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Diskectomy

Spinal microdiskectomy; Microdecompression; Laminotomy; Disk removal; Spine surgery - diskectomy; Discectomy

 

Diskectomy is surgery to remove all or part of the cushion that helps support part of your spinal column. These cushions are called disks, and they separate your spinal bones (vertebrae).

Description

 

A surgeon may perform disk removal (diskectomy) in these different ways.

  • Microdiskectomy: When you have a microdiskectomy, the surgeon does not need to do much surgery on the bones, joints, ligaments, or muscles of your spine.
  • Diskectomy in the lower part of your back (lumbar spine) may be part of a larger surgery that also includes a laminectomy, foraminotomy, or spinal fusion.
  • Diskectomy in your neck (cervical spine) is most often done along with laminectomy, foraminotomy, or fusion.

Microdiskectomy is done in a hospital or outpatient surgical center. You will be given spinal anesthesia (to numb your spine area) or general anesthesia (asleep and pain-free).

  • The surgeon makes a small (1 to 1.5-inch or 2.5 to 3.8-centimeter) incision (cut) on your back and moves the back muscles away from your spine. The surgeon uses a special microscope to see the problem disk or disks and nerves during surgery.
  • The nerve root is located and gently moved away.
  • The surgeon removes the injured disk tissue and pieces of the disk.
  • The back muscles are returned to place.
  • The incision is closed with stitches or staples.
  • The surgery takes about 1 to 2 hours.

Diskectomy and laminotomy are usually done in the hospital, using general anesthesia (asleep and pain-free).

  • The surgeon makes a larger cut on your back over the spine.
  • Muscles and tissue are gently moved to expose your spine.
  • A small part of the lamina bone (part of the vertebrae that surrounds the spinal column and nerves) is cut away. The opening may be as large as the ligament that runs along your spine.
  • A small hole is cut in the disk that is causing your symptoms. Material from inside the disk is removed. Other fragments of the disk may also be removed.

 

Why the Procedure Is Performed

 

When one of your disks moves out of place (herniates), the soft gel inside pushes through the wall of the disk. The disk may then place pressure on the spinal cord and nerves that are coming out of your spinal column.

Many of the symptoms caused by a herniated disk get better or go away over time without surgery. Most people with low back or neck pain, numbness, or even mild weakness are often first treated with anti-inflammatory medicines, physical therapy, and exercise.

Only a few people with a herniated disk need surgery.

Your doctor may recommend a diskectomy if you have a herniated disk and:

  • Leg pain or numbness that is very bad or is not going away, making it hard to do daily tasks
  • Severe weakness in muscles of your lower leg or buttocks
  • Pain that spreads into your buttocks or legs

If you are having problems with your bowels or bladder, or the pain is so bad that strong pain drugs do not help, you will probably have surgery right away.

 

Risks

 

Risks for anesthesia and surgery in general are:

  • Reactions to medicines
  • Breathing problems
  • Bleeding, blood clots, infection

Risks for this surgery are:

  • Damage to the nerves that come out of the spine, causing weakness or pain that does not go away
  • Your back pain does not get better, or pain comes back later
  • Pain after surgery, if all the disk fragments are not removed
  • Spinal fluid may leak
  • The disk may bulge out again

 

Before the Procedure

 

Tell your doctor or nurse what medicines you are taking, even medicines, supplements or herbs you bought without a prescription.

During the days before the surgery:

  • Prepare your home for when you come back from the hospital.
  • If you are a smoker, you need to stop. Your recovery will be slower and possibly not as good if you continue to smoke. Ask your doctor for help.
  • Two weeks before surgery, you may be asked to stop taking medicines that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and other medicines like these.
  • If you have diabetes, heart disease, or other medical problems, your surgeon will ask you to see the doctors who treat you for those conditions.
  • Talk with your doctor if you have been drinking a lot of alcohol.
  • Ask your doctor which medicines you should still take on the day of the surgery.
  • Always let your doctor know about any cold, flu, fever, herpes breakout, or other illnesses you may have.
  • You may want to visit the physical therapist to learn some exercises to do before surgery and to practice using crutches.

On the day of the surgery:

  • Follow instructions about when to stop eating and drinking.
  • Take the medicines your doctor told you to take with a small sip of water.
  • Bring your cane, walker, or wheelchair if you have one already. Also bring shoes with flat, nonskid soles.
  • Follow instructions about when to arrive at the hospital. Arrive on time.

 

After the Procedure

 

Your doctor or nurse will ask you to get up and walk around as soon as your anesthesia wears off. Most people go home the day of surgery. Do NOT drive yourself home.

Follow instructions about how to care for yourself at home.

