lumbar disc surgery

What is a diskectomy?

A diskectomy (sometimes spelled “discectomy”) is a surgery to remove part or all of an intervertebral disk in your spine. Intervertebral disks are the flat, round cushions that sit between the vertebrae (bones) in your spine and act as your spine’s shock absorbers.

Each disk has a soft, gel-like center (the nucleus pulposus) surrounded by a flexible outer ring (the annulus). Intervertebral disks are under constant pressure. A disk can tear, allowing some of the nucleus’ gel substance to leak out. This is a herniated disk (also called bulging, slipped or ruptured disk), and it’s the main reason people get a diskectomy.

Herniated disks most commonly affect your lower back (lumbar spine), but they can affect your neck (cervical spine) as well. It’s rare to have a herniated disk in your middle back (thoracic spine). Lumbar diskectomies are more common than cervical diskectomies.

Types of diskectomies

There are different types of diskectomies depending on the surgical approach and location:

• Open/standard diskectomy (SD): The surgeon makes a large skin incision (cut) and moves your back muscles to the side so they can directly view the area and operate on the disk.
• Minimally invasive surgery (MIS) diskectomy: The surgeon makes a small skin incision and then uses a series of progressively larger tubes (called dilators) to tunnel through your muscles. Special instruments (including an endoscope) help the surgeon see and operate in a smaller space. Versions of this same surgery are micro-endoscopic diskectomy (MED) and full endoscopic diskectomy (FE).
• Anterior cervical diskectomy and fusion (ACDF): This surgery is for your neck (cervical spine). The surgeon approaches the damaged disk from the front (anterior) of your neck. They then remove the disk (diskectomy) and follow it with a spinal fusion. A fusion involves placing bone grafts and/or implants where the disk originally was. This provides stability and strength for your neck.

Depending on your situation, your surgeon may remove part or all of the damaged disk. In addition, they may remove one disk (single-level) or more (multi-level).

Why would I need a diskectomy?

A herniated disk is the main reason people get a diskectomy. But not everyone with a herniated disk needs the surgery. Most people with this condition — about 60% to 90% — recover well from nonsurgical treatment, like NSAIDs, epidural steroid injections and physical therapy.

But for some people, the pain and other symptoms of a herniated disk don’t get better. Your healthcare provider may recommend a diskectomy if you have a herniated disk and:

• Leg or arm pain or numbness that’s severe or isn’t getting better, making it difficult to do everyday tasks.
• Severe weakness in the muscles of your arm, lower leg or buttocks.
• Pain that spreads into your buttocks or legs (sciatica).

If you have cauda equina syndrome (sudden weakness or numbness and bladder and bowel control issues), you’ll need surgery right away.

Is a diskectomy a major surgery?

Yes, a diskectomy can be a major surgery. But there are a few minimally invasive surgical approaches that are less major than an open diskectomy in terms of the days you spend in a hospital recovering. However, due to the delicate nature of your spine and spinal cord, you have to strictly follow your recovery instructions with any type of diskectomy to make sure your spine heals well.

How do I prepare for a diskectomy?

You’ll meet with your surgeon before your diskectomy. You can expect your surgeon to:

• Do a physical exam.
• Request imaging tests like an X-ray, myelogram or MRI.
• Do a complete medical history.
• Ask about the medications or supplements you take.
• Make changes to your medications, like removing or adding certain medications. Don’t stop taking medications unless your provider approves it.

Let your healthcare provider know if you use tobacco products. Nicotine within tobacco products can interfere with your healing. Your provider may ask that you quit using these products at least four weeks before your surgery.

Your surgeon will also explain any risks or side effects and give you information about how you can prepare. If you have any questions or concerns, make sure you ask your surgeon before the date of your surgery.

What happens during a diskectomy?

The steps of a diskectomy vary depending on the type of surgical approach. Your surgeon will go over the steps of the process in detail before the surgery. In general, you can expect:

Anesthesia

An anesthesiologist will give you anesthesia. Depending on what your surgeon decides is best for your situation, you may get general anesthesia where you’ll be asleep for the entire procedure or a local anesthetic where you’re awake but won’t feel any pain.

Incision

For an open diskectomy, your surgeon will make a 1- to 2-inch skin incision in the middle of your back over the affected disk. They’ll move your overlying muscles to one side to directly access your spine.

For a minimally invasive lumbar diskectomy, your surgeon will use a fluoroscopy (a special X-ray) to pass a thin needle through your skin to locate the affected vertebra and disk. They’ll then make a small incision (less than 1 inch) near the midline of your back.

Removing the disk

Your surgeon will use special tools to remove all or part of the herniated disk. If you’re getting an anterior cervical diskectomy and fusion, they’ll also do the spinal fusion.

Closing the incision

After your surgeon removes the disk, they’ll attach the muscle and skin back together with stitches, staples or medical skin glue.

How long does a diskectomy take?

A diskectomy typically takes one to two hours. The length of time may vary depending on the type of surgery. Your surgeon will let you know what to expect.

What happens after a diskectomy?

After a diskectomy, your care team will carefully monitor your vital signs until your anesthetic wears off. You’ll likely receive medications to manage pain or discomfort.

A minimally invasive (endoscopic) diskectomy is typically an outpatient procedure. This means you’ll be able to go home on the same day as your surgery. You’ll need to ask someone to drive you home from the hospital. You may need to stay in the hospital for a day or two if you have an open surgery.

You’ll also get instructions from your surgeon on how to take care of yourself. These will explain:

• How to care for the incision site.
• What activities and exercises are safe to do.
• What side effects to look out for.

You may find it uncomfortable to stay in one position for a long time, especially sitting or standing. Your surgeon might recommend physical therapy to improve and strengthen your muscles and range of motion.

What is the success rate of a diskectomy?

Lumbar discectomies have a success rate between 60% and 90%. Several factors contribute to the likelihood that your surgery will be successful. Your surgeon will be able to give you insight into what to expect.

What are the risks of a diskectomy?

Risks or complications are rare for a diskectomy but may include:

• Allergic reactions to anesthesia.
• Infection and/or bleeding at the incision.
• Blood clots.
• Damage to the nerves that come out of your spinal cord.
• Cerebrospinal fluid (CSF) leak.

Other issues include:

• No change to your pain or relief of symptoms.
• Return of the herniated disk, which may require another surgery (revision diskectomy). This happens in 5% to 15% of cases.
• Unstable spine, which may require more surgery.

How long does it take to recover from a diskectomy?

The recovery time for a diskectomy varies from one to four weeks depending on:

• The severity of the herniated disk and your symptoms before surgery.
• Your general health.
• How closely you follow your after-surgery care instructions.

You may feel pain at the incision site for a few days. And it can take time for the pain you felt before surgery to improve.

When can I return to my normal activities?

Most surgeons advise limiting significant bending, lifting and twisting motions for three to six weeks after surgery. Doing these motions too soon could increase your risk of experiencing another disk herniation.

In general, surgeons recommend that you can:

• Return to light activities two weeks after surgery.
• Resume routine activities six weeks after surgery.
• Go back to strenuous labor or contact sports about 12 weeks after surgery.

Your specific care instructions may be different. Be sure to follow your surgeon’s guidelines.

When should I see my healthcare provider?

Contact a healthcare provider right away if you experience:

• Signs of an infection at the incision, like swelling, skin discoloration and fever.
• Severe pain or worsening pain.
• Sudden numbness or muscle weakness.
• Difficulty breathing.
• Difficulty peeing or pooping.