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Intervertebral Discectomy

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Definition

Intervertebral discs are located between each backbone (vertebra). When damaged, these discs can put pressure on nerves as they leave the spinal cord. An intervertebral discectomy is a back surgery that removes all or part of these discs. The procedure is most often done on lumbar discs (located in the lower back). It may also be done on cervical discs in the neck. There are two methods for this surgery:

  • Open procedure—A large incision is made.
  • Microdiscectomy—Small incisions are made, and the doctor inserts tiny instruments through these incisions.

Reasons for Procedure

These discs normally serve as cushions between the bones. The discs can become damaged or dry with age. Injury can also cause a disc to bulge (or herniate ). These changes can create pressure on nerves leaving the spine. This can cause pain, numbness, and weakness.

Laparoscopic discectomy
laparoscopic discectomy small
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The best time to have this surgery is debatable. This is because—for some patients—having early surgery may not result in less pain or disability. In most cases, surgery is only done after other treatments have failed. Other treatments typically include:

  • Rest
  • Physical therapy
  • Medicines

The goal of surgery is to eliminate pain, weakness, and numbness caused by the disc pressing on a nerve. You may feel relief right away, or it may take months for the nerve root to heal. In some cases, your symptoms may not improve. Your doctor will carefully evaluate you before surgery to determine what the best option is.

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have intervertebral discectomy, your doctor will review a list of possible complications, which may include:

  • Bleeding
  • Infection
  • Nerve damage
  • Bladder or bowel incontinence
  • Leakage of spinal fluid
  • Another herniated disc (may happen within the first three months after surgery)

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

  • Smoking
  • Drinking
  • Chronic disease such as diabetes or obesity
  • Prior spine surgeries

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Physical exam
  • Ask about the pain and when it started
  • Use imaging studies to look at the disc and structures in the area, includind
    • MRI scan
    • Discography —injecting dye into a disc in the spine and taking an x-ray to determine if there are any leaks

Leading up to your procedure:

  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Anti-inflammatory drugs (eg, aspirin )
    • Blood thinners, like clopidogrel or warfarin
  • Arrange to have someone drive you home. Also, arrange for someone to help you at home.
  • Eat a light meal the night before the surgery. Do not eat or drink anything after midnight.
  • Wear comfortable clothing to the hospital.

Anesthesia

General anesthesia will be used. It will block any pain and keep you asleep during surgery.

Description of the Procedure

There are different types of surgical procedures, including:

Anterior Cervical Discectomy

A cut will be made in the skin on the left or right side of the neck. The doctor will go through a muscle to reach the spine. The disc material will be removed after the doctor uses an x-ray to confirm that it is the correct disc. A portion of the bone may be removed to give the nerve more space. A bone graft may be placed to fuse the vertebrae.

Posterior Cervical Discectomy

A cut will be made in the skin at the back of the neck. The muscles will be pushed aside. A small piece of bone will be removed to get to the disc space ( laminectomy ). Next, the doctor will gently push the nerve aside and remove the disc material.

Lumbar Discectomy

The doctor will make a 1-1½ inch cut in the skin on the lower back. The muscles will be moved out of the way. A small part of the bone may need to be removed to gain access to the nerve and disc. The disc or disc fragments will then be removed.

Discectomy
Sagittal Discectomy
The disc is removed from between the vertebrae.
Copyright © Nucleus Medical Media, Inc.

How Long Will It Take?

This depends on:

  • Which method your doctor uses (open or minimally invasive)
  • Which procedure you need

For example, the minimally invasive surgery may take longer, but the recovery is faster.

How Much Will It Hurt?

You will have pain while recovering. Your doctor will give you pain medicine.

Average Hospital Stay

This surgery is most commonly done in a hospital setting. It may be possible to go home on the same day of the surgery. If you have a cervical discectomy, you may have to stay in the hospital for a few days.

Post-procedure Care

During your stay, the hospital staff will take steps to reduce your chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chances of infection such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions

Bending, lifting, or twisting may be limited for six weeks.

You will work with a physical therapist to stretch and strengthen your muscles. This will help to decrease the risk of future back problems.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Numbness or tingling
  • Pain that you cannot control with the medicines you have been given
  • Pain, burning, urgency or frequency of urination, or bleeding in the urine
  • Cough, shortness of breath or chest pain
  • Loss of bladder or bowel control

In case of an emergency, call for medical help right away.

Revision Information

  • National Institute of Neurological Disorders and Stroke

    http://www.ninds.nih.gov/

  • North American Spine Society

    http://www.spine.org/

  • Canadian/American Spinal Research Organization

    http://www.csro.com/

  • Spinal Injury Foundation

    http://www.spinalinjuryfoundation.org/

  • Bach HG, Lim RD. Minimally invasive spine surgery for low back pain. Dis Mon. 2005;51:34-57.

  • Lavelle W, Carl A, Lavelle ED. Invasive and minimally invasive surgical techniques for back pain conditions. Anesthesiol Clin. 2007;25:899-911.

  • Treatment options: low back (lumbar). University of Southern California, Department of Neurological Surgery website. Available at: http://www.usc.edu/schools/medicine/departments/neurological%5Fsurgery/clinical/spina/treatmentoptions-lumbar.htm. Accessed September 8, 2009.

  • Treatment options: neck (cervical). University of Southern California website. Available at: http://www.usc.edu/schools/medicine/departments/neurological%5Fsurgery/clinical/spina/treatmentoptions-cervical.htm. Accessed September 8, 2009.

  • 6/7/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356:2245-2256.