Minimally Invasive Discectomy Surgery

The spine consists of a chain of 24 small, rectangular-shaped bones, called vertebrae, stacked on top of one another. It creates a canal that protects the spinal cord and nerve roots and makes the back's natural curves. The vertebrae consist of round, pillow-like discs with a tough outer layer that cushion and act as shock absorbers for the spinal bones.

A herniated disc (also called bulged, slipped or ruptured disc) occurs when the soft, jelly-like center of the disc pushes through the outer ring or causes the ring to bulge. The displaced herniated fragment puts pressure on the spinal cord and nearby nerve roots, often producing pain, numbness and weakness in one or both legs, a condition called sciatica. The disc material also releases irritants that can cause nerve inflammation. It can occur in any part of the spine, particularly in the neck (cervical spine) and back (lumbar spine).

Minimally invasive discectomy surgery may be an option when all other disc herniation treatments fail to make the symptoms go away.

What Is a Minimally Invasive Discectomy?

To better understand discectomy surgery, it would help to learn about minimally invasive spine surgery. Traditionally, spine surgery is performed through open surgery, which means spine doctors make long incisions to view and operate on the area of the injured part of the spine. Technological advances have recently allowed spine doctors to treat spine conditions with minimally invasive surgical techniques.

Unlike traditional surgery, minimally invasive spine surgery uses ports and/or small incisions to operate on the bones of the spine. The procedure uses laparoscopes and instruments equipped with video capabilities for spine doctors to view real-time X-ray images of the spine.

Additionally, minimally invasive spine surgery can be faster, safer and requires less recovery time due to reduced muscle and soft tissue trauma than open surgery. Spine doctors can also perform minimally invasive surgery as outpatient procedures and utilize only local anesthesia, which provides less risk for patients against adverse reactions to general anesthesia. Discectomy is a spine procedure that can be performed using minimally invasive surgery using tubular dilators and a microscope or endoscope.

How Does a Minimally Invasive Discectomy Work?

Discectomy is the most common procedure to remove herniated discs in the lumbar region. In a discectomy procedure, spine doctors make a small incision over the affected area of the spine, then use special instruments to gently pull the nerve away to expose the ruptured disc and remove just enough of the disc to release the pressure on the spinal nerves caused by a bulging or slipped disc. Spine doctors close the incision with stitches or surgical tape to complete the operation.

Spine doctors may perform discectomy surgery in three different ways:

• Microdiscectomy - is the most common procedure used to treat a single herniated disc and performed through a small incision at the disc herniation level and often involves using a microscope. In a microdiscectomy, spine doctors do not need to operate much on the spine's bones, joints, ligaments or muscles.
• Discectomy in the lower part of the back (lumbar spine) - may be part of a larger surgery that includes a laminectomy, foraminotomy or spinal fusion.
• Discectomy in the neck (cervical spine) - is often performed along with foraminotomy or spine fusion.

When To Have Back Surgery for Herniated Disc?

Fortunately, many symptoms caused by a herniated disc may get better or go away over time without requiring surgery. Spine doctors usually treat patients with lower back or neck pain, numbness or mild weakness with anti-inflammatory medicines, physical therapy and exercise. Limiting activities for two to three days can help improve symptoms, but there is no need for complete bed rest. Only some people with herniated discs need surgery. However, your spine doctor may recommend a discectomy if you have a herniated disc and:

• Leg or arm 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 arm, lower leg or buttocks.
• Pain that spreads into your buttocks or legs.
• If you have problems with your bowels or bladder, or the pain is so bad that strong pain medicines do not help.
• Loss of feeling in the genital/rectal region.
• History of metastatic cancer.
• A significant recent infection or fever.
• Radiculopathy or a fall/injury that caused pain.

How Long Is the Recovery for Minimally Invasive Discectomy?

There is up to a 20% to 25% chance that the disc will herniate again in a patient's lifetime, regardless of surgical or nonsurgical treatment. The risk of choosing nonsurgical treatment for a herniated disc is that symptoms take longer to go away as compared to patients who have had surgery earlier. Studies suggest that at around nine to 12 months, the results are not as beneficial as if a patient had surgery before nine months.

As with any surgical procedure, a minimally invasive discectomy has risks. These include bleeding, infection and reaction to anesthesia. Overall, the results of minimally invasive discectomy on patients are beneficial. Most patients can return to normal activities and move better after surgery. However, if you had nerve damage before surgery or had symptoms caused by another condition, your symptoms may not improve or completely disappear.

Over time, changes may occur in your spine, which may cause new symptoms. Follow instructions on moving properly, repositioning, sitting, standing and walking to prevent future spine problems. Talk to your doctor about the advantages and disadvantages of surgical and nonsurgical treatment to help you make an informed decision.