A lumbar discectomy is a surgical procedure used to remove degenerative or herniated discs in the lower spinal column. A small cut is made through the lumbar muscles to remove the discs pressing on the nerves. If physiotherapy and medication fail to relieve your back pain, then a professional spine surgeon would recommend a discectomy. At Dr. Rappard's facility in Los Angeles, we offer a variety of treatment options for both chronic and severe lumbar issues. Our specialists will work with you to determine the best course of action for your case and give you the best care for a speedy recovery.
Understanding Lumbar Discectomy
The term "discectomy" means "to cut out a disc." A discectomy could be carried out anywhere along the spinal column, from the cervical to the lumbar. The physician reaches the affected discs from the spine's lumbar area through the bone and muscles. The surgeon gains access to the herniated disc by removing a part of the lamina. A lamina is a bone that covers the spinal cord and makes up the posterior of the spinal column. The spinal nerves are then drawn back to one side. Based on the circumstances, one or several discs could be removed.
A lumbar discectomy could be performed using several different surgical equipment and techniques. An "open" method involves a large incision in the skin and muscle retractions to allow the surgeon immediate access to the affected area. A "minimally invasive" procedure, MISS, also known as a microendoscopic discectomy, involves making a small incision in the skin. The muscles are tunneled through using a set of gradually larger tubes known as dilators. These special tools allow the surgeon to view and work in a smaller area. The minimally invasive incisions made cause less disruption to the lumbar muscles and could shorten the time for recovery. Your physician will advise you on the best technique for your unique condition.
A fusion could be done concurrently with a lumbar discectomy to stabilize the spinal column for individuals who engage in heavy labor, athletics, or have an unstable spine. Fusion connects two vertebrae using a combination of hardware like screws or plates and bone grafts. During the recovery process, the two vertebrae merge into one fused bone. Fusion of a herniated or degenerative lumbar disc is rarely required.
Symptoms That Can Necessitate Lumbar Discectomy
If you've got a degenerative or herniated disc in your lumbar that's causing you pain, you would require this surgery. The following symptoms may indicate a need for a lumbar discectomy:
- Significant foot or leg pain, numbness, or weakness
- A herniated disc can be detected using diagnostic tests such as an MRI, myelogram, or CT scan, to name a few
- Experiencing severe leg pain that's worse than your back pain
- Leg weakness, genital numbness, and loss of bowel or bladder control
- Symptoms that have not changed for the better with physiotherapy or medication
A lumbar discectomy could be beneficial in the treatment of leg pain incurred as a result of:
- Herniated or Bulging Disc—This occurs when a gel-like substance within the disc bulges or ruptures through a weak spot in the surrounding walls known as the annulus. Swelling and irritation occur when this substance stretches out and painfully pushes on the spinal nerves.
- Degenerative Disc—As the discs age, bone spurs develop as the facet joints swell. The discs become less flexible and lose their cushiony properties as they shrink and dry out. The disc gaps get more compact. These modifications result in disc herniation or a condition known as stenosis.
Lumbar discectomy does not apply to all types of back discomfort. Furthermore, not everyone who suffers from disc herniation requires a lumbar discectomy operation. If you have tried alternative therapies and still suffer from severe symptoms, your doctor would recommend surgery. Physiotherapy and anti-inflammatory medications are two other options to consider first.
Discuss the pros and cons of minimally invasive surgical treatment versus open surgery with your physician. Minimally invasive surgery could result in reduced pain and a shorter recovery period. However, this method is not available in all surgical centers.
The Risks of a Lumbar Discectomy
Every surgical procedure carries some risk. The following are risks associated with this type of surgery:
- Only short relief and the necessity for more surgery
- Blood clots
- Excessive bleeding
- Anesthesia-related adverse effects
- Nerve damage
The risks may differ based on your general health and age. Therefore, you should consult with your physician about the concerns and risks that are most relevant to your situation.
What Can a Spine Surgeon Do for You?
Lumbar discectomy is an important surgical procedure used to remove degenerative and herniated discs in the lower spinal column. Your spine surgeon would run imaging tests, such as X-rays, CT scans, or MRIs, to get an accurate diagnosis of the root cause of your condition as well as to locate the area where pain and nerve compression are occurring due to a herniated disc.
Preparation for Lumbar Discectomy
In the surgeon's office, you would be required to sign consent as well as other documents so that the physician is aware of your medical records, that is, knowing your medications, vitamins, allergies, bleeding history, past surgeries, or anesthetic responses, to name a few. Talk to your doctor about any medications and supplements you're using, including over-the-counter, prescription, and herbal supplements. Presurgical testing like an electrocardiogram, a blood test, and chest X-rays could be done a few days before the operation. Seek medical advice from your primary care doctor about quitting certain medications and getting clearance for surgery.
Continue to take the drugs that your surgeon has recommended. Stop using all nonsteroidal anti-inflammatory medications like ibuprofen and naproxen, to name a few, as well as blood thinners like Coumadin, Plavix, or aspirin, seven days before the operation. To avoid healing difficulties and excess bleeding, quit using alcohol and nicotine one week before and two weeks after the surgery. Before surgery, you could be advised to clean your skin with Dial soap or Hibiclens (CHG). This kills germs and lowers the risk of surgical site infections. It's important to note that you should avoid washing the genital area, nose, ears, or eyes using Hibiclens.
