Discectomy for a Herniated Disc

Disc herniations can sometimes cause low back and/or leg pain. The term “herniate” means to bulge or to stick out. While conservative treatments (such as ibuprofen or physical therapy) are often effective for controlling symptoms, sometimes a herniated disc requires a surgical procedure called a discectomy.

What Is a Discectomy?

Cartilaginous discs sit between each vertebra in the spine to provide cushioning and support. When the spine or disc is affected by aging or injury, part of the disc can bulge out.

The bulging disc can press on the spinal cord or the nerve roots that branch off it, causing pain, tingling, or weakness in the legs. For example, pressure on the sciatic nerve causes sciatica, which is a type of pain in the leg and lower back.

During a discectomy, the pieces of a herniated disc that press on a nerve or on the spinal cord are surgically removed. All or part of the lamina, which is an area of bone at the back of the vertebra, will also be removed.

Purpose of a Discectomy

If you have low back pain, you should discuss your symptoms and treatment options with your healthcare provider.

Most of the time, conservative methods such as medications, physical therapy, or steroid injections are tried before surgery. In fact, a herniated disc often heals without surgery in a few weeks or months.

Your healthcare providers may consider a discectomy as a possible treatment for you if:

• You've tried conservative measures without adequate improvement.
• Your pain is interfering with normal activity or impairs your quality of life.
• Your leg weakness and/or numbness are worsening.
• You have difficulty standing or walking.
• You are otherwise in good health.

Contraindications

Sometimes, health issues can put you at high risk of discectomy complications. And some types of disc herniations are less likely to improve after this procedure.

Contraindications for discectomy include:

• Herniated discs in more than one location on the spine
• Osteoporosis or another bone-weakening disease
• Spinal stenosis
• Anatomical variations in your spine
• An active infection
  

Risks and Complications

Discectomy risks include infection, bleeding, injury to the dura mater (the covering around the spinal cord) or injury to nearby nerves, arteries, or veins.

The most common complication of discectomy is when another fragment of the disc herniates and causes similar symptoms in the future. A 2015 systematic review of studies found that after two years, pain may recur in up to 25% of patients who underwent a first discectomy. Of these, about 6% needed a second operation.

Types of Discectomy

A discectomy procedure can be done one of two ways and your surgeon will talk to you about the best method for your situation.

Open Discectomy

Open discectomy is done in a hospital setting with general anesthesia. The surgery takes around an hour and you may need to stay overnight in the hospital.

• During the procedure, you would lie face down on the operating table.
• Your surgeon will make an incision that is approximately 3 inches along your spine in the area of the slipped disc.
• Your procedure will begin with a laminotomy, which involves moving the muscles away from your spine and removing a small amount of bone and ligament.
• Once the laminotomy is done, the fragment of the herniated disc is removed.

The incision is closed and a bandage is applied.

Microdiscectomy

Microdiscectomy is a minimally invasive procedure that you can have as an outpatient. You may receive a local anesthetic or general anesthesia.

• Your surgeon will make an approximately 1-inch incision on your back, at the level of the affected disc.
• A special tube will be inserted into the incision, pushing the muscles and other tissue so that your surgeon can access your vertebrae.
• A tiny camera and a light are inserted into the tube, which projects an image of your spine onto a monitor.
• Your surgeon will use small surgical tools to remove the parts of the disc pressing on the nerve.

The incison is then closed and a bandage is placed over it.

Selecting a Surgeon

Orthopedic surgeons and neurosurgeons perform many kinds of back surgeries, including discectomies. iI's important to find a surgeon who does a large number of discectomies per year.

Your primary healthcare provider or orthopedist can give you recommendations, as can friends or family who might have undergone the same procedure. You should meet with your surgeon ahead of time so they can plan your procedure and you should ask any questions you have before you select a surgeon and schedule your procedure.

You'll also need to call your insurance company to make sure they will cover the cost of the surgery.

Preparing for Surgery

Prior to your discectomy, you will have some medical tests to check your heart health and overall health to ensure that you can tolerate surgery and anesthesia.

Tell your healthcare providers which medications you are taking. If you are on a blood-thinner, you might be instructed to stop taking it five to seven days before surgery, because they can increase the risk of bleeding.

You will be asked not to eat or drink after midnight the night before the surgery.

You will also need to arrange for someone to take you home after the surgery and to be around during your recovery.

Recovery 

You may have post-operative pain at the incision site immediately following your surgery.

It's a good idea to start walking as soon after your procedure as you are able. This will help speed recovery, prevent scar tissue, and mobilize your spine.

Within a couple of weeks, you should be able to ride a bike or swim. Most people get back to work in two to eight weeks, depending on how physical their job is.

Physical therapy can assist you in a speedy return to work and other activities. If your healthcare provider doesn't refer you to PT, you might consider asking them about it.

A Word From Verywell

If you feel anxious about undergoing a discectomy, it is important to speak with your surgeon about any concerns or fears you may have about the surgery. It is perfectly natural to feel some pre-surgery anxiety.

Educating yourself about the surgery, planning in advance, following the preoperative and postoperative instructions, and finding support from family and friends will help you transition more easily through your recovery