Spinal Discectomy

As a disc degenerates and breaks down, the inner core may swell and leak out through the outer portion of the disc. This condition is known as a herniated disc. The material that leaks out causes pressure on the spinal cord or the nerves that radiate from it, leading to pain that may travel to other parts of the body, such as from the low back down the leg or from the neck down the arm. Leg pain from a pinched nerve is usually described as sciatica.
However, not all herniated discs press on nerves, and it is entirely possible to have deformed discs without any pain or discomfort. Herniated disks are most common in men and women in the age group of 30 – 50 years, although they also occur in active children and young adults. Older people, whose disks no longer have fluid cores, are less likely to experience a herniated disc problem. People who do regular, moderate exercise are much less likely to suffer from disc problems than sedentary adults.
Discectomy is a surgical procedure to remove the damaged portion of a herniated disc (also called slipped, ruptured or bulging disc or disc prolapse) in your spine. The procedure involves removing the central portion of an intervertebral disc, which causes pain by stressing the spinal cord or radiating nerves. Discectomy works best on radiating symptoms. It’s less helpful for actual back pain or neck pain.
Your doctor may suggest discectomy if conservative, nonsurgical treatments, such as pain medications or physical therapy, haven’t worked or if your symptoms worsen.
There are several ways to perform a discectomy. Many surgeons now prefer minimally invasive discectomy, called microdiscectomy, which involves making small incisions and using a tiny video camera for viewing. Sometimes, surgeons may combine discectomy with spinal fusion or artificial disc replacement because they are concerned that the empty space where the disc was removed may eventually collapse and fill in with bone, leading to further problems.

 

Symptoms of herniated disc

Some people with herniated discs show no symptoms at all while others may suffer from severe pain. Most herniated discs occur in your lower back (lumbar spine), although they can also occur in your neck (cervical spine).

The most common signs and symptoms of a herniated disc are:

  • Arm or leg pain – Depending on the location of the herniated disc, the pain may radiate to other parts of your body. If the herniated disc is in your neck, the pain will typically radiate to the shoulder and arm. If the herniated disc is in your lower back, the pain is likely to travel to your hips, thigh and calf. It may also involve part of the foot. This pain may shoot into your arm or leg when you cough, sneeze or move your spine into certain positions.
  • Numbness or tingling – There might be numbness or tingling in the body part served by the nerves compressed by the herniated disc.
  • Weakness – Muscles served by the nerves affected by the herniation tend to weaken. This may impair your ability to move properly and also lift or hold items.

 

 

Reasons for the procedure

A discectomy is performed to relieve the pressure a herniated disc places on a spinal nerve.
Your doctor may recommend the procedure if:

  • A disc fragment lodges in your spinal canal, pressing on a nerve.
  • The weakness in your muscles/nerves hinders standing or walking properly.
  • Conservative treatment, such as medication or physical therapy, fails to improve your symptoms after six weeks.
  • Pain radiating to your other body parts, such as hips, legs, arms or chest, becomes difficult to manage.
  • Loss of bladder control.

 

Risks of the procedure

As with any surgical procedure, complications can occur. Some complications may include, but are not limited to, the following:

  • Bleeding.
  • Infection.
  • Leaking spinal fluid.
  • Injury to blood vessels or nerves in and around the spine.
  • Injury to the protective layer surrounding the spine.

Discectomy is a relatively safe procedure. However, you should discuss any concerns before the procedure because there may be other risks, depending on your specific medical condition.

 

Before the procedure

  • Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the surgery.
  • You may be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  • In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
  • Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
  • Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
  • Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
  • You will be taught special ways to do everyday things after surgery to protect the spine. This includes learning how to move properly, changing from one position to another, and sitting, standing, and walking.
  • If you smoke, you will be asked to stop it. People who have spine surgery and keep smoking do not heal as well. Ask the doctor for help.
  • Let the doctor know right away if you have any cold, flu, fever, herpes breakout, or other illness before the surgery.
  • On the day of the surgery, you will likely be asked not to eat or drink 6 – 12 hours before the procedure.
  • Take any medicines the doctor told you with a small sip of water.

