Discectomy: Spinal Decompression

Discectomy: Spinal Decompression

What is a Discectomy?

Discectomy or microdiscectomy is the removal of a part of an intervertebral disc or the entire disc that is putting pressure or irritation on the spinal nerve(s) offering relief from chronic, often debilitating, back or neck pain. The success rate for discectomy/microdiscectomy spine surgery is generally high, with one extensive medical study showing good or excellent results overall for 80-90% of people who have the procedure. Statistics do show that somewhere between 5% and 10% may suffer a recurrent disc herniation, either within a few months or many years later.

This procedure can be performed minimally invasive, called a microdiscectomy, through a small incision in the patient’s back. Utilizing several tubes, the physician will dilate the surgical area, being careful to avoid excessive cutting or tearing of the surrounding muscles and tissue. Unlike traditional open surgery, the minimally invasive lumbar laminectomy allows physicians to complete the entire procedure through a smaller incision, avoiding the additional trauma associated with larger incisions.

To help you understand the procedure, the indications, risks, perioperative care, and the overview of the procedure are briefly described below.

Who is a candidate for Discectomy?

Discectomy is performed in patients who have chronic back or neck pain that has not been eased by plenty of rest, medications, or nerve root blocks or injections, and those who developed progressive neurological signs and symptoms such as weakness of any extremity and numbness. Other symptoms that may be treated with a discectomy include:

  • Chronic arm or leg pain – In addition to localized pain at the site of the compressed nerve in your back, you may also experience radiating or shooting pain in your extremities. If your spine condition is in your cervical spine (neck), you may experience pain in your arm and shoulder. If the compressed nerve is in your lower back, you might experience radiating pain down your buttock and leg.
  • Numbness or tingling – This is often accompanied by pain in your arm or leg, you may experience a tingling or numbness that extends to your farthest extremities, such as your hand or foot. However, some people may only experience numbness or tingling without the radiating pain.
  • Weakness that occurs during daily activities – If the compressed nerve is unable to send strong signals to your surrounding muscles, you may experience weakness in the arm and hand or leg and foot.

Common spine conditions treated by laminectomy include:

  • Bulging discs
  • Herniated discs
  • Degenerative disc disease
  • Pinched nerve
  • Sciatica

Surgery will be deemed necessary for emergency situations like cauda equina syndrome (compression of the nerve bundle at the lower part or base of the spinal cord). Signs and symptoms of cauda equina syndrome may include any or all of the following:

  • Presence of bladder or bowel dysfunction – Bladder and bowel dysfunction constitutes a medical emergency. These symptoms require immediate attention because it may mean nerve damage or compression. It is vital that bowel or bladder problems are appropriately managed, because being unable to empty your bowel or bladder could lead to infections or sepsis, as well as bladder infections that can lead to kidney damage.
  • Development of neurological issues – Neurological issues such as loss of sensation, weakness, or numbness in the lower extremities may denote cauda equina syndrome.
  • Sexual Dysfunction – Some of the nerves on the base of the spine provide sensation and control to the genital regions. When sexual dysfunction happens, the may be squashed or trapped. Compression or squashing of these nerves may cause numbness or pain and difficulty with sexual function.

What are the Benefits of Discectomy?

Most patients feel better soon after discectomy. Some individuals recover within 1 to 3 months. In general, the benefits of discectomy include:

  • Less Pain – Discectomy decompresses the area of irritation and nerve compression which results in decreased pain from a pinched nerve.
  • Relief of leg or foot pain and arm pain
  • Reduction of numbness or weakness in upper and lower extremities
  • Improvement in one’s quality of life – After discectomy, you should be able to walk, stand or sit for long periods with ease

Risks Associated with Discectomy

No surgery is without risks. General complications may include any of the following:

  • Bleeding – In discectomy, bleeding is usually minimal.
  • Infection – All surgeries predispose a patient to infection. The risk of having an infected surgical wound is less than 1%. To avoid this, patients may be given a dose of antibiotics.
  • Nerve Injury – To expose the affected disc, the nerve needs to be moved slightly away from the site. In doing this, a very small chance of physical damage to the nerve is a possibility. Injury to the nerve can lead to a problem in the nerve function, as well as pain and signs of neurologic symptoms.
  • Deep Vein Thrombosis (DVT) – This is a risk of any surgical procedure. DVT occurs due to long periods of bed rest or immobility after any procedure. When immobile, the blood flows slower in the vein which can cause clotting.
  • Recurrent Disc Prolapse – There is a 5% chance that a piece of the disc may prolapse through the same area. It may happen any time after the surgery but is most common during the first few weeks.
  • Back Pain – There may be some on-going pain on the back after the surgery.
  • Scar Tissue – Scar tissue can develop in or around the nerve after surgery. It’s not common, but it can mimic the signs and symptoms of disc prolapse.
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Before Discectomy

Few days before surgery

  • Be sure to ask all questions you have in mind before discectomy. You should also inform your physician about medications that you are currently taking, any health problems you have, and general concerns about the procedure.
  • You may be asked to stop certain medications, as well as smoking or drinking that may delay your healing.
  • Arrange for someone to drive you home after surgery. You will be advised not to drive a few days after.
  • After assessment and thorough examination, your primary physician will explain the procedure’s advantages and disadvantages.
  • You will be prepared with instructions about the operation, what to expect after, possible course of action after the procedure including diet, therapy, and other post-operative care.

