Discectomy or microdiscectomy for a herniated disc
Surgery Overview
Discectomy (also called open discectomy) is the surgical removal of herniated disc material that presses on a nerve root or the spinal cord. Before the disc material is removed, a small piece of bone (the lamina) from the affected vertebra may be removed. This is called a laminotomy or laminectomy and allows the surgeon to better see and access the area of disc herniation.
Microdiscectomy uses a special microscope or magnifying instrument to view the disc and nerves. The magnified view makes it possible for the surgeon to remove herniated disc material through a smaller incision, thus causing less damage to surrounding tissue.
Before a discectomy, your doctor will examine you then order an imaging study, such as magnetic resonance imaging (MRI) or computed tomography (CT scan), to confirm that a herniated disc is causing your symptoms.
During discectomy, the surgeon removes the portion of the disc that is herniated and protruding into the spinal canal. The disc space may also be explored, and any loose fragments of disc can be removed.
These procedures are usually performed in a hospital, using general anesthesia. In some cases discectomy can be performed in an outpatient surgical centre.
What To Expect After Surgery
After a discectomy, you will be encouraged to get out of bed and walk as soon as the anesthetic wears off. You can use prescription medications to control pain during the recovery period and will be advised to resume exercise and other activities gradually. Other considerations include the following:
- You can sit as long as you are comfortable, but most people avoid sitting for longer than 15 to 20 minutes. After surgery, sitting can be uncomfortable for a while.
- Use walking as your primary form of exercise for the first several weeks. Getting up frequently to walk around will help decrease the risk that excess scar tissue will form. Scar tissue can keep the nerve root from gliding freely as you move, and can press on the nerve root. Walking will also provide exercise for your heart and lungs without stress to your back or the incision line (scar).
- Avoid any activities that cause pain.
- You may begin bicycling and swimming about 2 weeks after surgery as directed by your doctor or physiotherapist.
- If you work in an office, you may return to work within 2 to 4 weeks. If your job requires physical labour (such as lifting or operating machinery that vibrates) you may be able to return to work 4 to 8 weeks after surgery.
Many people are able to resume work and daily activities soon after surgery. In some cases, your health professional may recommend a rehabilitation program after surgery, which might include physiotherapy and home exercises.
Why It Is Done
When surgery is used to treat a herniated disc, it is done to decrease pain and allow for more normal movement and function.
Surgery is considered an emergency if you have cauda equina syndrome. Signs include:
- New loss of bowel or bladder control.
- New weakness in the legs (usually both legs).
- New numbness or tingling in the buttocks, genital area, or legs (usually both legs).
Surgery may be considered if tests show that your symptoms are due to a herniated disc and your doctor thinks surgery may help relieve the symptoms. In deciding whether to have surgery, you and your doctor will consider factors such as:1
- A history of persistent leg pain, weakness, and limitation of daily activities that has not gotten better with non-surgical treatment.
- Results of a physical examination that show you have weakness, loss of motion, or abnormal sensation (feeling) that is likely to get better after surgery.
- Diagnostic testing—such as magnetic resonance imaging (MRI), computed tomography (CT), or myelogram—that indicates your herniated disc would respond to surgery.
Should I have surgery for a herniated disc?
How Well It Works
People with milder symptoms tend to do well without surgery. People with prolonged symptoms that are severe enough to interfere with normal activities and work and require strong pain medications may gain relief from surgery. A study begun in 1990 followed about 500 people with low back pain caused by a herniated disc. Some had surgery and some did not. Follow-up information was gathered 5 years and 10 years after the beginning of the study.2, 3
- People with moderate to severe pain who had surgery noticed a greater improvement than those who did not have surgery.
- Those who had surgery noted more relief from the symptoms they considered most important than those who did not have surgery.
- At 5 years, 70% of those who had surgery reported improvement in their most important symptom, as compared with 56% of those who received non-surgical treatment.
- At 10 years, 71% of people who had surgery were satisfied with their current situation, compared with 56% of those treated non-surgically.
- But the type of treatment did not make a significant difference with regard to work and disability. The percent of people working at the time of the 10-year follow-up was similar, regardless of whether they had chosen surgical or non-surgical treatment.
Risks
As with any surgery, there are some risks. There is a risk of damaging the nerve roots or spinal structures during surgery. There is also some risk of infection following surgery, which may require antibiotics and additional surgery. Some people may get a vein thrombosis (blood clot) or embolus (the clot breaks away and causes a blockage of blood flow in the lung). These conditions can lead to death, but dying from these conditions is rare.
Because there are risks with general anesthesia, your doctor and medical staff will carefully monitor you during your surgery and recovery.
Before the surgery, there is no sure way that your surgeon can know how your nerves will respond after the pressure of the disc herniation is removed. So, there is a risk that your pain may not improve with surgery, or may only partly improve.
What To Think About
Discectomy may provide faster pain relief than non-surgical treatment, although it is unclear whether surgery makes a difference in what treatment may be needed later on.4
When comparing conventional open discectomy with microdiscectomy, people have reported being equally satisfied with both techniques.5
Spinal fusion is a procedure that joins together bones in the back. It is sometimes effective for neck problems, and can be combined with a discectomy. However, for the low back (lumbar spine), the procedure is controversial and complex and is not commonly performed with a discectomy. If a doctor suggests that you get a lumbar spinal fusion with a discectomy, get a second medical opinion to help you decide whether fusion is necessary.
Percutaneous discectomy is a procedure using a special tool through a small incision in the back to cut out or drain the herniated disc, thereby reducing its size. Percutaneous discectomy is considered less effective than open discectomy.4
A newer form of discectomy using laser beams (laser discectomy) is still in the research stage.5
Complete the surgery information form (PDF)
(What is a PDF document?) to help you prepare for this surgery.
| Author: | Douglas Dana Shannon Erstad, MBA/MPH | Last Updated: October 4, 2006 |
| Medical Review: | William M. Green, MD - Emergency Medicine Tom Bailey, MD - Family Medicine Robert B. Keller, MD - Orthopedics | |
 | ||
| |
| Topic Contents | |
| Surgery Overview | |
| What To Expect After Surgery | |
| Why It Is Done | |
| How Well It Works | |
| Risks | |
| What To Think About | |
| References | |