Open Lumbar Discectomy

Overview

A herniated or degenerative disc in the lower spine is removed by a procedure called a lumbar discectomy. The disc pushing on the nerve is removed by a posterior incision made through the back muscles. If rest, medications, or physiotherapy don't help your back or leg pain, or if you show symptoms of nerve damage including weakness or numbness in your legs, a discectomy might be advised. Either an open procedure or a minimally invasive one can be used for the surgery.

Lumbar Discectomy

Discectomy means cutting the disc. Anywhere along the spine, from the neck to the low back, a discectomy can be carried out. Through the muscles and bone, the surgeon accesses the injured disc from the back (posterior) of the spine. By chopping off a piece of the lamina, the surgeon can reach the disc. The bone known as the lamina creates a roof over the spinal cord and the back of the spinal canal. The spinal nerve is then pulled back to one side. One disc (single-level) or multiple discs (multi-level), depending on your specific situation, may be removed.

To carry out a discectomy, a range of surgical instruments and methods might be applied. A wide skin incision and muscle retraction are used in an open method so the surgeon can see the area well. A small skin incision is used in a minimally invasive procedure or a micro-endoscopic discectomy. The muscles are tunneled through using a series of dilators, or progressively larger tubes. The surgeon can view and operate in a smaller space with the aid of special instruments. Less damage is done to the back muscles after a minimally invasive incision, which could also shorten recovery time. Your surgeon will advise you on the approach that is most suitable for your particular situation.

For patients who are athletes, work physically demanding jobs, or have spinal instability, a fusion may be performed at the same time as a discectomy to assist stabilize the spine. To join two vertebrae together, fusion employs a combination of bone graft and hardware (screws/plates). The two vertebrae join together to form a single bone during the healing process. Rarely, fusion is necessary for lumbar disc herniation.

Lumbar Discectomy Indications

A discectomy may be appropriate for you if you:

MRI, CT, and myelogram results from diagnostic procedures that reveal a herniated disc
Severe numbness, weakness, or pain in your foot or leg
Leg (sciatica) pain is more severe than back pain
Symptoms that have not been alleviated by medication or physiotherapy
Loss of bladder or bowel control, leg weakness, and genital sensory loss (cauda equina syndrome)

Leg pain brought on by any of the following may benefit from a posterior lumbar discectomy:

Herniated or bulging disc. A weak point in the surrounding wall (annulus) might allow the gel-like material within the disc to rupture or swell. When this substance squeezes out and severely presses on a nerve, irritation and swelling result.
Degenerative disc disease. Bone spurs develop and facet joints swell as a result of degenerative disc disease, which occurs as discs deteriorate naturally. The discs lose their flexibility and insulating properties as they dry out and shrink. The disc's available space decreases. Stenosis or disc herniation is the result of these alterations.

Lumbar Discectomy Decision

After a few months of non-surgical treatment, the majority of herniated discs recover. Only you can determine whether surgery is the best course of action for you, even though your doctor may suggest many options. Be sure to weigh all the advantages and disadvantages before selecting a choice. After six weeks of non-surgical treatment, just 10% of persons with herniated disc issues still experience enough discomfort to consider the operation.

Who Performs Lumbar Discectomy?

Spine surgery can be carried out by an orthopedic or neurosurgeon. Complex spine surgery is a specialty area for many spine surgeons. Ask about your surgeon's training, particularly if your situation is complicated or if you've had multiple spinal surgeries.

Lumbar Discectomy Preparation

You will sign consent and other paperwork in the doctor's office so that the surgeon is aware of your medical history (allergies, medications/vitamins, bleeding history, anesthetic reactions, prior surgeries, etc.). With your healthcare practitioner, go over every medicine you use, including prescription, over-the-counter, and herbal supplements. Several days before surgery, preoperative testing, such as blood testing, electrocardiogram (ECG), and chest X-rays, may be required. To cease taking specific medications and make sure you are healthy enough for surgery, speak with your primary care physician.

Keep taking the prescription drugs that your doctor has prescribed. Stop using all blood thinners and non-steroidal anti-inflammatory drugs (such as ibuprofen, and naproxen) 7 days before the operation. To prevent bleeding and healing issues, stop smoking and consuming alcohol one week before surgery and two weeks afterward.

