Herniated Disk Surgery
What is Herniated disk surgery?
Herniated disk surgery is performed to alleviate and correct pinched nerves or tissues of the spine.
Most of the time, people who have bulging or herniated discs don't require herniated disc surgery. If you have been using conservative treatments like heat or ice, anti-inflammatory medications, and physical therapy for more than six weeks and are still having pain and other symptoms, your physician may recommend you have an operation. Herniated disc surgery may be needed if you have any of the following symptoms:
- Problems controlling your bladder or bowel function
- Difficulty standing up or walking
- Loss of feeling in your legs, or weakness in your leg muscles
In many cases, herniated disc surgery only involves the removal of the portion of the disc that is bulging. If the whole disc is removed, spinal fusion may also be necessary to permanently join the vertebrae on either side of the damaged disc. This provides spinal stability. In order to accomplish this, surgeons use special surgical hardware called instrumentation to hold the bones in alignment while healing takes place and new bone formation occurs where the damaged disc was removed. Very rarely, artificial discs are implanted.
Herniated Disk Surgery Procedures
- Discectomy: This can be a very effective herniated disc surgery for patients who have severe and disabling leg pain
- Percutaneous discectomy: Many doctors believe this herniated disc surgery does not have the rate of success achieved by open discectomy
- Laminotomy and laminectomy: These operations can be separate operations or may be completed in combination with the discectomy
Your spinal column is made up of 33 backbones called vertebrae all stacked up in a column. The vertebrae's job is to hold your body in an upright position and to protect your spinal cord. The unique shape of the vertebrae and the way they fit together provides a tunnel for the spinal cord and its nerves. In between each pair of vertebrae are discs that function like shock absorbers. These discs have tough outer bands and gel-like centers.
The spinal cord and nerves run down the middle of the stack of vertebrae and discs through the spinal canal. The nerves exit the spinal canal and run out to the other areas of the body to provide it with feeling and the ability to move.
When a disc herniation occurs, the soft gel-like material from the center of the disc squeezes out. This usually happens in the lower portion of the back because this is the area of the spine that carries the most weight. If the gel-like material presses on a nerve, the nerve becomes irritated. This causes pain that can travel to other parts of the body. The severity of the pain felt depends on how much gel is squeezed out and how much of the nerve is irritated.
Why herniated disk surgery such as microdiscectomy is done
A disc herniation occurs when a tear or a crack develops in the outer rim. Some of the gel-like material from the center of the disc then leaks through the tear, occupying room in the spinal canal. This can compress the spinal cord or the spinal nerves nearby. A microdiscectomy is herniated disc surgery that is performed to relieve pressure on the spinal cord or the nerves by removing either all or only part of the damaged disc. Herniated intervertebral discs are sometimes called ruptured discs, bulging or prolapsed discs or slipped discs.
Microdiscectomy herniated disc surgery might be advised if:
- Non-surgical treatment has been used and symptoms are not improving after six weeks
- Symptoms include weakness severe enough that makes it difficult to stand up or to walk
- A piece of a disc becomes trapped in the spinal canal or spinal cord and presses on a nerve
- Pain becomes unmanageable
How Microdiscectomy Surgery Is Performed
In order to perform this type of herniated disc surgery, a small incision is made in the lower back area. The incision is typically only 1 inch to 1 1/2 inch long.
- The muscles of the back are removed from the bony arch of the vertebrae. They can be moved instead of cut since they run vertically.
- The spine is then entered using a microscope or special operating glasses, following removal of the membrane that lies over the nerve roots
- Sometimes, the surgeon removes a portion of the facet joint to gain better access to the nerve root. This also helps to relieve pressure.
- The nerve root is moved to the side and the disc material is taken out
- Since almost all of the other tissue is not removed, this type of herniated disc surgery does not change the underlying structure of the spine
This surgery is considered to be safe. Like any operation, there are surgical risks involved. Possible complications associated with herniated disc surgery include:
- Damage to the blood vessels or nerves in and around the spine
- Damage to the protective tissues surrounding the spine
- Leakage of spinal fluid
What to expect during Microdiscectomy
Typically, herniated disc surgery is performed using a general anesthetic. This means you will be sleeping during your operation. You will be given medication through an intravenous (IV) line or to breathe through a mask that will help you relax and make you sleepy.
Laminotomy and laminectomy herniated disk surgery options
Each of your vertebrae has two laminae which are arch-shaped projections that lie close to the internal body. They are made of bone and they usually don't cause any problems. Having surgery on your laminae can be beneficial in helping other conditions. Some spinal disorders cause a great deal of pain because the spinal cord or nerves become compressed or pinched by other structures. Procedures performed on the laminae can widen the spinal canal, making more room in it and relieving pain and pressure. Some spinal deformities are also treated by surgery on the laminae.
When a laminectomy is performed, the entire lamina is removed. If only a part of the lamina is removed, the procedure is called a laminotomy.
Reasons for a laminectomy or laminotomy
The primary reason for either a laminectomy or a laminotomy is to decompress or remove pressure from the spinal cord or from the nerves that are near the spinal cord. When the lamina or a portion of it is removed, the spinal cord is still protected within the hard vertebrae of the spinal column. These procedures are used to treat many different conditions. Some of them include:
- Spinal stenosis
- Herniated discs
- Ankylosing spondylitis
- Degenerative disc disease
Sometimes a surgeon needs to remove the lamina or part of it in order to reach an intervertebral disc or a vertebra that needs to be repaired. In other cases, there may be a tumor that needs to be extracted that is lying near a vertebra and the lamina needs to be removed so the mass can be removed.
It is typical for many patients who have a laminotomy or laminectomy procedure to recover to their prior level of function within 12 months of surgery. It's important to remember that these surgeries can decompress the spinal cord and nerves, but they don't provide relief from the conditions that lead to degeneration or underlying factors such as obesity. This means that the relief these operations provide may not be lasting.
Herniated disk surgery experimental procedures
Several procedures are being performed that use very small incisions or they use injections to destroy damaged discs. Some examples of these procedures are electrothermal disc decompression and endoscopic discectomy. If your physician recommends one of these procedures to treat your condition, get more information about the procedure and also consider consulting another specialist for another medical opinion.
Some surgeons have been practicing laser discectomy for many years. This is still considered to be experimental because there is not enough research to prove that it is effective or safe. In this herniated disc surgery, a laser is used to dissolve a ruptured disc.
Other techniques that have been attempted but have not been proven effective in herniated disc surgery include the use of suction to remove portions, the center or all of a ruptured disc.
Care after herniated disk surgery
After the operation, the patient will be transferred to a recovery room where he/she will stay for a short while. Depending on the surgeon and the condition of the patient, he/she may be able to go home the same day of the herniated disk surgery procedure. In some cases, the patient is required to stay a few days in a hospital.
- Avoid stooping over or bending
- Avoid sitting too long
- Avoid lifting heavy objects