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Discectomy or Microdiscectomy for a Lumbar Herniated Disc

Discectomy is surgery to remove lumbar (low back) herniated disc material that is pressing on a nerve root or the spinal cord. It tends to be done as microdiscectomy, which uses a special microscope to view the disc and nerves. This larger view allows the surgeon to use a smaller cut (incision). And this causes less damage to surrounding tissue. Before the disc material is removed, a small piece of bone (the lamina) from the affected vertebra may be removed. This is called a laminotomy or laminectomy. It allows the surgeon to better see the herniated disc. Discectomy is usually done in a hospital. You are asleep or numb during the surgery. You will probably stay in the hospital overnight.

What To Expect After Surgery

After surgery, you will be encouraged to get out of bed and walk as soon as the numbness wears off. You can use prescription medicines to control pain while you recover. You can slowly resume exercise and other activities.

Other things to think about include the following:

• You may not be comfortable sitting at first. Most people avoid having to sit for longer than 15 or 20 minutes. But sitting will feel more comfortable over time.
• Walk as often as you can for the first several weeks. Getting up often to walk around will help lower the risk that too much scar tissue will form.
• Many people are able to resume work and daily activities soon after surgery. In some cases, your doctor may suggest a rehabilitation program. This may include physiotherapy and home exercises.
• If you work in an office, you may go back to work in 2 to 4 weeks. If your job requires physical labour (such as lifting or operating machinery that vibrates) you may be able to go back to work 4 to 8 weeks after surgery.

Why It Is Done

Surgery is done to decrease pain and allow you to regain normal movement and function.

You and your doctor may consider surgery if:

• You have very bad leg pain, numbness, or weakness that keeps you from being able to do your daily activities.
• Your leg symptoms do not get better after at least 4 weeks of non-surgical treatment.
• Results of a physical examination show that you have weakness, loss of motion, or abnormal feeling that is likely to get better after surgery.

Surgery is considered an emergency if you have cauda equina syndrome. Signs include:

• New loss of bowel or bladder control.
• New weakness in the legs (usually both legs).
• New numbness or tingling in the buttocks, genital area, or legs (usually both legs).

How Well It Works

Although surgery for a lumbar herniated disc doesn’t work for everyone, it works well for many people.

A study called SPORT randomly assigned about 500 people to two groups. Some had surgery, and some did not. The study found that after 2 years most people felt better and were able to be active, whether they had surgery or not. People who had surgery were slightly more likely to feel better. But the difference wasn’t big enough to prove that one treatment is better than the other.

Another study followed about 500 people over 10 years. Some had surgery, and some did not. This study showed that people who started with medium to very bad pain tended to feel better sooner if they had surgery. But after 5 to 10 years, the number of people in both groups who were able to do their daily activities was about the same whether they had surgery or not.

Risks

As with any surgery, there are some risks.

• Surgery doesn’t always work, or it may not work any better than other treatment.
• There is a slight risk of damaging the spine or nerves.
• There is some risk of infection.
• There are risks with anesthesia.

What To Think About

Discectomy for a lumbar herniated disc may provide faster pain relief than non-surgical treatment. But it is unclear whether surgery makes a difference in what treatment may be needed later on. People who have had either standard discectomy or microdiscectomy have reported similar improvements one year after surgery. Spinal fusion is a procedure that joins together bones in the back. For the low back (lumbar spine), spinal fusion is controversial and complex and is not commonly done with a discectomy.