Vertebrae that shape the spine in our back are supported & cushioned by tiny discs. These small discs are flat & round, with a solid outer layer (annulus) that encloses a jellylike material known as the nucleus. These discs play the role of shock absorbers for spinal bones. Thick ligaments connected to vertebrae hold the disc material in proper position but with time, discs wear out & lose their flexibility. When that happens, discs can hardly endure pressure of lifting, twisting & bending & bulging outwards. This causes severe leg & back pain & result in herniated discs. According to recent studies, highest prevalence of herniated discs is among patients aged 25 – 45 years, with men to women ratio of 2:1. Discectomy surgery can be successfully performed to treat this condition.
Discectomy is a surgical treatment procedure that is mainly useful in relieving painful & disabling symptoms that are caused as a result of pinched nerves in the spinal column due to herniated (damaged/bulging) inter-vertebral disc. This surgery aims to remove the damaged portion of the disc from the spinal column. Herniated (bulging) intervertebral disc can lead to pain, weakness & numbness, especially in legs initially & then can spread to the entire body if not treated efficiently. This is a last-resort treatment in most cases when other alternate treatment methods have failed to relieve symptoms being caused by herniated inter-vertebral disc.
Following are causes that result in a herniated disc in the lower back (lumbar) region & which requires discectomy procedure for treatment.
- Disc degeneration – Wear & tear as a result of old age
- Injury due to sudden twisting of the back
- Injury due to sudden & heavy strain on the back
- Repetitive activities that put strain on lower back can also cause injury to lumbar disc
Most herniated discs occur in patient’s lumbar spine, although they can also occur in cervical spine. Most usual signs & symptoms of herniated discs are given as follows.
- Arm or Leg Pain – Patients may feel intense pain in thigh, buttocks & calf if they suffer from herniated discs in lower back. If patients experience condition of herniated discs in neck, the pain will usually be most intense in the arm & shoulder. This pain may shoot into legs or arms when they sneeze, cough or move the spine into specific positions.
- Tingling or Numbness – Patients who have herniated discs often go through tingling or numbness in the area served by affected nerves.
- Weakness – Patient’s muscles may get weak & cause them to impair the ability to hold or lift items.
Patients also can have the problem of herniated discs without knowing one – it sometimes appears on spinal images of patients who have no symptoms at all.
Main aim of discectomy procedure is to provide relief from intense & constant pain & other disabling symptoms that accompany herniated (bulging) inter-vertebral discs form the spinal column. Discectomy will usually be advised under the following conditions.
- Patients having trouble standing/walking due to nerve damage
- Other alternate treatment methods (medication, physiotherapy, etc) have been unsuccessful
- Disc fragment (bone spur) gets lodged in spine, causing nerve impingement (pinching)
- Pain can be felt growing out from buttocks to arms & legs or even the chest
Patients who suffer from enumerated conditions may be considered as good candidates of discectomy.
- Diagnostic tests (CT, MRI or Myelogram) which show a herniated disc
- Severe pain in patient’s foot or leg
- Harsh pain in leg (sciatica) worse than back pain
- Conditions that have not fixed up with medications or physical therapy
- Weakness in leg, numbness in the genital region & loss of bowel control (caudaequina syndrome)
During initial appointment, surgeons may ask patients to undergo physical evaluation so that they can check the back for tenderness. Surgeons may also perform a neurological examination to check for the following.
- Muscle strength
- Walking ability
- Ability to feel vibration, light touches or pinpricks
In a majority of cases, a physical assessment & medical history are all that is required to make diagnosis. If surgeons suspect some other health condition or are required to see which nerves are affected, they may order the outlined imaging tests.
- X-Rays – X-rays are not capable of detecting herniated discs, but they may be done to rule out other causes of back pain, such as tumor, infection, spinal alignment problems or a broken bone.
- Computerized Tomography (CT scan) – CT scans take a series of X-rays from various angles & directions & then connect them to generate cross-sectional pictures of spinal column & structures around it.
- Magnetic Resonance Imaging (MRI) – Powerful magnetic field & radio waves are used to produce pictures of patient’s internal structures. This test may confirm the position of herniated disc.
- Myelogram – Surgeons inject dye into the spinal fluid of patients & then X-rays are performed. This test allows checking the pressure on nerves or spinal cord of patients due to multiple herniated discs.
- Nerve Tests – Electromyogram test & nerve conduction test precisely measures electrical impulses of patients along nerve tissue. This will spot the exact location of nerve damage.
Patients may be scheduled for pre-surgical tests (e.g. chest x-ray, blood test or electrocardiogram) several days before discectomy surgery.
- Health History – Patients should tell surgeons about their healthcare history including any allergies, vitamins, supplements, bleeding history, anesthesia problems & any prior surgeries.
