Why Lumbar Discectomy?
Why Lumbar Discectomy?
Most people have heard about lumbar discectomy surgery for herniated disks. This surgery has changed the way many people feel about back surgery. In the past many back surgeries had uniformly poor results, and the chance of a positive outcome was not that great. But, times have changed, and small incisions being done mostly as an outpatient back surgery have turned this once feared surgery to a “band aid operation”, with expected routine results. Though it is still a spine surgery and a healthy respect should be held for that fact, we do know that in the properly selected patient, the results can be very favorable. The key words are “properly selected”.
In general, patients that have lumbar discectomy surgery usually fall into two categories. The first group of lumbar discectomy patients are the unfortunate individuals that develop excruciating leg pain, with rapidly progressive weakness, and in true emergencies, lose the ability to control their bowels and bladder. Without getting too detailed, it means their legs cannot support their body, and they buckle, not from the pain, but from true lack of ability to control the muscles. In terms of the bowel or bladder, loss, it is not constipation. It is true loss of control where people will start to soil themselves. In this situation, surgery is usually done on an urgent basis. If you think this is what is happening to you, stop reading this Blog and call your doctor immediately, or go to the emergency room. Fortunately, for most lumbar discectomy patients, this is not the situation.
The second group of lumbar discectomy patients often present with a significant pain, but it is not associated with a progressive weakness, or loss of bowel or bladder control. But, even with time, physical therapy, medications, and injections, the disc herniation does not stop hurting. For these patients, after having the proper workup including x-rays and MRI’s, a surgeon may suggest lumbar discectomy surgery. A good outcome is associated with disk herniations that follow a predictable pattern of nerve irritation. To clarify, although you may have a disk herniation, it may not be located on the right area to cause your complaints. If that is the situation, surgery may not help your situation. A prudent surgeon will consider further treatments, or even other nerve type test before considering surgery in that situation.
In the best case scenario, a person would have continued pain from a defined disc herniation, with a corresponding pain pattern, numbness pattern or weakness complaint that is consistent with the nerve(s) entrapped by the herniated disc. If this person fails conservative treatment, there is a high likelihood of a successful outcome if surgery is performed. There are other factors that also weigh into the decision, and the likelihood of a successful lumbar discectomy surgery. A healthy normal weight person has a better chance of an uneventful and successful outcome. If you start adding in other factors such as multiple levels of disc herniations, obesity, diabetes, and other medical problems, the risks do go up and the outcome prediction does go down.
But, in a relatively healthy person, with a well-defined disc herniation, lumbar discectomy is an excellent choice. And, no matter what specific technique, as long as the disc is visualized, and properly removed, the outcomes will be predictably good.
- Oosterhuis T, Ostelo RW, van Dongen JM, Peul WC, de Boer MR, Bosmans JE, Vleggeert-Lankamp CL, Arts MP, van Tulder MW. Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral: a randomised trial and economic evaluation. J Physiother. 2017 Jul;63(3):144-153. PubMed PMID: 28668558
- Gadjradj PS, Arts MP, van Tulder MW, Rietdijk WJR, Peul WC, Harhangi BS. Management of Symptomatic Lumbar Disk Herniation: An International Perspective. Spine (Phila Pa 1976). 2017 Jun 19; PubMed PMID: 28632645
What is lumbar diskectomy? An incision is made just off the midline in the back. For the average sized person the incision is less than 1.5 inches or 3 centimeters, but may be larger for more than one disk removal. Care is taken to preserve the posterior spinous ligaments, and minimize stripping of the multifidus muscle attachments. Muscles are gently retracted to allow visualization of the bony covering or lamina in the ligament that covers over the spinal canal or the ligamentum flavum. The term Micro diskectomy can also describe a smaller incisions utilized with magnification. Micro diskectomy is the standard in most communities. Depending on the level, some of the bone will need to be removed to allow access. Tools including burs, Karason punches, and curettes aid in the removing of the covering bone and ligament. The nerve sac is then identified and protected. The nerve sac and nearby nerves are gently swept off the offending disc material. Disc herniation is then removed, and the nerve is now free to pressure. Associated bone spurs may also be removed. This is a general animation of the lumbar micro diskectomy operation, and you should discuss your individual concerns with your individual surgeon. For the properly selected patients without any other medical issues the success rate of improvement is greater than 90%. For the vast majority of patients they can resume normal activities within a few months. Most patients now have the operation performed on an outpatient basis. For the properly selected patient, few will ever need additional surgery on that disc level. Remember, surgery is indicated when you have failed non-surgical treatments, have corresponding physical exam findings that match the testing, and you have significant pain that is no longer tolerable. This is Dr. John Shim, and I hope this video helps you understand the lumbar micro diskectomy surgery. If you'd like more information about similar topics please subscribe to our newsletter or our YouTube channel.
Last modified: March 3, 2020