What Is a Discectomy and When Is it Performed?
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Discectomy Overview
Since its founding, more than 45 years ago, the spine surgeons at Texas Back Institute have performed tens of thousands of surgical procedures, but interestingly, discectomy has been performed more than any other. This is particularly good news for patients who might need this surgery. This procedure is successfully completed hundreds of times each month, and thousands of patients have had chronic pain reduced and have gotten a better quality of life.
Discectomy is surgery to remove the damaged part of a disk in the spine that has its soft center pushing out through the tough outer lining. A herniated disk can irritate or press on nearby nerves. A herniated disc occurs when the inner substance of the disc is pushed through a weakened outer layer.
The spine specialists at Texas Back Institute point out that discectomy works best for treating pain that travels down the arms or legs caused by a compressed nerve. The procedure is less helpful for treating pain that is felt only in the back or neck. Most people who have back pain or neck pain find relief with other treatments, such as weight loss, arthritis medication or physical therapy.
In most cases, a discectomy is recommended if other, nonsurgical treatments, have not been successful in alleviating pain or if the symptoms worsen. There are several ways to perform a discectomy which will be discussed here, but many surgeons prefer minimally invasive discectomy, which uses small incisions and a microscope or tiny video camera for viewing the procedure.
A diskectomy is done to relieve the pressure that a herniated disk, which can also be referred to as a “slipped,” “ruptured,” “bulging disk” or “disc prolapse,” places on a spinal nerve. A herniated disk occurs when some of the softer material inside the disk pushes out through a crack in the outer lining of the disk.
Table of Contents
Treats
Diagnosing
Recovery
A Brief Explanation of Herniated Disc
Examining the mechanics of the spine suggests the challenges of a herniated disc. According to an explanation found in “Medline Plus,” a publication of The National Library of Medicine, “The vertebral column provides protection to the spinal cord that runs through its central cavity. Between each vertebra is an intervertebral disk. The disks are filled with a gelatinous substance, called the ‘nucleus pulposus,’ which provides cushioning to the spinal column. The annulus fibrosus is a fibrocartilaginous ring that surrounds the nucleus pulposus, which keeps the nucleus pulposus intact when forces are applied to the spinal column. The intervertebral disks allow the vertebral column to be flexible and act as ‘shock absorbers’ during everyday activities such as walking, running and jumping.”
Age-related wear and tear are the primary cause of a herniated disk. This is usually a gradual process that spine specialists at Texas Back Institute call “disk degeneration.” With age, the disks become dehydrated, less flexible, and more prone to tearing or rupturing with even a minor strain or twist. Interestingly, most people can’t pinpoint the cause of their herniated disk.
Injuries associated with work or recreation activities can also cause a herniated disc. Something as simple as using the back muscles instead of the leg and thigh muscles to lift heavy objects can lead to a herniated disc. Twisting and turning while lifting also can cause a herniated disk. In rare instances a traumatic event such as a fall or blow to the back can cause this condition.
Spinal disk herniation, which is also known as a “slipped disk” or “ruptured disk” and sometimes is referred to as “bulging disk” occurs when the soft center of a spinal disk pushes through a crack in the tougher exterior casing. Most herniated disks occur in the low (lumbar region) back area. The lumbar spine is particularly susceptible to conditions like lumbar disk herniation, which can lead to significant spinal degeneration and may require surgical interventions such as diskectomy to alleviate pressure on spinal nerves originating from this region. This condition is quite common and may or may not cause symptoms.
Even a healthy, well-hydrated disc can be injured. Stretching or tearing of the annulus may result in back or neck pain. The discs are immediately in front of the spinal cord and exiting nerves, so when the herniated disc or protrusion compresses the spinal cord or nerves, leg or arm pain and numbness or weakness may occur.
Types of Minimally Invasive Surgery Discectomy Procedures
The spine surgeons at Texas Back Institute note there are three types of discectomy procedures, and each is minimally invasive. A minimally invasive procedure is one where the surgical incision is smaller, resulting in less tissue damage, fewer complications, such as infections, and quicker patient healing.
One form of this procedure is endoscopic discectomy. This is performed by creating a small incision in the skin and then inserting a small probe into the prolapsed or herniated disc. After the probe is passed through the skin, an endoscope with a built-in camera and light is inserted, allowing the surgeon to visualize the affected area on a monitor. Surgical instruments are then inserted to accomplish the surgery.
The surgeons at Texas Back Institute prefer minimally invasive discectomy. Minimally invasive lumbar discectomy, in particular, utilizes smaller dime sized incisions and causes less disruption to surrounding bone and muscle compared to traditional open lumbar discectomy, resulting in potential benefits like reduced recovery time and lower risk of complications.
Microdiscectomy is a minimally invasive discectomy technique that uses a specially designed surgical microscope to magnify and make the surgical field more visible. Microdiscectomy is considered the gold standard for open discectomy.
