A discectomy is a surgical procedure to remove an intervertebral disc that is putting pressure on a nerve leaving the spinal column. The procedure is most commonly performed on lumbar discs (located in the lower back) creating leg pain. However, it may also be used for cervical discs in the neck.

Reasons for Procedure

Discs between vertebrae in the back normally serve as cushions separating the bones. With age, discs may dry out and offer less cushioning. Injury can cause a disc to bulge and press on the nerve root leaving the spinal column. This may result in severe pain. A discectomy may be performed after conservative treatments have failed. This procedure produces the best results if performed within 3-6 months of pain onset.

Risk Factors for Complications During the Procedure

Chronic conditions (such as diabetes), prior spine surgeries, advanced age, and smoking increase surgical risks.

What to Expect

Prior to Procedure

Your doctor will likely do the following:

• Physical exam
• Ask about the pain and when it started
• Refer you to a neurosurgeon or orthopedic surgeon

Before scheduling the procedure, the surgeon may:

• Order a magnetic resonance image (MRI) of your back
• Order a discography (injection of dye into various areas of the spine to determine if they are the cause of the pain)

In the days leading up to your procedure:

• Review your regular medications with your surgeon—you may be asked to stop taking some drugs
• Ask about restrictions to your activities during the postoperative period
• Arrange to have someone drive you home
• Arrange for help at home after returning from the hospital

The day before and the day of your procedure:

• Do not eat or drink anything after midnight unless told otherwise by your doctor
• Wear comfortable clothing

Anesthesia

General or local with sedation

Description of the Procedure

There are different types of surgical procedures and techniques used for a discectomy:

Anterior Cervical Discectomy: The surgeon makes a cut in the skin on the left or right side of the neck. He or she will move muscle to reach the spine. The surgeon removes the disc material after confirming by X-ray that it is the correct disc. He or she may also remove a portion of the bone to give the nerve more space. A bone graft may be placed to fuse the vertebrae.

Posterior Cervical Discectomy: The surgeon cuts the skin at the back of the neck and pushes the muscle aside. A small piece of bone is removed to access the disc space. The nerve is gently pushed aside and the disc material removed.

Lumbar Discectomy: The surgeon makes a 1 inch-1.5 inch cut in the skin on the lower back. He or she will move the muscles out of the way and possibly a small part of the bone to gain access to the nerve and disc. The disc or disc fragments are lifted out.

There are a variety of techniques used to perform a discectomy. Your surgeon will pick the technique that is most appropriate for your particular case. An “open” technique involves a larger skin cut so that the surgeon can directly visualize the area of operation. A “minimally invasive” technique (e.g., microdiscectomy or percutaneous approach) uses a smaller skin cut and the assistance of a variety of tools to help the surgeon see the operation site and to help operate in a smaller space.

Some of the tools used are: a microscope (to aid in seeing the small area of operation); microsurgical tools (such as small drills); an endoscope (a tiny camera threaded into the operating site through a tube); and a laser (which can vaporize disc material instead of cutting it with a scalpel and removing it). Using these tools for a “minimally invasive” approach generally results in less pain, quicker recovery time, and less scarring compared to an “open” approach.

How Long Will It Take?

Usually one to two hours, the time in the operating room depends on the procedure. Microdiscectomy usually takes longer than an open procedure. But recovery is faster.

Will It Hurt?

Anesthesia prevents pain during surgery. Ask your doctor about medications to help with the pain during your recovery.

Possible Complications

• Bleeding
• Infection
• Nerve damage
• Bladder or bowel incontinence
• Leakage of spinal fluid
• In anterior cervical cases, damage to other structures in the neck or hoarseness

Average Hospital Stay

Most lumbar procedures are done as outpatient surgery. Cervical discectomy patients may be admitted to the hospital for a short overnight stay.

Postoperative Care

Follow your doctor’s instructions. He or she may limit bending, lifting, or twisting for six weeks. An exercise program will help stretch and strengthen your muscles and decrease the risk of future back problems.

Outcome

The goal is to eliminate pain caused by the disc pressing on the nerve as it leaves the spine. Patients often feel relief almost immediately. Even so, it takes months for the nerve root to heal. Lumbar patients may suffer another herniation, often within the first three months after surgery. Posterior cervical discectomy also carries a small risk of repeat herniation.

Call Your Doctor If Any of the Following Occurs

It is essential for you to monitor your recovery once you leave the hospital. That way, you can immediately alert your doctor about any problems.

If any of the following occur, call your doctor:

• Pain not relieved by medication
• Fever, chills, or other signs of infection
• Redness, swelling, increasing pain, bleeding, or discharge from the incision site
• Numbness and tingling
• Bowel or bladder incontinence