Surgery Overview
Discectomy is surgery to remove herniated disc material that is pressing on a
nerve root or the spinal cord.
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.
Microdiscectomy uses a special microscope to view the disc and nerves. This larger view allows the surgeon to use a smaller cut. This causes less damage to surrounding tissue.
During discectomy, the surgeon removes the part of the disc that is
herniated and is pushing into the spinal canal. Any loose fragments of disc are also removed.
It is usually done in a hospital. You are asleep or numb during the surgery. You will probably stay in the hospital overnight.
What To Expect After Surgery
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 may not be comfortable sitting at first. Most people avoid
having to sit for longer than 15 or 20 minutes. But sitting will feel more comfortable over time.
- Walk as often as you can for the first several weeks. Getting up often to walk around will
help lower the risk that too much scar tissue will form.
- If you work in an office, you may go back to work in
2 to 4 weeks. If your job requires physical labor (such as lifting or operating
machinery that vibrates) you may be able to go back to work 4 to 8 weeks after
surgery.
- Many people are able to resume work and daily activities
soon after surgery. In some cases, your doctor may suggest a rehabilitation
program. This may include
physical therapy and home exercises.
Why It Is Done
Surgery is done to decrease pain and allow you to regain normal movement and function.
You and your doctor may consider surgery if:
- You have very bad leg pain, numbness, or weakness that keeps you from being able to do your daily activities.
- Your leg symptoms do not get better after at least 4 weeks of nonsurgical treatment.
- Results of a physical exam
show that you have weakness, loss of motion, or abnormal feeling that is
likely to get better after surgery.
Surgery is considered an emergency if you have
cauda equina syndrome. Signs include:
- New loss of bowel or bladder
control.
- New weakness in the legs (usually both
legs).
- New numbness or tingling in the buttocks, genital area, or
legs (usually both legs).
Herniated Disc: Should I Have Surgery?
How Well It Works
Although surgery doesn't work for everyone, it works well for many people.
A study called SPORT randomly assigned about 500 people to two groups. Some had surgery, and some did not. The study found that after 2 years most people felt better and were able to be active, whether they had surgery or not. People who had surgery were slightly more likely to feel better. But the difference wasn't big enough to prove that one treatment is better than the other.1
Another study followed about 500 people over 10 years. Some had surgery, and some did not. This study showed that people who started with medium to very bad pain tended to feel better sooner if they had surgery. But after 5 to 10 years, the number of people in both groups who were able to do their daily activities was about the same whether they had surgery or not.2, 3
Risks
As with any surgery, there are some risks.
- Surgery doesn't always work, or it may not work any better than other treatment.
- There is a slight risk of damaging the spine or nerves.
- There is some risk of infection.
- There are risks with anesthesia.
What To Think About
Discectomy may provide faster
pain relief than nonsurgical treatment, although it is unclear whether surgery
makes a difference in what treatment may be needed later on.4
When comparing conventional open discectomy with
microdiscectomy, people have reported being equally satisfied with both
techniques.5
Spinal fusion is a procedure
that joins together bones in the back. It is sometimes effective for neck
problems. A cervical (neck) discectomy is usually combined with a fusion. But for the low back (lumbar
spine), the procedure is controversial and complex and is not commonly
performed with a discectomy. If a doctor suggests that you get a lumbar spinal
fusion with a discectomy, get a second medical opinion to help you decide
whether fusion is needed.
Percutaneous discectomy is a procedure using a special tool through a small incision
in the back to cut out or drain the herniated disc, thereby reducing its size.
Percutaneous discectomy is considered less effective than open
discectomy.4
A newer form of discectomy
using laser beams (laser discectomy) is still in the research stage.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
References
Citations
- Weinstein JN, et al. (2006). Surgical vs nonoperative
treatment for lumbar disk herniation: The spine patient outcomes research trial
(SPORT): A randomized trial. JAMA, 296(20):
2441–2450.
- Atlas SJ, et al. (2001). Surgical and nonsurgical
management of sciatica secondary to a lumbar disc herniation: Five-year
outcomes from the Maine Lumbar Spine Study. Spine,
26(10): 1179–1187.
- Atlas SJ, et al. (2005). Long-term outcomes of
surgical and nonsurgical management of sciatica secondary to a lumbar disc
herniation: 10-year results from the Maine Lumbar Spine Study. Spine, 30(8): 927–935.
- Deyo RA, Weinstein JN (2001). Low back pain.
New England Journal of Medicine, 344(5):
363–370.
- Jordan J, et al. (2009). Herniated lumbar disc, search
date July 2008. Online version of Clinical Evidence: http://www.clinicalevidence.com.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | William H. Blahd, Jr., MD, FACEP - Emergency Medicine |
|---|
| Specialist Medical Reviewer | Robert B. Keller, MD - Orthopedics |
|---|
| Last Revised | March 1, 2011 |
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Weinstein JN, et al. (2006). Surgical vs nonoperative
treatment for lumbar disk herniation: The spine patient outcomes research trial
(SPORT): A randomized trial. JAMA, 296(20):
2441–2450.
Atlas SJ, et al. (2001). Surgical and nonsurgical
management of sciatica secondary to a lumbar disc herniation: Five-year
outcomes from the Maine Lumbar Spine Study. Spine,
26(10): 1179–1187.
Atlas SJ, et al. (2005). Long-term outcomes of
surgical and nonsurgical management of sciatica secondary to a lumbar disc
herniation: 10-year results from the Maine Lumbar Spine Study. Spine, 30(8): 927–935.
Deyo RA, Weinstein JN (2001). Low back pain.
New England Journal of Medicine, 344(5):
363–370.
Jordan J, et al. (2009). Herniated lumbar disc, search
date July 2008. Online version of Clinical Evidence: http://www.clinicalevidence.com.
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