Finally, Percutaneous Discectomy is another type of discectomy where a percutaneous probe (which means “going through the skin”) is introduced via needle puncture on the skin. The probe is further inserted into the intervertebral disc and the bulging or herniated portion of the disc is removed.
Patients Ask:
What is ACDF surgery?
Texas Back Institute Responds: ACDF is the acronym for Anterior Cervical Discectomy and Fusion, and it has proven to be an effective tool for correcting discs that are herniated.
Anterior Cervical Discectomy and Fusion (ACDF) for neck pain
Healthy discs function as a flexible cushion between vertebrae bones, and this, in turn, allows the neck to bend and rotate. When age-related wear and tear on discs cause herniation or thinning that pinches the nerves, pain and other symptoms can occur.
A discectomy can be performed anywhere along the spine from the neck (cervical) to the low back (lumbar). The thoracic and lumbar spine are significant regions often affected by degenerative disorders, which may necessitate surgical interventions like diskectomy. A spine surgeon can reach the damaged disc from the front (anterior) of the spine through the throat area. By moving aside the neck muscles, trachea, and esophagus, the disc and bony vertebrae are exposed.
Surgery from the front of the neck is more accessible than from the back (posterior) because the disc can be reached without disturbing the spinal cord, spinal nerves, and the strong neck muscles. Depending on the patient’s symptoms, one disc (single level) or more (multi-level) may be removed.
This procedure, where the disc is removed, results in a space or gap between the bony vertebrae. To prevent the vertebrae from collapsing and rubbing together, a “spacer” bone graft can be inserted to fill the open disc space. The graft serves as a bridge between the two vertebrae to create a spinal fusion. The bone graft and vertebrae are fixed in place with metal plates and screws.
After this ACDF surgery, the body begins its natural healing process and new bone cells grow around the graft. After 3 to 6 months, the bone graft should join the two vertebrae and form one solid piece of bone. Instrumentation and fusion work together, similar to reinforced concrete.
This spinal fusion surgery has proven to stabilize the vertebrae, but patients may notice some range of motion loss. This decrease in mobility will vary according to neck mobility before surgery and the number of levels fused. If only one level is fused, patients may have a similar or even better range of motion than before surgery. If more than two levels are fused, patients may notice limits in turning their head and looking up or down.
The spine surgeons at Texas Back Institute pioneered a procedure that supplies the space between discs, without the loss of mobility. Over the past 20 years, this “Artificial Disc Replacement” (link to the latest blog posts about ADR and TBI) has emerged as an alternative to fusion.
Much like knee and hip replacement, the artificial disc prosthesis is inserted into the damaged joint space and preserves motion. The outcomes for artificial disc replacement compared to ACDF are similar, but this is not the case for those with facet joint arthritis or weak bones.
ACDF may be helpful in treating the following conditions:
The rubbery center of the disc can bulge or rupture through a weak area in the wall (annulus). Pain and swelling occurs when this material presses on a nerve.
The drying and shrinkage of discs with age. As the disc thins, the vertebrae bones rub and pinch the nerves. These changes can lead to canal stenosis, bone spurs, or disc herniation.
Narrowing of the canal through which the spinal cord passes. CSM is caused by bulging discs, enlarged facet joints and thickened ligaments. Pain, weakness of the arms / legs, and walking problems arise from spinal cord compression.
Patients Ask:
What Are the Options for Bone Grafts?
Any spinal fusion procedure, including the ACDF requires bone grafts to allow the fusion to be stable. This bone graft material has been called the “mortar” for this new spinal construction.
For patients choosing this ACDF procedure, there are several options for bone grafts. These include:
- Autograft
This is the patient’s living bone and is considered the “gold standard” for grafts. The marrow contains bone-growing proteins. It can be collected from drillings during the surgery or taken from the hip as an iliac crest bone graft. This graft has a higher rate of fusion. The disadvantage is the pain in your hip bone.
- BMA (bone marrow aspirate)
This is your living bone marrow, collected with a syringe from the hip (iliac bone) or vertebra. It is relatively painless compared to an iliac crest graft.
- Allograft
This is bone from an organ donor, collected and stored by a bone-bank. The donor graft has no bone-growing cells or proteins. Allograft is packed with shavings of living bone tissue taken from your spine during surgery.
- Cellular bone matrix
This comes from an organ donor that contains bone-growing stem cells. The putty is shaped and added to grafts.
- BMP (bone morphogenetic protein)
This is sometimes added to bone-graft material to stimulate bone growth naturally in the body.
What to Expect with the Discectomy Procedure
Before the discectomy:
Once a decision to have a discectomy has been made, here is what a patient should expect before the surgery:
- A medical examination will occur.
- Chest X-ray, EKG, and blood work will be completed.
