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Discectomy for Herniated Disc

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Updated February 24, 2010

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

What a Discectomy Is:

During a disectomy, the pieces of a herniated disc that press on a nerve or on the spinal cord are surgically removed. Discectomies are done when a herniated disc is causing either pain down the leg (sciatica) or arm, or nerve problems such as weakness or numbness. All or part of the lamina, an area of bone on the back of the vertebra, has to be removed so that the surgeon can reach the nerve and disc. Depending on how much bone is removed, this is called a laminectomy (all of the lamina is removed) or a hemilaminectomy (half of the lamina is removed).

When a Discectomy Is Needed:

Generally conservative methods such as medications, physical therapy, or steroid injections are tried first. In a lot of cases, a herniated disc heals without surgery, but it can take up to a year. Having a discectomy may greatly shorten the healing time. If your pain is intense, or the weakness/numbness is noticeable, a discectomy may be a good choice; if symptoms are mild or moderate, you may only need therapy. Either way, discuss your symptoms and options with your doctor.

Microdiscectomy:

Microdiscectomy is a minimally invasive procedure done in an outpatient setting. A very small incision is made in the skin and tiny tube-shaped implements are inserted all the way down to the disc. The entire surgery takes place through the implements. Because muscles are moved out of the way rather than cut, healing time is much faster and less painful than with an open procedure.

Open Discectomy:

Open discectomy is a traditional back surgery. It is done in a hospital setting under general anesthesia. You probably will only need to stay in the hospital for one day. Open discectomy involves making about a 1" incision. Because the muscles have to be cut to give the surgeon access to the disc, healing from an open discectomy may take longer and be more painful than with a microdiscectomy. Other than this, the two procedures are comparable. Studies show that after an initial recovery period, pain relief is about the same. Talk with your surgeon to determine the best type of discectomy for you.

Choosing a Surgeon For a Discectomy:

Both orthopedic and neurosurgeons perform many kinds of back surgeries, including discectomies. Either type of doctor will be well prepared for the job. The choice of a surgeon for a discectomy really comes down to your evaluation of the individual's skill level. Don't hesitate to ask many questions before deciding who exactly will do the procedure.

Effectiveness:

Discectomy works about 80 to 90% of the time and usually results in rapid relief of leg pain and other symptoms. Benefits of discectomy hold steady over time - a large study found that most surgery patients enjoyed complete pain relief even after 10 years. However, about 10% of patients will have a herniation in the same place within a year; 5-18% require another surgery. This may not be necessary, though: Studies show that surgery and conservative care for a subsequent herniation after a discectomy get about equal results.

Risks and Complications of Discectomy:

Risks include infection, bleeding, injury to the dura mater (covering around the spinal cord) or injury to nearby nerves, arteries or veins. You may experience another herniation after the surgery is over (called a recurrent herniation). If you notice redness or discharge from your incision, pain or weakness down your arm or leg, you get a fever, have problems urinating or are bleeding, call your doctor immediately.

After Your Discectomy:

Right after surgery, you may have post-operative pain at the incision site. Pain from your herniated disc may linger for a while, too. Your doctor may give you pain medication. It's a good idea to start walking as soon as you are able. This will speed recovery, prevent scar tissue and mobilize your spine. Within a couple of weeks, you should be able to ride a bike or swim. Most people get back to work in 2-8 weeks, depending on how physical their job is. Physical therapy can help you return to your regular activities quickly. Many patients, especially with a first discectomy, make a full recovery.

Sources:

Dewing et al. The outcomes of lumbar microdiscectomy in a young, active population: correlation by herniation type and level. Spine (Phila Pa 1976). Jan 2008

Atlas et al. Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the maine lumbar spine study. Spine (Phila Pa 1976). Apr 2005.

NASS. Open Discectomy. NASS. Burr Ridge, IL. Accessed: Feb 11 10.

Legrand et al. Spine Section of the French Society for Rheumatology. Sciatica from disk herniation: Medical treatment or surgery? Joint Bone Spine. Dec 2007.

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