Why Lumbar Discectomy?

Why Lumbar Discectomy?

Why Lumbar Discectomy?

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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 chances of a positive outcome was not that great.  But, times have changed, and the forces of marketing (small incisions, outpatient back surgery) have turned this once feared surgery to a “band aid operation”, with expected routine results. For patients who must have this surgery, confidence in a favorable outcome is good for the patients emotional state.   But, secondary to the marketing techniques of many of our “Spine Institutes”, some patients have lost the healthy respect that should be given to any surgical procedure. Having said that, 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.

Citations

  • 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

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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