Discectomy
Discectomy is the most common surgical procedure used to correct
herniated discs.
It is also the most widely used procedure in the entire back surgery sector. More disc removal operations are performed every year than any other type of operation on the spine. In this procedure, part of the herniated disc is removed, hopefully eliminating the pain. Disc removal procedures have been performed for over 60 years in various forms. The modern version is much improved, compared to the overly invasive procedures done years ago.However, even with the latest technological innovations, discectomy is still a real gamble. In many cases, the disc implicated is not even the source of pain. In other patients, the diagnosis is sound, but the operation does not go well. There are a host of reasons why back surgery complications can occur. Finally, in many scenarios, the diagnosis is valid, the procedure goes perfectly, but within a few weeks or months, the disc re-herniates, placing the patient right back where they started, needing treatment all over again.
Traditional Open Procedure
This is the antiquated form of open surgery utilized for decades. It is mostly a thing of the past in developed nations, but is still practiced in areas lacking modern innovations and updated care providers. The usual procedure goes like this:
* General anesthesia administered. * Surgical incision made in the skin. * Muscles are dissected away from the incision site. * Ligament and bone removed to access the injured disc. * Part of affected disc is removed. * Incision closed and patient stays in hospital 1-2 days. * Recovery is long, mostly due to the muscular dissection which requires weeks to heal.
Microendoscopic Discectomy
Microdiscectomy is the modern procedure utilizing a variety of high-tech practices and equipment. Many of these surgeries are performed through an anterior approach and some utilize laser scalpels, fiber optic visualization and other state of the art devices.
* Minimally invasive. * Local / spinal / general anesthetic used. * Surgical incision in the skin. * Muscles are not cut, but stretched. * Endoscope and fluoroscope used to image and view the area. * Part of affected disc removed. * Incision closed and patient can leave hospital the same day. * Shorter recovery time and less postoperative pain.
Recovery from Disc Removal Surgery
Recovering from back surgery
can be a difficult path and disc removal procedures are no exception to the rule. Standing and walking are encouraged as soon as possible, but activity level must be kept controlled for a few weeks. Hard physical labor is discouraged for 2 to 3 months.
Physical therapy
is usually prescribed to help the patient to regain mobility and range of motion, as part of a postoperative
rehabilitation
program. It is absolutely vital to fully understand what will be needed after the operation in terms of followup care and lifestyle modifications. Not adhering to your surgeon's recommendations will complicate the healing process, possibly causing troublesome health effects and may even result in a re-herniation immediately after the operation.
Complications from Discectomy
This procedure is usually performed while the patient is under general anesthesia. This fact alone raises health concerns for those in questionable health, especially the elderly or the obese. Local anesthetic is always preferable if it is available for your particular procedure. There is a risk of internal bleeding or leakage of spinal fluid after the operation. There is also the possibility of nerve damage or infection. After a disc removal operation, the patient has a greater chance of re-injuring the same disc. More than 20% of patients do not get any relief from surgery and more than half still have some symptoms post-surgery. Longterm results are worse still, with few patients enjoying continued benefits longer than 7 years.
Recommendation for Discectomy
I would never recommend
spinal surgery
if it can be avoided. Patients should completely exhaust all conservative and moderate
back pain treatment
options before even considering
back surgery.
If you feel that your doctor is pushing you to undergo surgery prematurely, make sure to get a
second opinion.
Some providers will do anything to get you onto their operating table… threats, coercion and downright lies. I have seen it all and heard it from the stories you send me every week. If you do need a disc removal surgery, talk to your doctor about procedural options and any factors which might help prevent a recurrence of the herniation in the future. For patients who have already had several discectomies and are now being courted to receive spinal fusion, be very careful… This is a truly drastic treatment option which rarely solves pain issues. Many would be better off researching options for disc replacement surgery instead or simply giving up the surgical revolving door in favor of conservative care.
Discectomy to Back Pain
6/11/06 Revised 11/4/11
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