Night before to the day of surgery

You may be advised to have an empty stomach the night before your surgery. An empty stomach will reduce the chances of complications such as aspiration or stomach contents going to the lungs from the stomach.

During the day of the surgery

Pre-operative medications will be given to you by the nurse or your physician. The healthcare staff will then transfer you to the operating room, and you will be positioned on the operating bed for the surgery. Anesthesia will be given.

The Procedure: How is Discectomy Performed

Discectomy is done under general anesthesia. The procedure lasts for around 60 minutes. An x-ray will be used to determine the area of the problematic disc and a small opening will be made. The muscle, ligaments, and nerves will be moved slightly away from the spine to expose the vertebra.  Then a small cut is made, and the prolapsed disc or any loose fragments of the disc material is removed. The operation will be closed and covered with wound dressings.

It is usually done as microdiscectomy, a discectomy performed minimally invasive, which involves the use of a special microscope to view the affected vertebrae, disc, and nerves. With microdiscectomy, a small incision is created on one side of your back. Then, a special microscope is passed through the opening to the affected spine. Through the established tunnel, the surgeon removes the affected disc (usually herniated or bulging disc), decompressing the pinched/ irritated nerve to relieve inflammation and pain.

After Discectomy

Immediately after surgery

After Discectomy, you will wake up in a recovery room. Your vital signs will be monitored and carefully watched. Once your surgeon verifies that you are doing well, you will be transferred to your hospital room.

Few days after surgery

Your incision site will be sore after surgery. You may feel discomfort when sitting during the first few days after the operation. Your healthcare staff (nurses or nursing assistants) will advise you to exercise or walk as tolerated to lower the risk of scar tissue formation.

At home

If you have concerns or problems at home during the first week after surgery, be sure to call your physician immediately.  In general, discectomy patients are requested for a follow-up visit in a week or two. Follow up visits may be scheduled at various intervals, depending on your condition or the discretion of your physician.

Please follow specific instructions given by your primary caregiver for your situation.

This article contains some of the common topics about discectomy including the indications, risks, and the overview of the procedure. Some information may not be discussed in this article, so please do contact us at Saint Camillus Medical Center to schedule an appointment. Call us at 817-519-3700, or visit us at 1612 Hurst Town Center Drive, Hurst, TX 76054.

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References:

  • “A Guide to Discectomy.” West Hertfordshire Hospitals NHS Trust. Web. <http://www.westhertshospitals.nhs.uk/ourservices/orthopaedics/documents/patientinformationleaflets/spinal/Disectomy_Leaflet-A4_final.pdf>.
  • “Back Surgery Microdiscectomy & Lumbar Laminectomy A Patient & Family Education Booklet.” Search – VCH Patient Health Education Materials Resource Catalogue. Web. <http://vch.eduhealth.ca/pdfs/fb/fb.723.b126.pdf>.
  • “Blood Clots After Surgery.” WebMD – Better information. Better health. Web. <http://www.webmd.com/dvt/blood-clots-after-surgery#1>.
  • “Cauda equina – Wikipedia.” Wikipedia, the free encyclopedia.Web. <http://en.wikipedia.org/wiki/Cauda_equina#Cauda_equina_syndrome>.
  • “Discectomy or Microdiscectomy for a Lumbar Herniated Disc | HealthLink BC.” HealthLink BC – 24/7 Health Advice You Can Trust. Web. <http://www.healthlinkbc.ca/health-topics/hw218424>.
  • “Lumbar Discectomy.” Hamilton Health Sciences. Web. <http://hamiltonhealthsciences.ca/documents/Patient%20Education/LumbarDiscectomy-th.pdf>.
  • “Lumbar ‘Discectomy.’” Spine Dragon – Home. Web. <http://www.spinedragon.com/docs/information_leaflets/bass_patient_information_lumbar_discectomy.pdf>.
  • “Why Can’t I Eat or Drink the Night Before Surgery? | Inside Mount Sinai.” Inside Mount Sinai | Latest Health Information, Patient Stories, & Research. Web. <http://inside.mountsinai.org/blog/why-cant-i-eat-or-drink-the-night-before-surgery/>.

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