A herniated or “slipped disc” in the low back is one of the most common conditions seen by spine specialists. Fortunately, better than 80-90% of those who develop a symptomatic disc herniation will improve without surgery.
Loss of bowel or bladder control as a result of a massive disc herniation and progressive weakness are definitive reasons to perform emergent surgery. For cases where non-surgical treatments including physical therapy, medication, and injections have been tried without any relief, surgery may also be recommended. Several things must be considered before surgery will and should be recommended. Assuming non-surgical care was tried and failed, it is important to note whether the clinical symptoms match with the findings from an MRI scan (or other diagnostic study) and the physical exam. Secondly, the presence of other medical conditions such as uncontrolled diabetes, advanced heart disease, and the use of blood thinning medications such as Coumadin and Plavix raise the risks of surgery considerably and may lead to a poor outcome.
The traditional surgery for a lumbar disc herniation has always been a lumbar discectomy. There are several different techniques and approaches to performing this procedure. Microdiscectomy, minimally invasive discectomy, and open discectomy are some of the names that are commonly used when describing this surgery.
This procedure involves making an incision (size varies) over the affected area of the low back. The underlying layers of muscle are split and dissection is carried down to the level of the back of the spine. Confirmation of this is usually made by x-ray (or fluoroscopy). A discectomy can be performed either from one side or bilaterally if the herniation is centrally located or large in size. A small amount of bone is trimmed away (laminotomy) to allow for access to the disc herniation and disc space. Some surgeons perform this procedure with a microscope while others use other forms of magnification to clearly visualize everything.
Once of the disc herniation is identified, a specialized retractor is placed to protect the nerves and small instruments (usually 1-2 mm) are used to remove the fragment(s) of disc. The area is inspected to ensure that the affected nerve(s) are free from all pressure. The layers of muscle and soft tissue are closed using sutures. The incision is closed with either sutures, staples, or a glue like substance (Dermabond).
In a healthy patient this surgery can be performed on an outpatient basis. It is normally performed under general anesthesia.
Recovery from this type of surgery is dependent on a number of factors. Many notice immediate improvements in regards to leg pain that was present before surgery.
Depending on the nature of the nerve compression, duration, and other encountered conditions, full recovery can range from a few weeks to a few months. Assuming all of the indications for surgery were met and the operation was carried out as planned, outcomes from this surgery are around 90% in regards to alleviating the nerve pain.
The general risks of this procedure include infection (superficial or deep), nerve injury, bleeding, recurrent herniation, development of spinal instability and risks associated with anesthesia.