Disc Surgery

Description

A ruptured disc, also called a herniated disc, occurs when the disc capsule breaks open and protrudes into the spinal canal, pressing on nerve roots. Gel oozes out of the disc and causes more pressure on the spinal cord or the nerve roots. Over time, the gel usually disintegrates, and the symptoms may be relieved.

When a disc ruptures, however, the pad between the two vertebrae is gone, and the gradual wearing of the bone leads to arthritis. This can cause serious pain if the arthritic spurs of the vertebrae press on the nerve root. The pain will worsen as years go by without treatment.

The pain of a ruptured disc is usually sharp and sudden. Commonly, the pain will be passed along the course of the nerve impinged by the ruptured disc. A disc pressing on the sciatic nerve root causes sciatica, sending pain from the buttock down the leg and into the foot.

A bulging disc, involving no fragmentation, cannot be seen on a normal x-ray but can be picked up easily on a CT or MRI scan. Many ruptured discs will respond to bed rest. A back brace may help relieve the stress on the disc, and physical therapy can help relieve any muscle spasms associated with a ruptured disc.

If the symptoms do not subside, surgery may be needed to remove some or all of the disc. What used to be a crude, major operation requiring long term disability has become a much more sophisticated procedure with little difficulty afterward.

Surgical Options

There are numerous options. There are several different procedures for decompressing a nerve root affected by lumbar disc protrusion. A patient with a contained disc herniation might be referred for discectomy, microdiscectomy, automated percutaneous discectomy, arthroscopic discectomy, or chemonucleolysis.

The standard procedure for the past 50 years has been laminectomy with discectomy. A laminectomy involves removing bone to relieve pressure on the nerve and to allow the surgeon access to any area requiring additional surgery, such as the removal of all or part of an abnormal disc.

In some cases, the surgeon removes the entire lamina, which makes up the back or posterior wall of the spinal canal. Sometimes, only a portion of the lamina is removed, which is called a laminotomy.

A discectomy simply means removal of a damaged disc.

Microsurgical discectomy was first described in the early 1980s. Its advantages are that a shorter surgical incision is required, the lamina need not be removed, and the ligaments between the laminae can also be preserved.

While the success rate of microsurgical discectomy is about the same as a standard laminectomy/discectomy, patients who undergo microsurgery can usually return to work and other activities more rapidly.

Various types of percutaneous discectomy may also be used in which protruding disc material is removed by inserting a needle or probe and sucking it out.

Finally, some physicians treat certain ruptures by injecting them with chymopapain, an enzyme that dissolves the disc. A needle is inserted into the center (nucleus pulposus) of the disc and chymopapain is injected into it in order to dissolve the jelly like material in the nucleus, thereby relieving the pressure that the bulging disc is placing on the nerve roots.

Neither percutaneous discectomy nor chymopapain treatment known as chemonucleolysis, is effective in treating people with extruded disc fragments lodged in the spinal canal.

Post Operation

After the operation, some patients feel a tingling sensation in the area that was previously painful. This symptom is the result of the former nerve root compression and will disappear with no further treatment.

A second common complaint after surgery is muscle spasms in the paraspinous muscles, causing the spine to tingle.

After laminectomy and discectomy, it will usually be three to four weeks before it is advisable to perform heavy labor or participate in sports.

Special training in back exercises and in the proper techniques for lifting, bending, and other movements is an integral part of rehabilitation after this or any other type of back surgery.

Questions to Ask Your Doctor

Are there other non-surgical kinds of treatment instead of surgery?

What will happen if the operation isn't preformed?

What are the risks?

Is a blood transfusion necessary?

How much improvement can be expected from this operation?

Will a second operation be necessary?

How long will the hospital stay be?

What medications will be prescribed and for how long?

When will normal activities be resumed?