Definition and Overview
Discectomy is the surgical removal of herniated or degenerative disc that stresses the spinal cord or radiating nerves.
In herniated disc, the annulus fibrous gets torn, irritating, compressing, or adding more pressure on the nerves, causing the patient pain, which severity can range from mild to excruciating. In some cases, it progresses and becomes chronic, even disabling. The pain can radiate to other parts of the body such as the shoulders and arms if the herniated disc is in the cervical region (neck) or the legs if it is in the lumbar spine (lower back).
Who Should Undergo and Expected Results
Discectomy is one of the treatment options for people with herniated discs, which typically have the following symptoms:
- Acute or chronic pain around the spinal region, which may extend to the closest body parts
- Tingling sensation
- Muscle weakness
- Muscle spasm
- Loss of control of the bladder and bowel
Slipped discs are caused by several factors such as age, degenerative disc disease, trauma or injury and sedentary lifestyle.
Discectomy is not usually the first form of treatment for patients with herniated discs. It is considered only when non-surgical options, including medications such as anti-inflammatories and epidural injections (which deliver medications directly into the spine), failed to correct the condition. Although spinal surgeries have greatly improved over the years, they still present some serious risks and complications, which the surgeon or spine doctor will discuss with the patient prior to the procedure. Normally, the doctor places the patient under non-surgical treatment for 3 to 4 months. If he remains unresponsive to treatment, discectomy will be considered.
How Does the Procedure Work?
Discectomy or herniated disc repair can be performed using the traditional or open method or by using minimally invasive techniques. The former is normally recommended when the disc has already ruptured and the nucleus has already gone past the disc wall. Between the two, it is the riskier option as it involves making a large incision either on the back or the neck, depending on the location of the herniated disc.
The minimally invasive surgery, on the other hand, is sometimes called microdiscectomy and is often performed in the lumbar area. It involves making small incisions on the lower back where an endoscope is inserted allowing the surgeon to see the exact location and condition of the herniated disc and its surrounding tissues. A laser is then used to remove the disc material that decompresses the nerves. This procedure is more ideal for people with the early slipped disc.
While open discectomy requires hospitalisation, microdiscectomy is often done on an outpatient basis and between the two, it has a shorter recovery time.
In both types of surgeries, however, certain preparations are necessary including going through lab and imaging tests to verify the herniated disc's location. The surgeon may also perform laminotomy, a surgical procedure that removes a part of the lamina to easily access the herniated disc. Both surgeries require general anesthesia.
Possible Risks and Complications
As a herniated disc repair procedure, discectomy has a high success rate. The minimally invasive surgery, for example, is 90% effective in offering immediate pain relief. However, this also means that the surgery does not offer any guarantee. The herniated disc can still recur, in which case the surgeon may suggest a revision (or another surgery).
As a surgical procedure, the patient can develop an infection, so the surgeon recommends antibiotics. It may also lead to bleeding and damage to the areas of the spine, including the nerves. Patients may also develop allergic reactions to the anaesthesia.
After the procedure, the patient is prohibited from performing strenuous activities, particularly lifting heavy objects, bending and playing sports until he is fully recovered.
Ehni BL, Satyan K. Lumbar discectomy. In: Benzel EC, ed. Spine Surgery. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 78.
Gardocki RJ, Park AL. Lower back pain and disorders of intervertebral discs. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 42.
Wilson AS, Samartzis D, Shen FH. Anterior cervical discectomy and fusion. In: Shen FH, Samartzis D, Fessler RG, eds. Textbook of the Cervical Spine. Philadelphia, PA: Elsevier Saunders; 2015:chap 30.