What is a lumbar discectomy?

In a discectomy, surgeons remove part or all of a damaged disc or discs in the spinal column.
In a discectomy, surgeons remove part or all of a damaged disc or discs in the spinal column.

A spinal disc is a sponge-like cushion located between the bones of the spine. Discs act as shock absorbers and allow the spine to flex. When a disc ruptures (herniates) it prolapses and presses on the nearby nerves, causing 

A lumbar discectomy is a surgical procedure in which the surgeon removes the damaged portion of a disc to relieve the pressure on the nerves.

What are the types of discectomy?

There are three ways a surgeon may choose to perform a discectomy:

  • Open or conventional discectomy in which the surgeon makes a comparatively large incision to allow clear vision and also removes some muscle and ligament.
  • Microdiscectomy is minimally invasive with a tiny incision. The surgeon does not remove any muscle or bone, but inserts a tube with a tiny camera/instruments to remove the damaged portion of the disc.
  • Laser discectomy is in wider use now. This procedure requires no incision. Instead, the surgeon burns the prolapsed tissue away with a laser inserted through a needle.

When is a lumbar discectomy performed?

The symptoms of a herniated or prolapsed disc can often improve with: 

  • rest
  • pain relievers
  • physical therapy
  • epidural injections

A lumbar discectomy usually is performed only when the noninvasive methods listed above have failed to provide relief. It is likely to prove useful to who have a herniated lumbar disc who:

  • feel unbearable pain doing their daily activities
  • have numbness or weakness in their lower limbs
  • have trouble walking or standing
  • lose control over bladder or bowel functions

How is a lumbar discectomy performed?

An orthopedic spine surgeon performs a lumbar discectomy under general anesthesia with the patient unconscious, or regional anesthesia with an epidural that numbs the region.

Prior to the surgery the patient undergoes blood tests, a CT scan, MRI, or other imaging tests. All usual precautions taken in preparation for anesthesia and surgery are followed.

Procedure

  • An anesthesiologist will administer anesthesia as the patient lies flat on their stomach.
  • The anesthesiologist will continue to monitor the patient’s vital functions during the procedure.
  • The surgeon will make an incision in the skin over the affected disc.
  • Muscle and ligaments attached to the disc will be removed in the case of an open discectomy, or the surgeon will insert a tube with a microscope for a microdiscectomy.
  • The surgeon will then remove the damaged tissue from the disc.
  • They may also remove a part of the bone around the herniated disc if necessary.
  • If a whole disc has to be removed, the surgeon might fill the space with bone from the patient’s pelvis or taken from a donor, or with synthetic bone.
  • The surgeon will then suture the incision area.
  • The anesthesiologist will bring the patient out of anesthesia and monitor until the patient’s condition is stable.
  • The patient is usually discharged within a day.

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What is the recovery time for a discectomy?

Patients are encouraged to start walking within a day or two. It is advisable to take a week or two off from work to allow healing to take place. After the surgery, for at least 2 to 4 weeks the patient should:

  • not lift heavy objects
  • sit for long periods
  • bend or stretch excessively

The patient will need to follow-up with the doctor for further treatment with physical therapy and rehabilitation exercises. Typically, the patient is able to resume normal life in 6 to 8 weeks.

How painful is a lumbar discectomy?

A lumbar discectomy is completely painless as it is done under anesthesia. The patient will feel nothing except the pinprick of the injection needle. Post-surgery, there is likely to be some amount of stiffness and pain that can be relieved with painkillers.

What are the risks and complications of a discectomy?

Discectomy is generally a safe option for patients who get no relief from non-surgical treatments. The risks may include:

What is the success rate of a discectomy?

Discectomy works well typically and it offers faster relief than other treatments. It still may not be the best choice for everyone and it is generally appropriate to exhaust all other options before choosing surgery.

Discectomy has been found to have about 90- to 95-percent success rate with only 5 percent of the patients experiencing recurring herniation.

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Medically Reviewed on 3/18/2020
References
Medscape Reference
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