 

Outlook (Prognosis)

 

Most people have pain relief and can move better after surgery. Numbness and tingling should get better or disappear. Your pain, numbness, or weakness may not get better or go away if you had nerve damage before surgery, or if you have symptoms caused by other spinal conditions.

Further changes may occur in your spine over time and new symptoms may occur.

Talk with your doctor about how to prevent future back problems.

 

 

References

Ehni BL, Satyan K. Lumbar discectomy. In: Benzel EC, ed. Spine Surgery. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 78.

Gardocki RJ, Park AL. Lower back pain and disorders of intervertebral discs. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 42.

Kreiner DS, Hwang SW; North American Spine Society, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014;14(1):180-191. PMID: 24239490 www.ncbi.nlm.nih.gov/pubmed/24239490.

Wilson AS, Samartzis D, Shen FH. Anterior cervical discectomy and fusion. In: Shen FH, Samartzis D, Fessler RG, eds. Textbook of the Cervical Spine. Philadelphia, PA: Elsevier Saunders; 2015:chap 30.

 
  • Herniated nucleus pulposis

    Herniated nucleus pulposis - illustration

    Herniated nucleus pulposus is a condition in which part or all of the soft, gelatinous central portion of an intervertebral disk is forced through a weakened part of the disk, resulting in back pain and nerve root irritation.

    Herniated nucleus pulposis

    illustration

  • Skeletal spine

    Skeletal spine - illustration

    The spine is divided into several sections. The cervical vertebrae make up the neck. The thoracic vertebrae comprise the chest section and have ribs attached. The lumbar vertebrae are the remaining vertebrae below the last thoracic bone and the top of the sacrum. The sacral vertebrae are caged within the bones of the pelvis, and the coccyx represents the terminal vertebrae or vestigial tail.

    Skeletal spine

    illustration

  • Spine supporting structures

    Spine supporting structures - illustration

    The spine is surrounded by many muscles and ligaments which give it great strength and flexibility. If these muscles or ligaments become damaged, back pain results.

    Spine supporting structures

    illustration

  • Cauda equina

    Cauda equina - illustration

    The spinal cord ends in the lumbar area and continues through the vertebral canal as spinal nerves. Because of its resemblance to a horse's tail, the collection of these nerves at the end of the spinal cord is called the cauda equina. These nerves send and receive messages to and from the lower limbs and pelvic organs.

    Cauda equina

    illustration

  • Spinal stenosis

    Spinal stenosis - illustration

    Spinal stenosis is a narrowing of the lumbar or cervical spinal canal. The narrowing can cause compression on nerve roots resulting in pain or weakness of the legs. Medications or steroid injections are often administered to reduce inflammation. If the pain is persistent and does not respond to these conservative measures, surgery is considered to relieve the pressure on the nerves.

    Spinal stenosis

    illustration

  • Microdiskectomy - series

    Microdiskectomy - series

    Presentation

    • Herniated nucleus pulposis

      Herniated nucleus pulposis - illustration

      Herniated nucleus pulposus is a condition in which part or all of the soft, gelatinous central portion of an intervertebral disk is forced through a weakened part of the disk, resulting in back pain and nerve root irritation.

      Herniated nucleus pulposis

      illustration

    • Skeletal spine

      Skeletal spine - illustration

      The spine is divided into several sections. The cervical vertebrae make up the neck. The thoracic vertebrae comprise the chest section and have ribs attached. The lumbar vertebrae are the remaining vertebrae below the last thoracic bone and the top of the sacrum. The sacral vertebrae are caged within the bones of the pelvis, and the coccyx represents the terminal vertebrae or vestigial tail.

      Skeletal spine

      illustration

    • Spine supporting structures

      Spine supporting structures - illustration

      The spine is surrounded by many muscles and ligaments which give it great strength and flexibility. If these muscles or ligaments become damaged, back pain results.

      Spine supporting structures

      illustration

    • Cauda equina

      Cauda equina - illustration

      The spinal cord ends in the lumbar area and continues through the vertebral canal as spinal nerves. Because of its resemblance to a horse's tail, the collection of these nerves at the end of the spinal cord is called the cauda equina. These nerves send and receive messages to and from the lower limbs and pelvic organs.

      Cauda equina

      illustration

    • Spinal stenosis

      Spinal stenosis - illustration

      Spinal stenosis is a narrowing of the lumbar or cervical spinal canal. The narrowing can cause compression on nerve roots resulting in pain or weakness of the legs. Medications or steroid injections are often administered to reduce inflammation. If the pain is persistent and does not respond to these conservative measures, surgery is considered to relieve the pressure on the nerves.

      Spinal stenosis

      illustration

    • Microdiskectomy - series

      Presentation

    A Closer Look

     

      Self Care

       

         

        Review Date: 5/9/2015

        Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Internal review and update on 08/05/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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