- You may be asked to have a neurological or psychological examination.
- If taking aspirin or anti-inflammatory medications daily, stop these medications at least one week before discectomy surgery.
- If you take prescription medications or other drugs, including herbals, ask your doctor how soon before surgery you should stop taking these.
- Patients are instructed to refrain from having anything to eat or drink for 6 to 8 hours before discectomy surgery.
- You will check into the hospital the morning of surgery.
- Prior to surgery, you will be asked to sign permits for discectomy surgery, anesthesia, blood, and blood products.
During the discectomy procedure:
- Prior to surgery, you will be asked to sign permits for discectomy surgery, anesthesia, blood, and blood products. General anesthesia will be used to ensure you are asleep and pain-free during surgery.
- An incision is made in the low back area.
- Fluoroscopy (live X-ray) is used to determine the correct level(s) to be operated on.
- The disc tissue that is compressing the nerve(s) is removed.
- The surgery takes approximately 1-2 hours.
After the discectomy procedure:
- The surgeon will contact your family while you are in recovery.
- After going to a hospital room, you will be able to use a PCA pump to get medication for pain control. This machine controls the amount of medication that can be received.
- Staff will usually get you out of bed the same day as the surgery.
- The hospital stay is usually one day.
- A brace or corset may be prescribed to restrict bending.
- You will be given any needed prescriptions and discharge instructions.
- A set of exercises that you can do at home will be provided.
- You will be able to ride in a car or plane upon leaving the hospital.
- Physical therapy is usually initiated after the first office visit with your doctor following surgery.
- Recovery from discectomy is usually relatively brief, but it varies greatly among patients and is dependent on the age and health of the individual. Return to work also varies greatly among patients and is related to overall health and the type of work you do.
Patients Ask:
How to Avoid Discectomy
The spine specialists at Texas Back Institute have always believed that surgery is always the final option for patient care. This means that a more conservative treatment program is used – including over-the-counter pain medications, physical therapy, diet changes and other lifestyle modifications – in hopes of avoiding surgery. If all else fails, then and only then is surgery discussed.
While it’s true that diskectomy reduces herniated disc symptoms in most people who have clear signs of a compressed nerve, such as pain that travels down the legs, relief from a diskectomy might not last a lifetime because it doesn’t cure the cause of the disk becoming injured or herniated in the first place.
To help prevent re-injury of the spine, it might help to attain and keep a healthy weight, eat a healthy diet, do low-impact exercises and limit activities that involve repeated bending, twisting, or lifting.
World Class Treatment
For patients who have learned that a surgical procedure on their back, spine or neck might be required to correct an injury or disease, there is an understandable feeling of concern, and perhaps dread. This does not have to be the case.
The surgeons and clinicians at Texas Back Institute are some of the best in the world at diagnosing and treating issues associated with the back, neck, and spine. To access this expertise and work with some of the most caring physicians you will meet, click here, and set an appointment. This may change your life.
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Frequently Asked Questions
ACDF is the acronym for Anterior Cervical Discectomy and Fusion, and it has proven to be an effective tool for correcting discs that are herniated.
For patients choosing this ACDF procedure, there are several options for bone grafts. These include:
- Autograft – This is the patient’s living bone and is considered the “gold standard” for grafts. The marrow contains bone-growing proteins. It can be collected from drillings during the surgery or taken from the hip as an iliac crest bone graft. This graft has a higher rate of fusion. The disadvantage is the pain in your hip bone.
- BMA (bone marrow aspirate) – This is your living bone marrow, collected with a syringe from the hip (iliac bone) or vertebra. It is relatively painless compared to an iliac crest graft.
- Allograft – This is bone from an organ donor, collected and stored by a bone-bank. The donor graft has no bone-growing cells or proteins. Allograft is packed with shavings of living bone tissue taken from your spine during surgery.
- Cellular bone matrix – This comes from an organ donor that contains bone-growing stem cells. The putty is shaped and added to grafts.
- BMP (bone morphogenetic protein) – This is sometimes added to bone-graft material to stimulate bone growth naturally in the body.
The spine specialists at Texas Back Institute have always believed that surgery is always the final option for patient care. This means that a more conservative treatment program is used – including over-the-counter pain medications, physical therapy, diet changes and other lifestyle modifications – in hopes of avoiding surgery. If all else fails, then and only then is surgery discussed.
While it’s true that diskectomy reduces herniated disc symptoms in most people who have clear signs of a compressed nerve, such as pain that travels down the legs, relief from a diskectomy might not last a lifetime because it doesn’t cure the cause of the disk becoming injured or herniated in the first place.
To help prevent re-injury of the spine, it might help to attain and keep a healthy weight, eat a healthy diet, do low-impact exercises and limit activities that involve repeated bending, twisting, or lifting.
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