Surgery for a Herniated Disc
Discectomy, Fusion, Spinal Instrumentation: Learn Your Options
Although most patients with a herniated disc respond well to non-surgical treatments, some patients do need surgery. In general, surgery should be considered only after several months of non-surgical treatment. Many surgical procedures can be performed using minimally invasive techniques (meaning less cutting and entering the body). These techniques result in smaller incisions, shorter hospital stays, less pain after surgery, and a faster recovery.
The most typical surgery for a herniated disc is a discectomy. This is a surgical procedure that removes all or part of the damaged intervertebral disc. If the problem is in the neck, this procedure is usually done through the front and is called an anterior discectomy (described in more detail below). Sometimes the surgeon may create more space for the disc and nerve by removing a portion of the bone covering the nerve. This is called a laminectomy (described in more detail below).
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More recently, surgeons are performing discectomies using various less invasive techniques (sometimes known as micro, mini-open, minimally invasive, or percutaneous discectomies). In these techniques, surgeons perform the entire surgery through a very small incision, or through a tube which allows them to insert a tiny camera and special surgical instruments. Sometimes the disc is replaced with an artificial disc, although this is more common in the neck than in the low back.
Sometimes multiple spinal procedures are needed to reduce the pain. Other spinal surgeries include:
- Anterior Cervical Discectomy and Fusion: A procedure that reaches the cervical spine (neck) through a small incision in the front of the neck. The intervertebral disc is removed and replaced with a small plug of bone, which in time will fuse the vertebrae.
- Cervical Corpectomy: A procedure that removes a portion of the vertebra and adjacent intervertebral discs to allow for decompression of the cervical spinal cord and spinal nerves. A bone graft, and in some cases a metal plate and screws, is used to stabilize the spine.
- Laminoplasty: A procedure that reaches the cervical spine (neck) from the back of the neck. The spinal canal is then reconstructed to make more room for the spinal cord.
- Spinal Fusion: A procedure that often includes instrumentation and bone graft to stabilize the spine. Instrumentation refers to medical devices such as cages, plates, screws, and rods. There are different types of bone graft materials including the patient's own bone (autograft), donor bone (allograft), and bone morphogenetic protein. A spinal fusion may be included with another surgical procedure such as a discectomy or laminectomy.
- Spinal Laminectomy: A procedure for treating spinal stenosis by relieving pressure on the spinal cord. A part of the lamina (a part of the vertebra) is removed or trimmed to widen the spinal canal and create more space for the spinal nerves.
If your doctor recommends surgery, always ask the purpose of the operation, results you can expect, and possible complications. Feel free to ask for a second opinion if back surgery is suggested; this is your right. Your doctor will be happy to refer you to a specialist to re-evaluate your condition.
Spine surgery should always be taken seriously. Therefore, it is a good idea to be in the best physical condition possible. Here are a few helpful tips:
- Eat right. Good nutrition is key to keeping your immune system healthy. Eat a balanced diet and take a vitamin supplement in the weeks before your surgery. This will help reduce your risk of infection.
- Get in shape. Weak muscles and low cardiovascular endurance make recovery from surgery more difficult. Talk to your doctor about how to start an exercise program that is right for your condition before and after spine surgery. If you already exercise regularly, make sure your doctor approves your exercise routine, and then keep it up!
- Lose weight. Back pain can make losing weight or weight maintenance a challenge. If you are overweight, it is a good idea to slim down before your surgery. Why? Because more body weight strains the spine and may slow the healing process and increase post-operative pain. If you need to lose more than 25 pounds before surgery, ask your doctor about safe methods to shed those unwanted pounds.
- Don't smoke. If you are a smoker, being told to quit may be the last thing you want to hear! However, it is the most important step you can take to help ensure a safe and successful surgery. Quitting at least one month before surgery could decrease your chance of experiencing serious complications such as problems with anesthesia and post-operative pneumonia. Ultimately, patients who quit smoking increase the likelihood of a successful spinal surgery. If you think quitting may be difficult for you, talk to your doctor about smoking cessation programs in your area.
Pain is always a cause for concern. To recover and remain pain-free, follow the treatment plan your doctor has outlined. Make sure you have regular check-ups, and tell you doctor if you are not getting better. You may think a hurt back is the end of active life style. Think again! A herniated disc is no reason to stop enjoying life. With care and proper medical treatment, you will have a healthy back once again.