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.
(Back to Top)
|