Discectomy or microdiscectomy for a herniated disc

Surgery Overview

Discectomy (also called open discectomy) is the surgical removal of herniated disc material that presses on a nerve root or the spinal cord. 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 and allows the surgeon to better see and access the area of disc herniation.

Microdiscectomy uses a special microscope or magnifying instrument to view the disc and nerves. The magnified view makes it possible for the surgeon to remove herniated disc material through a smaller incision, thus causing less damage to surrounding tissue.

Before a discectomy, your doctor will examine you then order an imaging study, such as magnetic resonance imaging (MRI), computed tomography (CT scan), or myelogram to confirm that a herniated disc is causing your symptoms.

During discectomy, the surgeon removes the portion of the disc that is herniated and protruding into the spinal canal. The disc space may also be explored, and any loose fragments of disc can be removed.

These procedures are usually done in a hospital, using general anesthesia. In some cases, discectomy can be done in an outpatient surgical center.

What To Expect After Surgery

After a discectomy, you will be encouraged to get out of bed and walk as soon as the anesthetic wears off. You can use prescription medicines to control pain during the recovery period and will be advised to resume exercise and other activities gradually. Other things to think about include the following:

  • You can sit as long as you are comfortable, but most people avoid sitting for longer than 15 to 20 minutes. After surgery, sitting can be uncomfortable for a while.
  • Use walking as your primary form of exercise for the first several weeks. Getting up frequently to walk around will help decrease the risk that excess scar tissue will form. Scar tissue can keep the nerve root from gliding freely as you move, and can press on the nerve root. Walking will also provide exercise for your heart and lungs without stress to your back or the incision line (scar).
  • Avoid any activities that cause pain.
  • You may begin bicycling and swimming about 2 weeks after surgery as directed by your doctor or physical therapist.
  • If you work in an office, you may return to work within 2 to 4 weeks. If your job requires physical labor (such as lifting or operating machinery that vibrates) you may be able to return to work 4 to 8 weeks after surgery.

Many people are able to resume work and daily activities soon after surgery. In some cases, your doctor may recommend a rehabilitation program after surgery, which might include physical therapy and home exercises.

Why It Is Done

When surgery is used to treat a herniated disc, it is done to decrease pain and allow for more normal movement and function.

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).

Surgery may be considered if tests show that your symptoms are due to a herniated disc and your doctor thinks surgery may help relieve the symptoms. In deciding whether to have surgery, you and your doctor will consider factors such as:1

  • A history of persistent leg pain, weakness, and limitation of daily activities that has not gotten better with at least 4 weeks of nonsurgical treatment.
  • Results of a physical examination that show you have weakness, loss of motion, or abnormal sensation (feeling) that is likely to get better after surgery.
  • Diagnostic testing, such as magnetic resonance imaging (MRI), computed tomography (CT), or myelogram, that indicates your herniated disc would respond to surgery.

Click here to view a Decision Point. Should I have surgery for a herniated disc?

How Well It Works

People with milder symptoms tend to do well without surgery. People with prolonged symptoms that are severe enough to interfere with normal activities and work and require strong pain medicines may gain relief from surgery. A study begun in 1990 followed about 500 people with low back pain caused by a herniated disc. Some had surgery and some did not. Follow-up information was gathered 5 years and 10 years after the beginning of the study.2, 3

  • People with moderate to severe pain who had surgery noticed a greater improvement than those who did not have surgery.
  • Those who had surgery noted more relief from the symptoms they considered most important than those who did not have surgery.
    • At 5 years, 70% of those who had surgery reported improvement in their most important symptom, as compared with 56% of those who received nonsurgical treatment.
    • At 10 years, 71% of people who had surgery were satisfied with their current situation, compared with 56% of those treated nonsurgically.
  • But the type of treatment did not make a significant difference with regard to work and disability. The percent of people working at the time of the 10-year follow-up was similar, regardless of whether they had chosen surgical or nonsurgical treatment.

Risks

As with any surgery, there are some risks. There is a risk of damaging the nerve roots or spinal structures during surgery. There is also some risk of infection following surgery, which may require antibiotics and additional surgery. Some people may get a vein thrombosis (blood clot) or embolus (the clot breaks away and causes a blockage of blood flow in the lung). These conditions can lead to death, but dying from these conditions is rare.

Because there are risks with general anesthesia, your doctor and medical staff will carefully monitor you during your surgery and recovery.

Before the surgery, there is no sure way that your surgeon can know how your nerves will respond after the pressure of the disc herniation is removed. So there is a risk that your pain may not improve with surgery, or your pain may only partly improve.

What To Think About

Discectomy may provide faster pain relief than nonsurgical treatment, although it is unclear whether surgery makes a difference in what treatment may be needed later on.4

When comparing conventional open discectomy with microdiscectomy, people have reported being equally satisfied with both techniques.5

Spinal fusion is a procedure that joins together bones in the back. It is sometimes effective for neck problems, and can be combined with a discectomy. But for the low back (lumbar spine), the procedure is controversial and complex and is not commonly performed with a discectomy. If a doctor suggests that you get a lumbar spinal fusion with a discectomy, get a second medical opinion to help you decide whether fusion is necessary.

Percutaneous discectomy is a procedure using a special tool through a small incision in the back to cut out or drain the herniated disc, thereby reducing its size. Percutaneous discectomy is considered less effective than open discectomy.4

A newer form of discectomy using laser beams (laser discectomy) is still in the research stage.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

References

Citations

  1. North American Spine Society Task Force on Clinical Guidelines (2000). Herniated disc. North American Spine Society Phase III Clinical Guidelines for Multidisciplinary Spine Care Specialists. La Grange, IL: North American Spine Society.
  2. Atlas SJ, et al. (2001). Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: Five-year outcomes from the Maine Lumbar Spine Study. Spine, 26(10): 1179–1187.
  3. Atlas SJ, et al. (2005). 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, 30(8): 927–935.
  4. Deyo RA, Weinstein JN (2001). Low back pain. New England Journal of Medicine, 344(5): 363–370.
  5. Jordan J, et al. (2007). Herniated lumbar disc, search date November 2006. Online version of Clinical Evidence (8).

Last Updated: July 21, 2008

Author: Shannon Erstad, MBA/MPH

Medical Review: William M. Green, MD - Emergency Medicine & Robert B. Keller, MD - Orthopedics

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