Before surgery, you could be instructed to wash your skin with Dial or Hibiclens (CHG). Infections at surgical sites are decreased and microorganisms are killed. (Avoid getting CHG in the nose, genital area, eyes, or ears.)

The Day of Surgery

Before surgery, avoid eating or drinking after midnight (unless the hospital tells you otherwise). Take your prescribed medications with a little sip of water.
Use antimicrobial soap while showering. Wear loose-fitting, recently washed clothing.
Wear closed-back, flat-heeled footwear.
Remove all jewelry, contacts, body piercings, nail polish, and other cosmetics.
Leave all jewelry and valuables at home.
Bring a list of your prescriptions, along with the recommended dosages and typical take-times.
Bring a list of any food or drug allergies.

To finish the required documentation and pre-procedure work-ups, arrive at the hospital two hours before your scheduled surgery time (the surgical center one hour in advance). You will speak with an anesthesiologist who will go over the concerns and effects of anesthesia.

Lumbar Discectomy Surgery

The process consists of five steps. A typical surgery lasts between one and two hours.

Prepare the patient. On the operating table, you will be lying on your back while receiving an anesthetic. When you fall asleep, you are rolled onto your belly and given cushions to support your chest and sides. Cleansing and preparation are done to the area where the incision will be made.
Make an incision. The surgeon uses a fluoroscope, or special X-ray, to detect the damaged vertebra and disc by inserting a small needle through the skin and down to the bone. A skin incision is created over the problematic vertebrae in the center of your back during an open discectomy. The number of discectomies that will be performed determines how long the incision will be. A single-level incision measures between one and two inches. To reveal the bony vertebra, the muscles of one side of the back are pulled back. To confirm the proper vertebra, an X-ray is obtained. A small cut (less than 1 inch) is created on one side of your back during a minimally invasive discectomy. The muscles are then gradually separated to make room for the bony vertebra by passing a series of progressively larger dilators around one another.
Perform a laminotomy. Then, using a drill or bone-biting instruments, a tiny incision of the lamina is created above and below the spinal nerve. A laminotomy can be performed on one (unilateral), both (bilateral), or several levels of the vertebrae.
Remove the disc fragments. The surgeon carefully retracts the nerve root's protective sac after removing the lamina. The herniated disc is identified after the surgeon uses a surgical microscope to search for it. To release the spinal nerve root, the ruptured piece of the disc is the only part that is removed. The whole disc is not taken out. Additionally removed are any bone spurs or synovial cysts that can impinge on the nerve root. Fusion for a single-level lumbar discectomy is not frequently done. However, a fusion may be used to treat other disorders such as recurrent disc herniation or spinal instability.
Close the incision. The muscles are released from the retractor holding them. With sutures or staples, the incisions in the muscle and skin are closed. Skin glue is used to close the incision.

What Happens After Lumbar Discectomy?

In the postoperative recovery area, you will awake. Monitoring of breathing, heart rate, and blood pressure will take place. Any discomfort will be treated. When you awaken, you might start moving gently (sitting in a chair, walking). Most people can return home that same day. In one to two days, other patients can be discharged from the hospital. For the first 24 to 48 hours, make sure you have assistance at home. For two weeks following surgery or up until your follow-up visit, adhere to the surgeon's home care instructions. Typically, you can anticipate:

Restrictions

Be careful not to bend or twist your back.
Never lift anything more than five pounds.
No hard activities, such as housework, yard work, or sexual activity.
If you are using painkillers or muscle relaxants, avoid driving for the first two to three days. You can drive if your discomfort is well-controlled.
Avoid consuming alcohol. Blood-thinning and bleeding risks are both increased. Additionally, avoid combining alcohol and painkillers.

Wound Care

You can take a shower the day after surgery if skin glue protects your wound. Every day, gently cleanse the area with soap and water. Avoid picking or rubbing the glue. Clean off.
You can take a shower two days following surgery if you have staples, steri-strips, or stitches. Every day, gently cleanse the area with soap and water.
Cover the incision with a dry gauze bandage if there is drainage. Call the office if drainage soaks through two or more bandages in a single day.
Avoid immersing the wound in a bath or pool.
Avoid putting lotion or cream over the incision.
Following each shower, put on fresh clothing. Lie down on fresh sheets. Until your incision has healed, no pets in the bed.
At your follow-up visit, staples, steri-strips, and sutures are removed.