 

During the procedure

Discectomy may require an overnight stay in the hospital. The procedure may vary depending on your condition and your doctor’s practices.
Generally, the surgery follows this process:

  • You will be asked to remove clothing and given a gown to wear.
  • An intravenous (IV) line will be started in your arm or hand. Additional catheters may be inserted to monitor the status of your heart and blood pressure, as well as for obtaining blood samples.
  • If there is excessive hair at the surgical site, it may be clipped off.
  • A catheter will be inserted into your bladder.
  • The surgery will be performed while you are asleep under general anaesthesia. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
  • There are two ways to perform discectomy, depending on your condition and your doctor’s choice. When the surgery is performed through the anterior (front) of the neck, it is called anterior cervical discectomy. However, when many pieces of the herniated disc have squeezed into the posterior (back) of the spine, surgeons may need to operate through the back of the neck using a procedure called posterior cervical discectomy.The surgeon may also do the procedure using a special video camera.
  • In an anterior discectomy, the patient is positioned facing the ceiling with the head bent back and turned slightly to the right. A two-inch (3-5 cm) incision is made two to three fingers above the collar bone across the left-hand side of the neck. The left side is chosen to make the incision to avoid injuring the nerve going to the voice box. Retractors are used to gently separate and hold the neck muscles and soft tissues apart so the surgeon can get a clear view of the front of the spine. A needle is inserted into the herniated disc, and an X-ray is taken to identify and confirm it is the correct disc. A long strip of muscle and the anterior longitudinal ligament that cover the front of the vertebral bodies are carefully pulled to the side. Then forceps are used to take out the front half of the disc. Next a small rotary cutting tool (a burr) is used to carefully remove the back half of the disc.
  • In posterior discectomy, the patient is made to lie face down with the neck bent forward and held in a headrest. The surgeon makes a short incision down the center of the back of the neck. The skin and soft tissues are separated to expose the bones along the back of the spine. Then the surgeon may use an X-ray to identify the injured disc. A burr is used to shave the edge off the lamina bones, the back part of the ring over the spinal cord. If the disc protrudes straight backward into the spinal cord, surgeons may need to completely remove both lamina bones in order to see better and to be able to clear all the pieces of the disc near the spinal cord. After shaving the lamina bone, the surgeon cuts a small opening in a ligament within the spinal canal and in front of the lamina bone. By removing part of this ligament, the surgeon exposes the spot where the disc fragments are pressed against the spinal nerve. Next, the spinal nerve is gently moved upward.
  • A surgical microscope is used to help the surgeon see and remove pieces of disc material and any bone spurs that are near the spinal cord.
  • The muscles and soft tissues are put back in place, and the skin is stitched together.
  • The surgery usually takes 4 – 6 hours.
  • A small dressing is applied over the incision.
  • Your surgeon may place a drain into the wound, which is typically removed on the day following the procedure.
  • A rigid or soft cervical collar may be put on your neck for immobilization.

 

After the procedure

After the surgery, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you may be taken to your hospital room. You may be healthy enough to go home the same day you have surgery, although an overnight stay in the hospital stay may be necessary. If you have any other serious medical condition, your doctor may prolong your stay in the hospital.

  • Intravenous fluids may be continued until you can drink fluids well by mouth.
  • Once you are able to drink normally, you will be able to start eating your normal diet.
  • 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.

Aftercare at home

Before you are discharged from the hospital, your doctor and other members of the hospital staff will give you additional self-care instructions for you to follow at home.

You should visit your doctor for a follow-up visit approximately 12-14 days after surgery. The incision will be inspected. Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

  • At first, you may not be comfortable sitting. Most people avoid having to sit for longer than 15 or 20 minutes. In fact, you may be advised to limit the amount of time you spend sitting for four weeks following the surgery. But sitting will feel more comfortable over time and without any restrictions.
  • Limit activities involving lifting, bending and stooping for four weeks after discectomy.
  • 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.
  • You should inform your doctor if you have difficulty swallowing or any other discomfort related to surgery.
  • There are no permanent restrictions after 6 months of the date of surgery.

To avoid re-injuring your spine, your doctor may recommend weight loss, a low-impact exercise program, and ask that you limit some activities that involve extensive or repetitive bending, twisting or lifting.

Recovery

You may return to work 2-6 weeks after surgery depending on the amount of lifting, walking and sitting your job involves. If you have a job that includes heavy lifting or operating heavy machinery, you may be advised to wait 6-8 weeks before returning to work.