- Medications – Patients should discuss medications that they are currently consuming with the surgeons. Some medicines may need to be stopped or continued.
- Specific Medications – Patients should stop consuming non-steroidal anti-inflammatory medications like Advil, Naprosyn, Motrin, Aleve, Nuprin & blood thinners like Plavix, Coumadin, one to two weeks before surgery as directed by the surgeon.
- Activities to Avoid – Additionally, patients need to stop smoking, drinking alcohol & chewing tobacco several weeks before discectomy surgery because these activities may lead to bleeding problems.
- Food Intake – No drink or food is permitted 10 – 12 hours before surgery.
Discectomy surgery needs incredible skill, precision & expertise. Once patients have decided to undergo this surgical intervention, then the next vital step is to clear every doubt that they have with the surgeon. Before signing the consent form, patients should make sure they ask as many questions as possible.
- Can you explain my diagnosis report?
- What are the reasons causing my symptoms?
- What is discectomy surgery?
- Why is it recommended to me?
- Do you have any experience in performing discectomy surgery?
- What are my other treatment alternatives?
- What are potential benefits of discectomy for me?
- What can I expect if I do not wish to undergo this surgery?
- What is the overall success ratio of this surgery & how does it compare to your success rate?
- What are the major complications of discectomy surgery & how often do they occur?
- What should I expect during recovery phase following discectomy surgery?
- When will I be able to return back to my daily routine?
Discectomy surgical procedure is performed in the following steps.
- Anesthesia – Discectomy will mostly be performed as a major surgical procedure requiring administering general anesthesia to prevent pain & discomfort to the patient during surgery. Patients are usually required to lie down on the stomach so the spinal column is easier to access.
- Incisions – Surgeons will make incisions as per the requirement of particular surgery. These incisions are used to gain access to herniated (damaged/bulging) inter-vertebral disc after carefully shifting aside various back muscles & other soft tissue. Surgeons might also require removing small portions of the spinal column, or certain ligaments, to get access to the damaged disc. Mostly, the surgeon will only remove a particular piece of intervertebral bone that is causing impingement (pinching) of spinal nerves, thus relieving constant pain & disability being caused as a result of this pinching of nerves. In case the surgeon requires removing the entire intervertebral disc due to extensive damage to it, the surgeon will use a ‘spacer’ (made from grafted bone material / synthetic material) to fill in the gap left by the removed intervertebral disc.
- Completion – Surgeons will then ensure that the adjacent intervertebral disc can fuse together to restrict its motion. This helps to heal the intervertebral bone faster & prompt & quicker recovery from surgery. This procedure is mostly performed as an outpatient procedure where the patient is allowed to go home the same day after discectomy surgery in case the surgeon/doctor cannot identify any potential risks of complications.
Doctors will advise patients to avoid lifting heavy weights & other strenuous exercises for a few weeks after surgery. The surgeon might also advise a course of physical therapy in order to regain lost strength & movement in the spine.
Patients need to schedule follow-up appointments with surgeons for about three weeks after discectomy surgery. Healing time of patients varies from 2 to 4 weeks depending upon the underlying condition treated & their general health. Patients may feel extreme pain at the site of incision. This discomfort & pain may not be fully relieved immediately after surgery. Patients should maintain a positive attitude & earnestly obey surgeon’s instructions. Majority of patients can go back to work within a month, some may, however, require to waiting for at least 6 – 10 weeks. Recurrences of back pain may also sometimes happen. Solution to avoiding recurrence is prevention which can be attained by taking the following steps.
- No smoking
- Proper lifting techniques
- Appropriate exercise program
- Good posture during standing, sitting, sleeping & moving
- Convenient work area
- Healthy weight & lean body mass
- Stress management, relaxation techniques & positive attitude
There are certain risks or complications that patients might face as discectomy is in itself a critical & complex surgery. Following are some of the potential risks that might arise due to discectomy.
- Cerebrospinal Fluid Leakage, also known as a ‘dural tear’ but it does not affect the success of discectomy surgery. This can be prevented & treated with the patient taking complete bed rest for the leakage to heal naturally
- Nerve root damage
- Inconsistent bladder & bowel movement
These are typical risks involved in discectomy surgery. However, these complications are seen in very rare cases.
Good results are attained in 75 to 90 percent of patients treated with discectomy surgery. However, complete recovery depends upon patient’s lifestyle & willpower. In a recent health report that compared discectomy surgery with other nonsurgical treatments for treating herniated discs, the outcomes which were noted are described as follows.
- Patients with harsh leg pain (sciatica) benefit more from discectomy surgery than those with back pain
- Patients with lesser pain do well with nonsurgical treatment
- Patients with moderate to extreme pain who had undergone discectomy surgery notice greater relief than those who did not undergo discectomy surgery
It has been observed that discectomy provides greater & faster pain relief than any nonsurgical treatments.
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