Medications

As advised by your surgeon, take your pain medications. As your discomfort lessens, cut back on the quantity and frequency. Don't take the painkiller if you don't need it.

Constipation can result from narcotics. Consume foods high in fiber and drink plenty of water. Laxatives and stool softeners can aid with bowel movement. There are two over-the-counter options: Dulcolax and Miralax.

Activity

To lessen discomfort and swelling, apply ice to your incision 3-4 times daily for 15-20 minutes at a time.
Unless you are asleep, avoid being in one position for longer than an hour. Pain increases when you are stiff.
Every 3 to 4 hours, get up and take a 5- to 10-minute walk. As you are able, steadily increase your walking.

Lumbar Discectomy Recovery

2 weeks after surgery, make a follow-up visit with your surgeon. Some patients may require physiotherapy.

Depending on the underlying condition that was treated and your general health, the recovery period can be anywhere between 1 and 4 weeks. The area of the incision where you may experience pain. After surgery, the first pain might not be gone. Maintain a positive attitude and, if instructed, diligently carry out your physiotherapy exercises.

With jobs that are not physically demanding, the majority of people can return to work in 2 to 4 weeks or less. Others might need to wait at least 8 to 12 weeks before going back to work if their positions demand them to lift or operate large objects.

Backaches commonly recur. Prevention is the key to reducing recurrence:

Proper lifting methods
Maintaining a proper posture during moving, sitting, standing, and sleeping
Suitable exercise regimen
A comfortable workspace
Lean body mass and a healthy weight
A constructive attitude and relaxation exercises (e.g., stress management)
Avoid smoking

Lumbar Discectomy Results

Eighty to ninety percent of patients who undergo lumbar discectomy experience positive outcomes. The results of a study comparing surgical and nonsurgical care for herniated discs were as follows:

Surgery is more beneficial for sciatica patients than for those with back pain.
Nonsurgical treatment works well for people whose pain is less severe or getting better.
Compared to individuals who did not have surgery, those with moderate to severe pain report more improvement.

Similar results have been demonstrated for less invasive discectomy procedures and open discectomy. While reduced blood loss, less muscular stress, and quicker recovery are all advantages of minimally invasive methods, not all patients are good candidates for them.

A discectomy may offer pain relief more quickly than nonsurgical options. Uncertainty exists on whether surgery affects the potential need for future treatment. A recurrent disc herniation will occur in 5 to 15% of individuals, either on the same side or the other side.

Lumbar Discectomy Complications

Risks are associated with all surgeries. Any surgery might have general complications, such as bleeding, infection, blood clots, and anesthesia-related side effects. There is a higher risk of problems when spinal fusion and discectomy are performed together. The following are examples of specific discectomy-related complications:

Deep vein thrombosis (DVT). When blood clots develop inside the leg veins, a potentially dangerous condition known as deep vein thrombosis (DVT) results. Lung collapse or even death is a possibility if the clots escape and reach the lungs. DVT can, however, be treated or prevented in several ways. So that your blood is moving and less likely to clot, get out of bed as soon as you can. Blood can be prevented from pooling in the veins by wearing a support hose and pulsatile stockings. Additionally, medications like aspirin, heparin, or coumadin may be taken.
Lung problems. After surgery, the lungs must function at their peak to deliver enough oxygen to the tissues for healing. Pneumonia can develop if mucus and germs build up in the collapsed portions of the lungs. Your nurse will advise you to take deep breaths and cough frequently.
Nerve damage or persistent pain. Any procedure on the spine carries the chance of injuring the spinal cord or nerves. Damage might result in paralysis or even numbness. However, nerve injury from the disc herniation itself is the most frequent reason for persistent discomfort. Some disc herniations could harm a nerve irreversibly, rendering it resistant to decompressive operations. Spinal cord stimulation or other therapies could help in these circumstances. Make sure you have reasonable expectations for your pain before surgery. With your doctor, go over your expectations.

Conclusion

Your activity level might be greatly affected by low back pain, especially if it travels down your leg. Your doctor may recommend a spine surgeon who performs a lumbar discectomy if nonsurgical methods are ineffective at controlling your pain and symptoms. Lumbar discectomy has become more widely available thanks to these developments. Ask your doctor to refer you to a spine surgeon if you experience low back and leg discomfort so they can make an appropriate diagnosis. It's possible that you could be a candidate for lumbar discectomy.