Morning Of Surgery
- Before surgery, avoid eating or drinking after midnight unless your doctor instructs you otherwise. You could take approved medications with a little sip of water
- Use antibacterial soap when taking a shower. Dress in clean, loose-fitting clothes
- Put on closed-back, flat-heeled shoes
- Remove all hairpins, make-up, body piercings, contacts, and nail polish to name a few
- Leave all jewelry and valuables at home
- Carry a list of your prescriptions, along with the recommended dosages and regular take-times
- Carry a list of any drug or food allergies
Arrive at the facility two hours before your scheduled operation time (surgical center one hour prior) to finish the pre-surgery work-ups and complete the relevant documentation. An anesthesiologist would speak with you and discuss the effects of using anesthesia as well as the risks involved.
The procedure falls into five steps. The procedure usually takes between one and two hours.
Step 1: Prepare the Patient for Surgery
You will be placed on the operating room table on your back and be administered an anesthetic. When you fall asleep, the doctor will roll you onto your stomach and give you cushions to support your sides and chest. The region around the incision is cleaned and prepared.
Step 2: Create an Incision
The physician makes use of a fluoroscope (a type of X-ray) to spot the affected disc and vertebrae by penetrating a small needle into your skin down towards the bony vertebrae. An open lumbar discectomy involves making a skin cut down the center of the back across the injured vertebrae. The size of the incisions is determined by the number of discectomies that would be conducted. A single incision measures between one and two inches long.
The lumbar muscles are stretched to one side to expose the vertebra. An X-ray is done to make sure that the right vertebra is being examined. A small cut, approximately less than an inch, is made on one part of the back during a MISS lumbar discectomy. These muscles are progressively separated to make room for the bony vertebrae by placing a set of gradually larger dilators around one another.
Step 3: Carry Out a Laminotomy
The lamina is then opened slightly below and above the spinal nerves using a bone-biting tool or a drill. A laminotomy could be made on one, both, or several levels of the vertebrae.
Step 4: Take Out The Disc Fragments
After taking out the lamina, your physician gently pulls back the nerve root's protective sac. The surgeon then uses a tiny surgical microscope to locate the herniated discs. Only the fractured disc pieces are removed to free the nerve root of the spinal column. The whole disc is not taken out. Additionally, synovial cysts or bone spurs that could cause nerve root pressure are taken out. Fusion is not often used in single-level discectomies. However, a fusion would be used to treat other disorders such as spinal instability or recurring disc herniation.
Step 5: Seal the Small Incision
The retractor that holds the muscles in place is withdrawn. Staples and sutures are used to close the skin incisions and muscles. Skin glue is normally used to seal the incisions.
You will regain consciousness in the post-operative recovery section. Your doctor will keep an eye on your breathing, blood pressure, and heart rate. Any pain would be attended to. Once awake, you could begin mild movements like walking or sitting on a chair, to name a few. Most people can return home that same day. Other people can be discharged from the hospital in one to two days. Make sure you have somebody at home to assist you during the first 48 hours. Adhere to the physician's home care recommendations for two weeks after the operation or until your check-up appointment. During this phase, you're likely to expect the following:
- Be careful not to bend or twist your back
- No more than 5 pounds should be lifted
- No strenuous physical activity such as housework, yard work, or sex
- If you are using painkillers or muscle relaxants, avoid driving for the first two to three days. You can operate a motor vehicle if the pain is controllable
- Avoid consuming alcohol. This thins your blood and raises the chances of bleeding. Furthermore, don't combine alcohol and pain relievers
- If Dermabond skin glue was used to cover your wound, you can take a shower the next day. Using soap and water, gently clean the area each day. Avoid picking or rubbing the skin. Pat to dry
- Showering is permitted two days post surgery if you have steri-strips, staples, or stitches. Using soap and water, gently clean the area each day. Clean off
- If there's any drainage, wrap the wound using a dry gauze covering. Call your surgeon's office if the drainage overflows through 2 or more bandages in a single day
- Avoid soaking the wound in a pool or bath
- Avoid using lotion or cream over the incision
- After each bath, change into clean clothes. Sleep on fresh bed linens. Pets are not permitted in bed until the wound has healed
- At the follow-up session, any staples, steri-strips, or sutures used will be removed
- Take pain relievers as prescribed by your doctor. As the pain reduces, decrease the dosage and frequency. Do not take the painkillers if it is not necessary
- Using narcotics causes constipation. Therefore, consume foods high in fiber and drink plenty of water. Laxatives and stool softeners can aid with bowel movement. Over-the-counter medications like Senokot, Colace, Miralax, and Dulcolax can also be helpful options
- Use ice on your incisions to relieve pain and edema. 3 to 4 times per day for 15 to 20 minutes
- Unless you're asleep, avoid lying or sitting in one posture for more than an hour. More pain is caused by stiffness
- Every three to four hours, get up and take a five-to-10-minute stroll. Gradually increase your walking distance if possible
Find a Spine Surgeon Near Me
Low back pain, especially if it extends down to the legs, can significantly reduce your level of activity. If non-surgical treatments fail to relieve your pain and discomfort, your doctor will direct you to a spine surgeon who deals with lumbar discectomy. Lumbar discectomy has become more widely available thanks to developments in outpatient surgery and minimally invasive technologies.
If you're suffering from low back pain, consult with your doctor or request a referral to a competent spine surgeon who would provide an accurate diagnosis of your condition. Dr. Rappard's practice in Los Angeles specializes in the care and treatment of lumbar issues. Our professionals offer a broad range of alternative treatment options to people suffering from severe or chronic lumbar problems. Feel free to reach us at 424-777-7463 to explore the best alternative treatments for your condition.