Spine surgery

Lumbar discectomy (lumbar microdiscectomy)

This article provides general information about lumbar discectomy (lumbar microdiscectomy) surgery and is not a substitute for advice from Dr Reddy. It does not consider your individual health, diagnosis or treatment plan.

 

A lumbar discectomy, also known as a lumbar microdiscectomy, is a surgical procedure to remove the damaged part of an intervertebral (spinal) disc.

The spine is made up of a series of bones called vertebrae through which the spinal cord travels. The spine protects the spinal cord from injury. Spinal nerves run from the spinal cord through openings in the vertebrae called intervertebral foramina. Rubbery discs sit between each vertebra to cushion them and give the spine flexibility. Discs are strong but the outer shell can deteriorate and weaken with age, leading to damage. Discs may also become damaged through injury. This damage may lead a disc’s core to bulge and even extrude out. This is called a herniated disc or a protruded disc. A herniated disc may press onto the spinal cord or spinal nerves, causing pain, numbness and weakness.

A lumbar discectomy or microdiscectomy works to reduce the symptoms of a herniated disc in the lower spine.

Why might someone need a lumbar discectomy?

A lumbar discectomy is usually only recommended if a person has severe or ongoing symptoms of disc herniation that do not ease with nonsurgical treatment such as physical therapy and anti-inflammatory medication.

You may need a lumbar discectomy if you have:

  • persistent, severe symptoms of a herniated disc, including pain in the lower back, buttocks, hip and legs, and numbness, tingling (pins and needles) and weakness in the legs, which impact on your ability to function
  • significant or worsening weakness, including difficulty standing or walking
  • symptoms of cauda equina syndrome, including loss of control of bowel or bladder functions or changes in sensation around the saddle region (buttocks, back of legs and inner thighs), or severe low back or leg pain – this is a rare condition but serious condition that requires immediate medical help

Dr Reddy will assess things like your age, health, medical condition, and your anatomy to advise the most appropriate treatment for you.

How is a lumbar discectomy done?

A lumbar discectomy, also called a microdiscectomy, is often performed using minimally invasive techniques. Once a person has general anaesthetic to put them to sleep, the surgeon makes a small incision (surgical cut) to the skin then carefully moves muscles aside to reach the herniated disc. They will use special tools to remove the part of the disc pressing on the spinal nerves or cord. The surgeon will also take out any other structures compressing the nerves, such as osteophytes (bony spurs or overgrowths) and any loose disc fragments.

If the surgeon must remove the whole disc, the surgeon may replace it with bone, called a spinal fusion, or an artificial disc, called a lumbar disc replacement.

The surgeon then closes the incision with self-dissolving sutures, and places a dressing over the wound.

What are the benefits of a lumbar discectomy?

A discectomy on a herniated disc relieves most people of their leg and buttock pain and some people relief of their back pain. It may take several weeks or months for some people to feel relief. Muscle usually gets stronger after surgery but may not return to full strength. It may take months for numbness to reduce.

The amount of improvement usually corresponds with how long you had pain, and whether there has been spinal nerve damage. If the disc herniated as part of the ageing process, your symptoms may return a few years after surgery because discs continue to weaken as we get older. If this happens, you may need to have surgery again.

What are the risks of a lumbar discectomy?

A lumbar discectomy is a relatively safe and simple procedure, though all surgical procedures carry risk.

Some potential risks of this procedure include but are not limited to:

  • bleeding, infection, blood clots, and reaction to anaesthesia, as with any surgical procedure
  • symptoms persisting despite surgery
  • new back or leg pain after surgery
  • cerebrospinal fluid leak – the membrane covering the spinal cord or dura mater may be inadvertently punctured, leading to leakage of fluid and needing repair during the operation
  • disc herniation happening again – this is because of the small chance that material may come out of the disc after surgery
  • instability

Very rare risks of a lumbar discectomy include:

  • damage to the spinal nerve roots, resulting in worsened pain, weakness or numbness
  • leg paralysis due to nerve damage
  • incontinence (bowel and bladder problems)
  • impotence in males (erectile dysfunction)

Dr Reddy will discuss the risks with you in more detail and answer any questions you may have.

How should I decide to have a lumbar discectomy?

The decision to undergo lumbar discectomy involves thorough discussion with Dr. Reddy, considering the procedure’s benefits, risks, and limitations.

If you do not have surgery to stop the pressure on your spinal nerves, there may be risks. In serious cases, not having surgery may include more damage, pain, numbness, paralysis or loss of bladder and bowel control.

If you decide to have surgery, you will need to sign a consent form. Please read this carefully before signing it. If you have any questions, ask Dr Reddy.

How should I prepare for a discectomy?

You may need to stop eating and drinking for several hours before your surgery. It is important to tell Dr Reddy which medication you take since this can affect your healing and blood clotting.

Smokers should refrain from smoking before surgery since this increases the chance of infection and slows down healing.

Speak with Dr Reddy to learn exactly what you need to do to prepare for surgery.

What happens after surgery?

After surgery, you will be taken to a recovery room where your healthcare team will monitor your health. Some people will be able to leave hospital on the same day, but most patients need to stay overnight, depending on their circumstances.

If your job does not require much physical activity, you may be able to return to work after 2 to 6 weeks. If you have a job that includes heavy labour, you may not be able to return to work for about 6 to 8 weeks.

To maintain a healthy spine, it’s a good idea to keep a healthy weight, eat healthily, exercise regularly and avoid too much bending, twisting or lifting.

 

Please only refer to this information in consultation with Dr Reddy. If you have any questions, ask Dr Reddy.

 

Sources
  • Boos N, Rieder R, Schade V, Spratt KF, Semmer N, Aebi M. The diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations. Spine 1995;20(24):2613-25.
  • Saal JA. Natural history and nonoperative treatment of lumbar disc herniation. Spine 1996;21(24 Suppl):2S-9S.
  • Chou R. Subacute and chronic low back pain: Surgical treatment. UpToDate [online serial]. Waltham 2014.
  • Carragee E. Surgical treatment of lumbar disk disorders. Jama 2006;296(20):2485-7.
  • Schoenfeld AJ, Weiner BK. Treatment of lumbar disc herniation: evidence-based practice. International journal of general medicine 2010;3:209.
  • Peul WC, van den Hout WB, Brand R, Thomeer RT, Koes BW, Group L-THSIPS. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial. Bmj 2008;336(7657):1355-8.
  • Asch HL, Lewis PJ, Moreland DB, Egnatchik JG, Young JY, Clabeaux DE, et al. Prospective multiple outcomes study of outpatient lumbar microdiscectomy: should 75 to 80% success rates be the norm? Journal of Neurosurgery: Spine 2002;96(1):34-44.
  • Ambrossi GLG, McGirt MJ, Sciubba DM, Witham TF, Wolinsky J-P, Gokaslan ZL, et al. Recurrent lumbar disc herniation after single-level lumbar discectomy: incidence and health care cost analysis. Neurosurgery 2009;65(3):574-8.
  • Neurosurgical Society of Australasia (Lumbar discectomy)