A discectomy is a surgical procedure in which a portion of a damaged or herniated intervertebral disc is removed to relieve pressure on the spinal cord or nerve roots. It is typically performed to alleviate pain, numbness, or weakness caused by a compressed nerve. Recovery time and post-operative care will depend on the type of surgery and individual case.
What is a discectomy?
A discectomy is a surgical procedure that involves the removal of a portion or all of a damaged or herniated intervertebral disc in the spine.
The intervertebral disc is a cushion-like structure that sits between the bones in the spine (vertebrae) and acts as a shock absorber. When a disc becomes damaged or herniated, it can put pressure on nearby nerves and cause pain, numbness, or weakness in the legs or arms.
During a discectomy, a small incision is made in the lower back and the surgeon uses special instruments to remove the damaged portion of the disc. This can be done through traditional open surgery, which involves a larger incision, or through a minimally invasive procedure called a microdiscectomy, which uses a small incision and a microscope to guide the surgery.
Which conditions are treated with a discectomy?
A discectomy is typically performed when symptoms are due to a damaged or degenerated intervertebral disc. Examples include:
- Herniated disc: A herniated disc occurs when the soft inner material of the disc bulges out through a tear in the outer layer. This can put pressure on nearby nerves and cause pain, numbness, or weakness in the legs or arms.
- Degenerative disc disease: As we age, the discs in our spine can become worn and damaged, leading to chronic pain and stiffness.
A discectomy is typically performed when non-surgical treatments such as physical therapy, medications, or epidural injections have not been effective in relieving the symptoms caused by a herniated disc or other conditions that affect the spine.
It is usually considered as a last resort when other options have been exhausted.
However, in some cases, surgery may be recommended right away if the patient is experiencing symptoms of spinal cord compression.
Open discectomy vs minimally invasive (microdiscetomy)
A discectomy can be performed as a traditional open surgery or as a minimally invasive microdiscectomy. The two procedures differ in terms of the type of incision made, the instruments used, and the recovery time.
It’s important to note that both types of discectomy have their own advantages and disadvantages, and the best option will depend on the individual case and the surgeon’s expertise.
Open discectomy
An open discectomy involves a larger incision in the lower back, which allows the surgeon to directly access the damaged disc. The surgeon will use special instruments, such as a scalpel or a laser, to remove the damaged portion of the disc.
This procedure is typically used for larger herniated discs or for patients with multiple herniated discs.
Microdiscectomy
A minimally invasive microdiscectomy involves a smaller incision in the lower back, typically about 1-2 cm. The surgeon uses a microscope to guide the surgery and special instruments, such as a small retractor, to remove the damaged portion of the disc.
This procedure is typically used for smaller herniated discs or for patients who have had previous spinal surgery.
A microdiscectomy is considered to be a less invasive procedure, it may have a shorter recovery time, less pain and scarring, and less risk of complications than an open discectomy.
What to expect the day of surgery
Sometimes, a discectomy can be performed an outpatient surgical center and a hospitalization is not necessary. Regardless of the setting, the day of surgery is generally the same.
- Arrival at the hospital: The patient will arrive at the hospital on the day of the procedure, usually in the morning. The patient will be taken to a pre-operative area where vital signs will be checked and the patient will be given an IV for fluids and medications.
- General anesthesia: The patient will be given general anesthesia, this means you will be asleep and pain-free during the procedure.
- Surgery: The procedure typically takes about 1-2 hours to complete, depending on the type of discectomy performed. After the surgery, the patient will be taken to the recovery room to be monitored for any complications.
- Recovery room: After the surgery, the patient will be taken to the recovery room to be monitored for any complications. The patient will be given pain medication to control any post-operative pain. The patient may experience some discomfort or pain in the lower back and legs, but this should gradually improve over time.
What is the recovery time?
The recovery time for a discectomy can vary depending on the type of surgery (open or minimally invasive) and the individual case. However, there are some general guidelines for recovery time:
- Open Discectomy: Recovery time for an open discectomy typically takes about 6-12 weeks. During this time, the patient may experience some pain and discomfort in the lower back and legs, but this should gradually improve over time.
- Minimally Invasive Microdiscectomy: Recovery time for a minimally invasive microdiscectomy typically takes about 2-6 weeks. The patient may experience less pain and discomfort compared to an open discectomy.
In both cases, the patient will be advised to avoid heavy lifting, bending, or twisting for several weeks to allow the incision to heal properly and reduce the risk of complications.
What are the risks of a discectomy?
As with any surgical procedure, a discectomy carries certain risks that should be considered. Some of these include:
- Bleeding: There is a risk of bleeding during or after the surgery.
- Infection: As with any surgical procedure, there is a risk of infection at the surgical site.
- Persistent or new pain: Some patients may experience persistent or new pain after the surgery.
- Spinal cord or nerve root injury: there is a risk of injury to the spinal cord or nerve roots during the surgery, which can lead to new or worsening symptoms.
How effective is a discectomy?
In general, the success rate of discectomy is estimated to be between 80-90%. However, the success of the procedure can vary depending on several factors, including the size and location of the herniated disc, the degree of nerve compression, and the overall health of the patient.
Is a discectomy right for me?
Discectomy is typically recommended for individuals who have a herniated disc that is pressing on a nerve or the spinal cord, causing symptoms such as leg pain and weakness, or who have not responded to more conservative treatment options such as physical therapy, medications, and/or spinal injections.
Your healthcare provider will also consider other factors, such as your overall health and any other medical conditions you may have, when determining if discectomy is appropriate for you.
It’s important to discuss the benefits and risks of discectomy with your doctor and to consider all your options before deciding on any treatment.
References
Dohrmann, George J, and Nassir Mansour. “Long-Term Results of Various Operations for Lumbar Disc Herniation: Analysis of over 39,000 Patients.” Medical principles and practice : international journal of the Kuwait University, Health Science Centre vol. 24,3 (2015): 285-90. doi:10.1159/000375499
