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Aug 10, 2006
Discectomy: Pros & Cons
by SirGan
 Most people have already heard about one operation called Discectomy but don’t know a lot about it. Well, it is important to point out that open discectomy is the most common surgical treatment for ruptured or herniated discs of the lumbar spine. It is about using surgery to remove part of the damaged disc which is relieving the pressure on the nerve tissue and alleviating the pain. The surgery involves a small incision in the skin over the spine, the removal of some ligament and bone material and the removal of some of the disc material. What are the most important advantages of this operation? Well, good thing is that open discectomy has been performed and improved over the course of the past 60 years and in these last couple of years -it has been refined by improved diagnostic tools such as magnetic resonance imaging (MRI) and computerized tomography (CT). Several researches done in the past have shown that good results are achieved in 80% to 90% of the cases treated with open discectomy. Studies have also shown that people with radicular pain may have more pain relief than those who undergo open discectomy for low back pain.Pathophysiology of the conditionBefore anything has been told about this operation, it is important to know some facts about spine and herniation. Back is a complex network of bones, ligaments, muscles and nerves. All parts work together to balance and bear the weight of body. Most people know what vertebra is but not too many know what vertebral discs are. Well, they are cushioning and connecting materials that lie between the bones of the spine. What is herniation? You see, when the outer wall of this disc- annulus fibrosus becomes weakened through age or injury, it may tear and eventually- bulge out. This is called disc herniation, disc prolapse, or a slipped or bulging disc. Herniated disks can affect how you're able to perform everyday tasks and can cause severe pain that influences almost everything you do.
When someone has a herniated disk, he or she may have a difficult time with ordinary movements, including sitting or bending over. All this is accompanied with sharp pains in back or down one of legs. Although sometimes the pain is simply unbearable – good thing is that herniated disks aren't likely to result in paralysis and, except in rare instances, it can damage spine or make injury worse.
Proper indications for discectomyEveryone should know that not all patients with herniated discs are candidates for the open discectomy procedure. Operation is usually the last option if other possible treatments such as rest, physical therapy, anti-inflammatory medications and epidural injections couldn’t help. That’s why- only if back and leg pain does not respond to conservative treatment and continues for four to six weeks or longer- discectomy is indicated! Before the operation, doctor may prescribe diagnostic tests, such as X-rays, MRI or a CT scan, to verify the source of the pain. If a diagnosis of herniated disc is confirmed, open discectomy may be recommended.
How it is being done?It is important to point out that this operation is performed under general anesthesia. What happens during the procedure? Well, the surgeon will make one-inch incision in the skin over the affected area and remove the muscle tissue from the bone above. Every patient should know that in some cases bone and ligaments may also be removed for the surgeon to be able to visualize the bulging disc without damaging the nerve tissue. This is called laminectomy! During a laminotomy just a portion of lamina is removed to relieve pressure on a nerve or allow the surgeon access to a disk that's pressing on a nerve. When surgeon do all the preoperative preparations, the section of the disc that is protruding from the disc wall will be removed. This will relieve all the symptoms! It is also very important to understand that there are no implants and no material is used to replace the disc tissue that is removed.
Microdiscectomy and arthroscopical approachMost people don’t know that this operation can also now be performed arthroscopically. This means that it is being done through a smaller incision using specialized tools under local anesthesia. There is also one type of operation called Microdiscectomy. It is about using 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.
MicroEndoscopic Discectomy (MED)
Patients should also know about one other type of operation which is called MicroEndoscopic Discectomy! Big difference is that during this procedure some surgeons have chosen to perform the operation under local or spinal anesthesia allowing the patient to stay awake throughout the procedure. A fluoroscope- a machine which projects live x-ray pictures onto a screen is brought. The disc space is confirmed using the fluoroscope, and a long acting, local anesthetic is injected through the muscle and around the bone protecting the disc. Then a half to one-inch incision is made through which the thin wire is placed and lowered until it touches the bone. Progressively larger dilators are brought down on top of one another following the wire. By the time the 4th or 5th dilator is placed, the muscles are stretched to an opening roughly the size of a nickel. The retractor is held in place by a mechanical arm attached to the table. Finally, the endoscope with a camera is attached to the edge of the working channel. Why it is being done? Well, it projects an image up to the size of the TV screen. This allows for microscopic manipulation and removal of the tissues which could be extremely helpful!
Discectomy with bone-graftingWe have already pointed out that the cervical discectomy is the most common surgical procedure to treat damaged cervical discs. When the damaged disc is localized in the neck- the operation is called anterior. It is called anterior because the cervical spine is reached through a small incision in the front of the neck. During the surgery, the soft tissues of the neck are separated and the disc is removed. Logically- in order to maintain the normal height of the disc space, the surgeon may choose to fill the space with a bone graft. What exactly is bone graft!? A bone graft is a small piece of bone, either taken from the patient's body or from a donor or bone bank. This bone fills the disc space and ideally will join or fuse the vertebrae together. This is called fusion. Although it may sound complicate- these operations became routine these days!
What happens after a surgery?Well, every patient should know that after discectomy, like after any kind of surgery- patient may feel pain at the site of the incision. Not only that- patients should be aware that the original pain may not be completely relieved immediately after surgery. In most cases- some analgesics are being prescribed to ease the patient through the immediate postoperative period.
Not only that- once the patient is being discharged from the hospital, physician may prescribe a physical therapy. Note that none patient should attempt to drive an automobile until have been instructed to do so by physician.
Possible complication of discectomyPossible complications from open discectomy include:
PrognosisSeveral researches done in the past have shown that most people with jobs that are not physically challenging can return to work in two to four weeks or less. Of course- those with jobs that require heavy lifting or operating heavy machinery may need to wait at least six to eight weeks after surgery to return to work. Again, physical therapy may have a role in your recovery. Full recovery after a discectomy can be expected within eight to twelve weeks in most cases.
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