Last updated date: 06-Feb-2023
Originally Written in English
Discectomy refers to a type of surgical procedure to correct or remove the herniated disc in the spinal cord. The damaged herniated disc can cause irritation or compression on the surrounding nerves. Therefore, the treatment procedure aims to remove parts of the herniated disc to ease pressure exerted on the spinal nerve column.
The spinal column or the backbone comprises a chain of bones referred to as the vertebrae. The spinal cord runs via the spine. The bones play a significant role in protecting the spinal cord against any form of injury or trauma. The discs are situated in every vertebra to give support and cushioning. Major nerves known as the nerve roots run from the spine via small holes within bones (foramen).
Why Discectomy is performed
The initial aim of performing or recommending a discectomy is to ease and manage the pressure that the herniated disc places on the nerves. A herniated disc is also referred to as ruptured, bulging, or slipped disc or sometimes disc prolapsed. It usually occurs if the soft content in the disc pushes out via a crack in the tough exterior.
Therefore, surgery might be necessary if you have a herniated disc in the lower back that causes various symptoms. Pain, weakness, and tingling around the back region and in one of the legs are possible symptoms associated with a herniated disc.
Alternatively, the healthcare provider can recommend the procedure if;
- Conservative treatment options, including steroid injection and physical therapy, fail to address the symptoms within 6 to 12 weeks.
- You experience pain that radiates into the legs, buttocks, chest, or arms and becomes too severe to manage
- You have a problem walking or standing due to weakness of the nerves
Lumbar discectomy is not appropriate for all forms of back pain. Furthermore, not every person with a herniated disc requires a lumbar discectomy. In case you have tried other treatment alternatives but still experience serious symptoms, then surgery is the best option. However, anti-inflammatory medications and physical therapy are the essential treatments to consider first.
Discuss the threats and advantages associated with minimally invasive surgery against open surgery with the physician. Minimally invasive surgery can result in minimal pain and a quicker recovery period. This form, however, is not available in all surgical centers.
What to Expect During the Procedure
The entire procedure can take one to two hours, depending on the severity. Thus, during the operation, you should expect the following;
Once in the operating room, the surgeon or medical provider will ask you to lie on the surgery table. After that, they will administer general anesthesia to make you unconscious during treatment and prevent you from experiencing any pain. Alternatively, you may receive local anesthesia; although this won’t make you asleep, you will not feel pain or discomfort.
As soon as the anesthesia effect commences, the doctor will roll you over onto the stomach. The sides and the chest are supported using pillows. They will then cleanse and prep the area where the incision is to be created.
- Creation of the incision
With the help of a special x-ray device known as a fluoroscope, the surgeon will insert a thin needle or catheter via the skin. The needle is then directed down towards the bone to find the herniated disc or damaged vertebra.
With the open discectomy technique, the incisions are created down the central part of the back above the injured vertebrae. The incision length depends on the number of times the doctor intends to perform a discectomy. The level of one incision usually ranges from one to two inches in length.
The doctor will retract the posterior muscles on one of the sides to expose the bony vertebra. After that, he or she will use x-ray technology to confirm the appropriate vertebra.
With a minimally invasive discectomy, the surgeon will create a small incision on one side of the back. Through the incision, they will pass a chain of progressively large dilators one after the other. This is to steadily separate the muscles and form a tunnel towards the bony vertebra.
- Creation of a laminotomy
The next step involves creating a small opening around the lamina below and above the spinal nerves. This is done using bone biting equipment or drill. The laminotomy is performed on a single (unilateral) side, both sides (bilateral), or on several vertebrae levels.
- Removal of the disc portions
After removing the lamina, the physician carefully pulls the cushioning sac of the nerve root. He or she will then view via the surgical microscope to locate the herniated disc. To decompress the spinal nerve root, only the punctured part of the disc is extracted. It is not necessary to remove the whole disc. A synovial cyst or bone spur that is pressing on the nerve root is also taken out.
Fusion is seldom used for a single-level lumbar discectomy. Other disorders, including recurring disc herniation or spinal dysfunction, can be addressed using a fusion.
- Closure of the incision
After the procedure, the retractor that keeps the muscles in place is removed. The doctor will either use sutures or staples to seal the skin incisions and muscle. They will also use skin glue to close the incision.
What to Expect After Discectomy
After the procedure, you will be transferred into the recovery room before the anesthesia effect wears off. The heart rate, blood pressure level, and respiratory rate will also be measured. Any form of discomfort and pain will be solved. You should begin gentle movement as soon as you wake up; it can include sitting in a chair or walking.
Discectomy procedure is mostly done on an outpatient basis. Therefore, the majority of patients can go home on that same day. Other patients will be discharged from the hospital within one to two days. Be sure you have someone at home who will assist you for the first 24 to 48 hours.
It’s also essential to adhere to the instructions and home care guidelines for at least two weeks after treatment. Some of the crucial instructions include;
- Refraining from bending or twisting the back
- Avoiding lifting heavy loads weighing more than five pounds
- Staying away from strenuous exercises, such as yard activities, housework, or sex
- Do not drive for at least the first two to three days following surgery or while using muscle relaxants and pain medications. However, as soon as pain is under control, you can start driving.
- Avoid consuming any alcoholic beverages. This is because it thins the blood and raises the risks of severe bleeding. Furthermore, you should not combine alcohol and any pain relievers.
Discectomy helps alleviate herniated disc symptoms among the patients with clear evidence of nerve compression, such as radiating pain. Discectomy, on the other hand, may not be a permanent treatment. This is because it does little to undo the mechanism that caused the disc to herniate initially.
Set up a follow-up consultation with the specialist two weeks following surgery. For some people, physical therapy may be necessary.
The discectomy recovery period ranges from one to four weeks, based on the underlying condition and the overall health. You can experience discomfort in the area of the incision. It is likely that the initial pain will not be totally gone soon after surgery. Maintain a good mood and faithfully follow all recommended physical therapy activities.
For occupations that are not physically demanding, one can return to work in 2 to 4 weeks or sometimes less. Others will be required to wait at least 8 to 12 weeks before returning to work. This is especially for occupations that include heavy lifting or running heavy machinery.
Back pain recurrence is usually common. However, you can prevent this by;
- Maintaining a good posture when standing, sitting, sleeping, or moving
- Practicing appropriate lifting methods
- Opting for a proper exercise plan
- Working in an ergonomic area
Risks of Discectomy
Discectomy is usually considered a safe treatment procedure. However, just like any other surgical operation, discectomy is also associated with a few risks of complications. Some of the possible complications one might experience during or after the treatment include;
- Bleeding on the surgical area
- Leakage of the spinal fluid
- Injury or damage of the nerves or blood vessels inside or around the spinal cord
- Negative reaction to anesthesia
- Formation of blood clots
- Temporary results and the need for an additional surgery
The risks associated with discectomy can vary from one person to another depending on the age, extent of the damage, and overall health. It’s thus essential to first discuss with the physician regarding the potential risks for undergoing the treatment.
In general, discectomy is a surgical procedure to extract degenerative or herniated discs in the spine. The method involves the creation of an incision on the posterior via the back muscles to take out the disc, putting pressure on the nerve. This eventually eases chronic symptoms associated with a herniated disc. Usually, doctors recommend the treatment if medication and physical therapy fails to address the condition fully.
CloudHospital specializes in providing comprehensive treatment and care to patients with a herniated disc. It works with a team of experts with skills and experience in this field. Furthermore, they are determined to treat the condition to give you a better life quality.