When conservative treatments do not provide long-lasting relief of arm or leg pain, surgical intervention may be considered. A discectomy is a surgical treatment for disc herniation in either the neck or back. It relieves compression of the spinal cord or spinal nerve by removing the portion of the disc that is herniated or bulging beyond its usual boundaries. The most common condition where discectomy surgery is considered are to relieve pain stemming from herniated, or bulging, discs in the spine when other, less invasive options have not worked.
A discectomy is a surgical procedure performed to treat pain that is caused by a prolapsed or herniated disc. It is the removal (hence the term ‘-ectomy’) of the intervertebral disc that causes compression or irritation to the adjacent nerve root.
Discectomy is usually recommended to patients who experience chronic pain (caused by the prolapsed disc) that has not been alleviated by rest, medications, or injections. Surgeons also suggest this type of procedure to individuals who developed progressive neurological deficits or signs and symptoms like weakness, numbness and loss of sensation. Other conditions that may indicate the need for discectomy include:
• Immobility – as a result of pain or weakness
• Nerve damage – a condition that affects nerve function
• Cauda Equina syndrome – a serious condition that results from nerve impingement
This type of discectomy is done by creating a small incision in the skin. A small probe is then inserted to 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 inserted to accomplish the surgery.
Microdiscectomy is a minimally invasive discectomy technique that uses a specially designed surgical microscope that magnifies and makes the surgical field more visible. Microdiscectomy is considered the gold standard for open discectomy.
In this type of discectomy, a percutaneous probe is introduced via needle puncture on the skin. The probe is further inserted into the intervertebral disc and the bulging or herniated portion of of the disc is removed.
Discectomy is an elective surgery, which means that it is subject to choice made by the patient and the surgeon and scheduled in advance. Prior to the procedure:
• The patient must understand and gather information about the procedure. If there are concerns or doubts about the procedure, a discussion should be made between the surgeon and the patient. All fears and doubts should be addressed and clarified.
• Blood and urine tests may be carried out to assess current patient’s health.
• Physical examination and assessment is done to rule out other conditions.
• Certain medications may be prescribed or stopped to prevent complications.
• The surgeon may also order diagnostic scans prior to the procedure.
• The patient should be placed on NPO (nothing by mouth) few hours before the surgery.
• Smoking and drinking alcohol should be avoided several days before the surgery.
Discectomy is generally a safe surgical intervention. But as with any operation, there are potential risks or complications. These include the following:
• Nerve injury
• Deep vein thrombosis
• Dural tear
• Recurrent disc herniation or prolapse
• Thromboembolic complications
• Scar tissue
• Back pain
After the procedure, the patient will be monitored in the recovery room for few hours. If the patient remains without any complications, he or she will be transferred to his or her room.
When the anesthesia wears off, the patient will be started on a clear liquid diet before returning to a full solid diet, which usually occurs few days post-surgery. It will be ordered when normal bowel function returns.
Painkillers may be prescribed to alleviate post-operative pain and discomfort.
A physical therapist will be present to assist patient in exercises and movements to strengthen the body. After regaining adequate strength, the patient is usually discharged several days post-op, subject to regular follow-up and assessment during the recovery period.
Once you have decided to have a discectomy, below is what you should expect before the 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.