When patients have leg or arm pain due to herniated discs (e.g., in the lumbar L5-S1 area of spine), a surgical procedure called discectomy may be necessary. Discectomies are usually considered if a patient has had combinations of severe leg pain, numbness or weakness despite conservative management.
What is a Disc Herniation?
Discs, which act as shock absorbers for the spine, are located in between each of the vertebrae in the spine. Each disc contains cartilage in a tire-like outer band (called the annulus fibrosus) that surrounds a very firm but gel-like cartilage substance (called the nucleus pulposus).
A herniation occurs when the outer band of the disc breaks or cracks and the gel-like substance from the inside of the disc leaks out, placing pressure on the spinal canal or nerve roots. In addition, the nucleus releases a chemical that can cause irritation to the surrounding nerves causing inflammation and pain.
To relieve nerve pressure and pain, surgery usually involves removing the displaced part of the damaged disc (called a discectomy). In order to gain access to the nerve in the spinal canal and to the offending disc fragment, a small opening (laminotomy) is made in the outer bony covering of the lumbar spine called the lamina. This is done with a small burr or micro-sized punch. The disc fragment itself is removed with micro instruments. In this manner, the nerve is freed of pressure. In rare instances, such as with recurrent disc herniations, and only if necessary, the space left by the removed disc will be filled with a bone graft – a small piece of bone usually taken from the patient’s hip. The bone graft is used to join or fuse the vertebrae together (called a fusion). In some cases, some instrumentation (such as plates or screws) may be used to help promote fusion and to add stability to the spine.
Micro- and Open Discectomy
Traditionally, open discectomy for a herniated disc is performed through a one to two-inch incision in the patient’s back.
We also perform less invasive discectomy surgeries, utilizing minimally invasive techniques. Minimally invasive surgery uses smaller incisions, are more muscle sparing, and use specialized instruments such as microscopes.
Recovery from Discectomy
The biggest advantages of this procedure are that none of the muscles, ligaments, or other soft tissue structures needs to be cut or disrupted in any significant way. This translates into decreased pain after surgery and an enhanced rate of recovery. This technique can often be done on an outpatient basis. Many patients can return to work in just a few days.
Dr. Antonacci can discuss the options of performing this type of procedure with you. This technique is only appropriate for certain types of disc herniations.