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Open discectomy is the most common surgical treatment for ruptured or herniated discs of the lumbar spine. This surgery is used to remove a 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. Open discectomy has been performed and improved over the course of the past 60 years and in the last couple of years it has been refined by improved diagnostic tools such as magnetic resonance imaging (MRI) and computerized tomography (CT). in the success rate of this procedure is 80% to 90%. Studies have also shown that it is more successful in people with radicular pain than in those with low back pain.

Pathophysiology of the condition

Vertebral discs are cushioning and connecting materials that lie between the bones of the spine. When the outer wall of this disc 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. Once the inner disc extends out it can press sensitive nerve tissue in the spine. This then causes weakness, tingling, or pain in the back area and into one or both legs. Herniated disks can affect your ability to perform everyday tasks and can cause severe pain. Although sometimes the pain is simply unbearable, herniated disks aren't likely to result in paralysis.

Proper indications for discectomy

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 didn’t help. 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 is it done?

This operation is performed under general anesthesia. The surgeon makes a one-inch incision in the skin over the affected area and removes the muscle tissue above the bone. 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 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 finishes all the preoperative preparations, the section of the disc that is protruding from the disc wall will be removed. This should relieve all the symptoms. No implants and no material is used to replace the disc tissue that is removed. 

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