Overview
Discectomy is a surgical procedure to treat low back pain associated with failing or damaged spinal discs. A surgeon removes a part of the disc to ease pressure on the nearby nerves to minimize low back pain and shooting pain down the legs (sciatica).
This blog delves deep into discectomy, its purpose, and its procedure.
What is discectomy?
Discectomy is a procedure involved in removing the damaged portion of a herniated disc in the spine. A herniated disc may irritate or compress nearby nerves. Discectomy is mainly used to efficiently treat pain that radiates down the arms or legs. More-conservative treatments, such as physical therapy, may offer relief to many people with back or neck pain.
The doctor can recommend discectomy if conservative, non-surgical treatments fail or when the symptoms worsen. There are many ways in which doctors perform a discectomy. Most surgeons now choose minimally invasive discectomy using a probe and a tiny incision.
Why is a discectomy performed?
Surgeons perform a discectomy to ease the pressure a herniated disc places on a spinal nerve. When the softer material inside the disc slips out of the crack in the outer lining of the disc is called a herniated disc.
The doctor can suggest discectomy if:
- People have trouble standing or walking due to nerve weakness
- Conservative treatment, including physical therapy or steroid injections, fails to improve the symptoms after six to 12 weeks
- Pain radiating into the buttocks, legs, arms, or chest becomes challenging to manage
How is a discectomy performed?
Before the surgery
Doctors administer general anaesthesia to the patient before the surgery. The patient also needs to fast a few hours before the surgery. The doctor may adjust the dose and provide specific instructions if a patient needs blood-thinning medications.
During the surgery
The patient lays with their face down on an operating table. There are different types of discectomies the surgeon may perform. They include:
Standard or ‘open’ discectomy
The surgeon makes a cut/incision for a clear view of the disc and uses surgical instruments to trim away a part of the disc. In this surgery, surgeons often include laminectomy to remove a part of the vertebra’s outer arch called ‘lamina’ to relieve the pressure on the nerves.
Microdiscectomy
Most surgeons opt for microdiscectomy as it is a minimally invasive procedure. During microdiscectomy, the surgeon makes a tiny incision in the back to remove a small portion of the lamina to view the disc. The procedure is called hemilaminectomy. Afterwards, the surgeon cuts a part of the disc similar to the standard discectomy. The difference is that with this surgery, they can operate using a minor cut.
Percutaneous discectomy
The surgeon makes a small incision in percutaneous (through the skin) discectomy. Afterwards, they use a special X-ray imaging device, a fluoroscope, to guide a slender tube through the incision and into the herniated disc. The surgeon then places special tools through the tube to remove material from the disc and ease the pressure off nearby nerves.
Surgeons use various techniques to perform percutaneous discectomies, including using a laser to remove the disc material, injecting a chemical that dissolves disk material or treating the inner disk with heat or radio waves to shrink it.
After the surgery
After the surgery, the patient may be under observation for a couple of hours. If there are no complications, the patient is discharged on the same day. However, the patient may need a family member or a friend to drive them home.
The doctor may provide instruction for after-care. They are as follows:
- The incision should be kept clean
- Antibiotics may be prescribed
- Avoid activities such as lifting, bending, and sitting for a prolonged period as it may stress the spine
- Overweight patients are recommended to lose weight
- Consult the doctor before resuming daily activities or exercise
- Patients may resume daily activities after 2 to 6 weeks
When to seek medical help?
The patient must immediately contact the doctor if patient notices signs of infection. The symptoms of infection are as follows:
What are the risks of discectomy?
Discectomy is generally a safe surgery. But, as with any other surgery, there are risks of complications that may include:
- Infection
- Excess bleeding or blood clots
- Excessive spinal fluid leakage
- Injury to the spinal nerves or the blood vessels
- Damage to the protective layer around the spine
Conclusion
Surgeons perform discectomy for patients with chronic back pain caused due to ageing or injured spinal discs. Experts may first suggest patients try non-surgical treatments before opting for surgery. The doctor may only suggest surgery when patients have nerve damage symptoms, including numbness, burning, or ‘pins and needles,’ and hypersensitivity to touch. The exercise recommended to strengthen muscles and support the spine may help prevent future flare-ups of a painful disk.
Frequently Asked Questions (FAQs)
1. What are the results of a discectomy?
Discectomy minimizes herniated disc symptoms in most people with clear nerve compression signs, such as radiating pain. However, discectomy cannot be a permanent solution since it does not reverse the process of herniation.
2. How effective is discectomy?
Clinical trials indicate that discectomy minimizes pain and disability in the short term compared to not undergoing surgery. However, it does not guarantee that symptoms will not return in the future.
The results of clinical studies are inconclusive to show if microdiscectomy is more effective or safer than open discectomy or vice versa. Microdiscectomy could minimize complications and reduce the recovery time.
3. What is a slipped disc?
A slipped disc occurs if a soft cushion of tissue between the bones in the spine bulges out. It is painful when it presses on nerves. It generally gets better with rest, gentle exercise, and painkillers.
