Many patients with herniated discs experience severe pain, often leading them to explore radical solutions such as disc surgery. This overview explores herniated disc surgery, including when it's recommended, the steps of the procedure, and potential risks.

What is Discectomy?

Herniated disc surgery removes part of a damaged spinal disc that's pressing on nerves, causing pain and difficulty in everyday activities like walking. (1)

Not all herniated disc cases require surgical treatment. Doctors typically prefer non-surgical treatments such as rest, medication, and physical therapy before considering surgery. (1)

Indications

Herniated disc surgery is considered a last resort when conservative treatments (physical therapy and medication) fail to improve symptoms.

A patient might be considered a candidate for disc surgery if: (2)

• Pain worsens over time and becomes unbearable.
• Nerve damage leads to significant muscle weakness or numbness.
• Loss of bowel or bladder control (indicating severe nerve compression).

Results

Disc surgery often offers significant relief and improved quality of life. While surgery isn't a guaranteed cure, it has a high success rate. Here is what you need to know: (4)

• High success rate: Success rate of disc surgeries exceeds 80%.
• Pain relief: Patients often first notice pain improvement, followed by restoring leg strength and sensation. Generally, the improvement in leg pain is more noticeable compared to back pain.
• Improved mobility: The ability to move and perform daily activities significantly improves gradually after a short recovery period from the surgery.
• Risk of Recurrence: Whether with conservative treatment or surgery, there is a 20-25% chance of the disc recurring in the future.

Your doctor will explain the expected outcomes in detail and weigh the benefits of surgery against its risks for your specific condition before making a final decision.

Risks

As with any surgery, there are small potential risks associated with disc surgery, including bleeding, infection, or a severe allergic reaction to anesthesia. (4)

Specific risks of disc surgery include: (4)

• Nerve injury.
• Tear in the sac surrounding the nerves (dural tear).
• Bacterial infection.
• Blood accumulation outside the vessels (Hematoma), which can cause pressure on the nerves and pain recurrence.
• Recurrence of the herniated disc.

Preparation

You will receive specific instructions from your doctor before surgery. This may include fasting and temporarily stopping certain medications, especially blood thinners. (3)

Surgery Steps

Under general anesthesia, your doctor will remove small portions of spinal bone and ligaments to reach the herniated disc. The damaged parts of the disc will then be removed partially or completely. (3)

If the entire disc must be removed, the surgeon may need to fill the gap with a piece of bone and fuse it with the adjacent vertebrae using metal pieces. (3)

There are different ways to perform disc surgery, including: (4)

• Microdiscectomy: This is the most common procedure for treating a herniated disc. It requires a 2.5 cm incision, and using specialized instruments to remove the portion of the disc that is compressing the nerve root.
• Endoscopic Discectomy: A newer, less invasive option, particularly effective for treating a single herniated disc. It involves a one small incision of about 1 cm or less, and then an endoscope is used to visualize the disc and surrounding structures. This technique offers less postoperative pain, minimal tissue or nerve damage, and a shorter recovery period. (5)
• Open Surgery: Traditional surgery requires a larger open incision to access the spine and treat multiple vertebrae or more complex conditions.

Recovery

You'll likely be discharged the same day or require a short hospital stay.

Your doctor will likely recommend that you start walking soon after surgery. To prevent further injury, you may need to avoid certain activities like heavy lifting, twisting, or bending. Physical therapy can also help speed up your recovery. (6)

Most people can return to work within 2-6 weeks, but if your job involves heavy lifting or operating heavy machinery, you may need to wait up to 8 weeks. (3)

Herniated Disc Surgery at Dr. Soliman Fakeeh Hospital

Dr. Soliman Fakeeh Hospital is a leading center for treating disc and spine problems. Our team consists of top orthopedic and spinal surgeons with exceptional expertise in performing various types of disc surgery.

References

1. HSS - Discectomy
2. AANS - Herniated Disc
3. Mayo Clinic - Diskectomy
4. American Academy of Orthopaedic Surgeons - Herniated Disk in the Lower Back
5. American Academy of Orthopaedic Surgeons - Endoscopic Diskectomy‍
6. Verywell Health - Herniated Disc Surgery: Overview