Lumbar discectomy is a surgery to remove a herniated or degenerative disc in the lower spine. The incision is made posterior, through the back muscles, to remove the disc pressing on the nerve. Discectomy may be recommended if physical therapy or medication fail to relieve leg or back pain or if you have signs of nerve damage, such as weakness or loss of feeling in your legs. The surgery can be performed in an open or minimally invasive technique.
Discectomy is surgery to remove lumbar (low back) herniated disc material that is pressing on a nerve root or the spinal cord.
It tends to be done as microdiscectomy, which uses a special microscope to view the disc and nerves. This larger view allows the surgeon to use a smaller cut (incision). And this causes less damage to surrounding tissue.
Before the disc material is removed, a small piece of bone (the lamina) from the affected vertebra may be removed. This is called a laminotomy or laminectomy. It allows the surgeon to better see the herniated disc.
Discectomy is usually done in a hospital. You are asleep or numb during the surgery. You will probably stay in the hospital overnight.
You may be a candidate for discectomy if you have:diagnostic tests (MRI, CT, myelogram) that show a herniated discsignificant pain, weakness, or numbness in your leg or footleg pain (sciatica) worse than back painsymptoms that have not improved with physical therapy or medicationleg weakness, loss of feeling in the genital area, and loss of bladder or bowel control (cauda equina syndrome)Posterior lumbar discectomy may be helpful in treating leg pain caused by:Bulging or herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation and swelling occurs when this material squeezes out and painfully presses on a nerve .Degenerative disc disease: As discs naturally wear out, bone spurs form and the facet joints inflame. The discs dry out and shrink, losing their flexibility and cushioning properties. The disc spaces get smaller. These changes lead to stenosis or disc herniation.
Most herniated discs heal after a few months of nonsurgical treatment. Your doctor may recommend treatment options, but only you can decide whether surgery is right for you. Be sure to consider all the risks and benefits before making your decision. Only 10% of people with herniated disc problems have enough pain after 6 weeks of nonsurgical treatment to consider surgery.
A neurosurgeon or an orthopedic surgeon can perform spine surgery. Many spine surgeons have specialized training in complex spine surgery. Ask your surgeon about their training, especially if your case is complex or you’ve had more than one spinal surgery.
You may be scheduled for presurgical tests (e.g., blood test, electrocardiogram, chest X-ray) several days before surgery. In the doctor’s office, you will sign consent and other forms so that the surgeon knows your medical history (allergies, medicines/vitamins, bleeding history, anesthesia reactions, previous surgeries). Discuss all medications (prescription, over-the-counter, and herbal supplements) you are taking with your health care provider. Some medications need to be continued or stopped the day of surgery.Stop taking all non-steroidal anti-inflammatory medicines (Naprosyn, Advil, Motrin, Nuprin, Aleve, etc.) and blood thinners (Coumadin, Plavix, etc.) 1 to 2 weeks before surgery as directed by the doctor. Additionally, stop smoking, chewing tobacco, and drinking alcohol 1 week before and 2 weeks after surgery because these activities can cause bleeding problems. No food or drink is permitted past midnight the night before surgery.
Shower using antibacterial soap. Dress in freshly washed, loose-fitting clothing.Wear flat-heeled shoes with closed backs.If you have instructions to take regular medication the morning of surgery, do so with small sips of water.Remove make-up, hairpins, contacts, body piercings, nail polish, etc.Leave all valuables and jewelry at home (including wedding bands).Bring a list of medications (prescriptions, over-the-counter, and herbal supplements) with dosages and the times of day usually taken.Bring a list of allergies to medication or foods.Arrive at the hospital 2 hours before (surgery center 1 hour before) your scheduled surgery time to complete the necessary paperwork and pre-procedure work-ups. An anesthesiologist will talk with you and explain the effects of anesthesia and its risks. An intravenous (IV) line will be placed in your arm.
After surgery, you will be encouraged to get out of bed and walk as soon as the numbness wears off. You can use prescription medicines to control pain while you recover. You can slowly resume exercise and other activities.
Other things to think about include the following:
You will awaken in the postoperative recovery area, called the PACU. Blood pressure, heart rate, and respiration will be monitored. Any pain will be addressed. Once awake, you will be moved to a regular room where you’ll increase your activity level (sitting in a chair, walking). Most patients can go home the same day. Other patients can be released from the hospital in 1 to 2 days.
Schedule a follow-up appointment with your surgeon for 2 weeks after surgery. Physical therapy may be necessary for some people.The recovery time varies from 1 to 4 weeks depending on the underlying disease treated and your general health. You may feel pain at the site of the incision. The original pain may not be completely relieved immediately after surgery. Aim to keep a positive attitude and diligently perform your physical therapy exercises if prescribed.Most people can return to work in 2 to 4 weeks or less with jobs that are not physically challenging. Others may need to wait at least 8 to 12 weeks to return to work for jobs that require heavy lifting or operating heavy machinery.Recurrences of back pain are common. The key to avoiding recurrence is prevention:Proper lifting techniquesGood posture during sitting, standing, moving, and sleepingAppropriate exercise programAn ergonomic work areaHealthy weight and lean body massA positive attitude and relaxation techniques (e.g., stress management)No smoking
Good results are achieved in 80 to 90% of patients treated with lumbar discectomy . In a study that compared surgery and nonsurgical treatment for herniated discs, the outcomes were :People with leg pain (sciatica) benefit more from surgery than those with back pain.People with less severe or improving pain do well with nonsurgical treatment.People with moderate to severe pain who had surgery notice a greater improvement than those who did not have surgery.Similarly, minimally invasive discectomy techniques have been shown to be comparable in outcomes with open discectomy . While the benefits of minimally invasive approaches include shorter operative time, less blood loss and muscle trauma, and faster recovery, these newer techniques are not appropriate for all patients. Ask your surgeon if minimally invasive microendoscopic discectomy is appropriate for you.Discectomy may provide faster pain relief than nonsurgical treatment. However, it is unclear whether surgery makes a difference in what treatment may be needed later on. About 5 to 15% of patients will have a recurrent disc herniation, either at the same side or the opposite side.
As with any surgery, there are some risks.