When Is It Time For a Discectomy

What Is Discectomy?

A discectomy is an invasive surgery, and the surgery removes a damaged portion of a spinal disc. In preparation for the procedure, patients will have to temporarily adjust their lifestyle. There are risks to undergoing a discectomy, and the complications include bleeding, infection, leaking spinal fluid, and injury to the area around the spine. Patients are put under general anesthesia and, ideally, only a fragment of the disc has to be removed. In some cases, a synthetic or donated bone will replace a removed disc. Most patients will be able to go home the same day as the surgery, though a short hospital stay may be necessary. Usually, patients will be able to return to regular work within two to six weeks. Sometimes, the doctor advises a longer recovery.¹

Who Needs Discectomy Surgery?

The discs in the spine act as shock absorbers. Specifically, they allow the body to bend and move without the bones rubbing together. In spinal disc herniation, the disc is pushed between the bones. As a result, the disc puts pressure on nearby nerves. Because of this, the patient can experience pain, numbness, and weakness in the back as well as in the arms and legs. When the herniated disc is not fixed after a few months with noninvasive treatment, surgery may become necessary. For example, patients who experience unbearable pain, have trouble standing or walking, or have bladder control issues will likely undergo discectomy. Unfortunately, surgery does come with side effects and complications, so patients should consider the alternative options first. Surgery reduces pain more quickly. Furthermore, discectomy is just one surgery that the surgeon performs.²

Additional Surgeries

The surgeon could also perform a lumbar laminotomy. Specifically, the laminotomy removes a small bone from the vertebra. The bone protects the spinal cord, and the laminotomy gives the surgeon access to the herniated disc. Additionally, the laminotomy can relieve nerve pressure and stop leg pain and sciatica. A laminotomy is the removal of part of the lamina. Meanwhile, a laminectomy is the removal of most, or all, of the lamina. Furthermore, spinal fusion may be performed so that the spine is more stable. Namely, the surgeon fuses two vertebrae together. The two vertebrae are located on either side of the damaged disc. Usually, spinal fusion prevents the bones from moving and causing more pain. Artificial disc surgery replaces the removed disc. Most of the time, the artificial disc is plastic or metal. As a result, the artificial disc stabilizes the spine and lets the body move more easily.³

Types of Discectomy

Lumbar discectomy is the common name for the surgery. The lumbar is the lower back, and lumbar discectomy is the surgery of a herniated disc in the lower back. On the other hand, cervical discectomy is related to the neck area. Usually, the surgery is done on the back of the neck. Anterior cervical discectomy and fusion is surgery of a herniated or degenerative disc in the front of the neck. Namely, it is discectomy in the throat area. A graft replaces the disc. The graft fuses the bones above and below the disc together. The surgery relieves neck and arm pain. During the surgery, patients are put under anesthesia and an incision is made in the throat. In most cases, patients are allowed to return home the same day⁴

Herniated Disc Diagnosis

The herniated disc has to be diagnosed before discectomy is performed. A doctor can diagnose herniated disc using several methods. A neurological examination can test reflexes, muscle strength, walking ability, and touch sensitivity. The latter tests the patient’s capability to feel light touches, pinpricks, and small vibrations. A physical exam will show the doctor where the tenderness and pain originate from. Most of the time, a physical exam and examination of the patient’s medical history is enough to diagnose herniated disc. Additionally, X-rays cannot detect herniated disc, but they are used to rule out other causes of back pain. However, a CT scan, MRI, or myelogram could locate the herniated disc. There are also nerve tests that can pinpoint the nerve damage, such as electromyograms and nerve conduction studies. The tests measure the electrical impulses that move along the nerve tissue, and they can detect any impulse problems.⁵

Noninvasive Treatment

Even before the doctor recommends a discectomy, there are other treatment options for herniated disc that could work. Over-the-counter pain medications can help to relieve symptoms within weeks. For example, medications like Advil or Aleve might be effective. If OTC medications are not working, a doctor could prescribe narcotics for short-term relief, anticonvulsants, muscle relaxers, or cortisone injections. Unfortunately, all of these medications come with the potential for side effects. In addition, a doctor will direct the patient to a physical therapist. Physical therapists can teach exercises that minimize pain. Many patients will find that a combination of pain medications and physical therapy will relieve the herniated disc symptoms without surgery. There are also alternative treatment options available to patients. The alternative treatment options do not come with the side effects of medications.⁶

Chiropractic Care

For example, chiropractors can provide a nonsurgical treatment option for patients with herniated discs. Chiropractors regularly work with physical therapists and doctors for a variety of conditions. Chiropractic care can relieve back pain and other symptoms of herniated disc. The type of disc injury will determine what treatment method the chiropractor will use. Chiropractic care does not treat every patient, such as those who have an advanced loss of muscle use or other complications. The chiropractor may use spinal manipulation and other forms of manual therapy and therapeutic exercises. For example, the flexion-distraction technique and pelvic blocking techniques might be used. Similar to physical therapists, chiropractors will recommend lifestyle changes, stretches, and exercises to try at home. Alternative therapy is not for everyone, but it is a treatment option that many patients should try before turning to discectomy.⁷