-aged people, without any congenital instability of the spine, generally do not have spinal instability. Therefore, they only need a simple removal of the nucleus pulposus without screws or fixation.

Surgery should be as minimally invasive as possible; if not feasible, an open surgery is also fine. If the condition allows for minimally invasive surgery, the choice between open surgery and minimally invasive surgery depends on the surgeon’s skill level, with a skilled open surgery often being much better than a suboptimal minimally invasive one.

Back pain, if not caused by common diseases, is easily misdiagnosed, because it’s usually confined to either orthopedic spinal clinics or urological surgery, and the doctors there, whether specialists or general practitioners, are surgeons skilled in performing surgeries, with very little knowledge beyond surgery, especially when facing complex diseases, and lack the capability of internal doctors who methodically make diagnoses.

Listening to Li Min explain so logically, the Elderly Director felt very pleased, realizing the young man had indeed learned a lot.

Seeing how well he had recovered after the surgery, the Elderly Director began to arrange his discharge. Yang Ping advised him to wait until his stitches were removed, assuring him there was no rush since the hospital was well-staffed to cover for them.

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