Improve Quality Of Your Life After Discectomy -part 1

: Admin : 2022-09-22

The most common surgery for lower back pain is a discectomy, which is used to treat disc herniations. It is frequently used in conjunction with other spinal procedures such as laminotomy, foraminotomy, artificial disc replacement, and other forms of spinal fusion. There are two types of discectomy techniques: traditional open discectomy and minimally invasive discectomy.

Why is it done?

A discectomy is performed to relieve the pressure that a herniated disc (also known as a slipped, ruptured, bulging, or prolapsed disc) places on a spinal nerve. A herniated disc occurs when some of the softer material within the disc pushes through a crack in the disk's outer lining.

A discectomy may be recommended by a doctor if:

• Standing or walking becomes difficult due to nerve weakness.
• After 6 to 12 weeks of conservative treatment, such as physical therapy or steroid injections, symptoms do not improve.
• The pain spreads to the buttocks, legs, arms, or chest and becomes unbearable.

Indications

The most common reason for discectomy is a herniated disc with nerve root compression or spinal canal stenosis, which is associated with the following symptoms:

• Radiculopathy is severe, and neurological deficits are progressive.
• no response to adequate non-surgical conservative treatment
• Cauda equina syndrome after lumbar discectomy
• Soft disc herniations require a cervical discectomy.

Contraindications

• Discectomy has the same contraindications as spinal surgery, which include:
• stenosis of the bony spinal canal
• overt segmental instability
• Dural involvement in malignant tumors
• neurological or vascular disorders resembling disc herniations

What you can expect

During the discectomy procedure

Diskectomy is typically performed under general anesthesia, so you are not awake during the procedure. Ideally, only the portion of the disc that is compressing the nerve is removed. However, in order to reach the herniated disc, small amounts of spinal bone and ligament may need to be removed.

If the entire disc must be removed, your surgeon may need to fill the space with bone from a deceased donor or your own pelvis, or a synthetic bone substitute. Metal instrumentation is then used to fuse the adjoining vertebrae together.

Following a discectomy

Following surgery, you are transferred to a recovery room where the medical team monitors for complications from the surgery and anesthesia. You may be able to leave the hospital on the day of surgery. However, for those with serious medical conditions, a brief hospital stay may be required.

You may be able to return to work in 2 to 6 weeks, depending on the amount of lifting, walking, and sitting required by your job. If your job requires heavy lifting or the use of heavy machinery, you may have to wait 6 to 8 weeks before returning to work.

Procedure

A general overview and example of various discectomy techniques are provided below 1,2. The technique may vary, particularly in certain settings such as extraforaminal discectomy.

Traditional open discectomy

• unilateral posterior technique
• interlaminar space exposure and incision
• Ligamentum flavum removal after laminotomy/hemilaminectomy or without bone removal
• Exposed discal hernia
• confirmation of the nerve roots and gentle release
• posterior longitudinal ligament incision at the site of maximum disc herniation
• disc herniation resection and removal
• Exclusion of residual herniations and confirmation of complete nerve root decompression
• A paraspinal approach between the multifidus and longissimus muscles, as well as additional complete or partial facetectomy with or without spinal instrumentation, may be required for an extraforaminal discectomy.