Discectomy
The purpose of a discectomy (cervical or lumbar) is to remove the fragment of spinal disc that is causing the pressure on the spinal nerve. An open discectomy is a procedure where the surgeon uses a small incision and looks at the actual herniated disc in order to remove the disc and relieve the pressure on the nerve. It is performed under general anesthesia. The procedure takes about an hour, depending on the extent of the disc herniation, the size of the patient and other factors. It is done with the patient face down. In order to remove the fragment of herniated disc, the surgeon will make an incision in the center of the back. It is usually about 3 cm in length. The surgeon pulls back the muscles and removes a piece of bone and ligaments from the spine. The is called a laminotomy.
Once the herniated fragment is found, it is removed. The incision is closed and a bandage is applied.
Some patients feel relief of their leg pain upon awakening and others feel relief in a few weeks. Still others do not experience relief. Gentle activities are encouraged after surgery. Eventually activities are increased and the patient will start an exercise program.
Many people are disillusioned and jump into surgery thinking that the pain relief is instantaneous and normal activities immediately resumed. Also there are risks and may be complications.
The most common problem of a discectomy is the chance that another fragment of disc will herniate and cause similar symptoms down the road. The literature claims the chances of recurrence is 10-15%, but we have found through 26 years of experience in treating back and neck pain patients that it is probably closer to 25%. The longer the symptoms have been present, the less chance of success with surgery.
Other risks include spinal fluid leaks, bleeding and infection. All of these can be treated but may require longer hospitalization and additional surgery.
Endoscopic microdiscectomy is a procedure that accomplishes the same goal as a traditional discectomy, but uses a smaller incision. The surgeon uses a small camera to find the fragment and special instruments to remove it.
No one wants to have surgery unless all other conservative treatments have been exhausted.
Spinal Fusion is often performed when there are multiple herniations and/or degenerated discs. The fusion is either performed with bone grafts or metal hardware fusing the vertebrae together after the discs have been removed. There can be problems with the bone graft in terms of infection or shifting of the graft preventing it from holding the spine in a stable position. In these cases, a second surgery would be necessary. When hardware is used, the screws may break or loosen, which also requires additional surgery. Sometimes as time goes on, further degeneration can take place leading to more osteoarthritis. The literature discusses the increased chance of adjacent segment degeneration due to the stress that the fusion of one segment has on the other segments. In other words, adjacent discs may degenerate due to the lack of movement of the fused vertebrae. Fusion surgery is still controversial, with fusion of three or more segments rarely recommended. Patients considering this option should exercise extreme caution by proactively researching all other non-surgical methods such as VAX-D.
