Your spinal column is composed of the lumbar spine, cervical and thoracic. The lumbar, the lower side of your back, comprises six vertebrae with a disc linking each vertebra. Each intervertebral disc has a shell of solid cartilage and a soft center that cushions the vertebrae. However, the disc can rupture due to aging, injury, or wearing down, putting pressure on the adjacent nerves, which causes severe pain. The ruptured discs can adversely impact your life as the pain makes it impossible to perform your routines at work or home.
The lumbar disc herniation can be corrected surgically through a percutaneous lumbar discectomy. The procedure aims to decompress the compressed nerve roots adjacent to the herniated disc. When struggling with severe lower back pain and numbness in Los Angeles and suspecting lumbar disc disease, you should not hesitate to contact DR. George Rappard for a consultation. We will examine your back and establish if you are a candidate for percutaneous lumbar discectomy.
Overview of the Surgery
Percutaneous lumbar discectomy is a new surgical treatment for lumbar spine disc disease. The surgery is performed to extract the ruptured disc material that puts pressure on or compresses the nerves causing pain. Percutaneous means utilizing a small cut or incision through the skin. On the other hand, discectomy is a surgical procedure for removing the ruptured disc material compressing the nerve roots. Therefore, the surgery is a minimally invasive treatment that uses small tools inserted in the middle of the intervertebral disc to cut out, suck or destroy the small bone material and other tissues of the bulging or ruptured disc.
Due to its minimally invasive nature, the surgery has proved safe and efficacious with little or no complications. Besides, it takes a shorter time to perform than an open surgery treatment which involves making a large incision on the back to open the spine to extract the bulging disc.
History of the Surgery
Historically, medical professionals have used open surgery to perform intervertebral disc decompression procedures. Severe complications caused surgeons to abandon the treatment. Over the years, disc decompression surgical procedures have advanced highly, with percutaneous discectomy being introduced in the 1960s. Early results from the surgery showed that it was safe and productive in relieving back pain. Over the years, the surgery has improved, creating a new perspective on spine surgery.
Candidacy for the Treatment
Percutaneous lumbar discectomy treats patients with ruptured or bulging intervertebral discs. The intervertebral discs act as cushions, and when they are damaged, you will experience lower back or neck pain, sciatica, spinal stenosis, or muscle weakness. Spinal stenosis happens when the spinal canal narrows, compressing the spine. Sciatica is pain that travels down the leg, otherwise called radicular pain.
The symptoms of lumbar disc illness worsen if you do not begin treatment early. When you visit us at DR. George Rappard for the first time with symptoms of disc compression, we will not go directly to surgery. Instead, we will prescribe medication and recommend physical therapy. Not all patients with a compressed or ruptured disc are candidates for percutaneous lumbar discectomy. We will recommend the treatment if:
- Your medical records, physical checkup, and diagnostic tests like MRI or CT scan point to a bulging or ruptured intervertebral disc, and the material in the middle of the disc has not herniated into the spinal canal.
- The symptoms like pain, muscle weakness, and numbness in the legs persist after over four weeks of conservative or nonsurgical treatments like chiropractic procedures, exercise, physical therapy, and medicine.
- The symptoms are extreme and have restricted you from performing daily activities.
- You experience loss of bowel or bladder function or control.
- The signs of severe nerve root damage, like pain, are becoming worse.
- You have lost genitalia function.
You should note that the percutaneous discectomy will not be performed if an MRI or scan shows intervertebral disc material in the spinal canal or if you are experiencing spinal stenosis.
Preparations for the Surgery
Once we have conducted a physical exam and diagnostic tests and established that you are qualified for percutaneous discectomy, you must start preparing for the procedure. The preparations for this surgery begin with signing the relevant paperwork to consent to the treatment. Do not worry about sourcing these documents because they will be provided at the facility where you are receiving the surgery.
After giving consent to the treatment, you must provide your medical records and any medication you are currently taking. If you are allergic to any medicine, you should inform the surgeon so that they can know whether to use local or general anesthesia for the surgery.
Also, you should discuss the medication you are using with your doctor to determine if it is safe for treatment. If you are using medicines like NSAIDs or blood thinners, you can be forced to stop them for a minimum of seven days before the surgery.
On the actual date of the treatment:
- It would help if you did not eat anything eight hours before the surgery, although you can take medicine using water.
- It would be best if you took a bath using an antiseptic soap.
- It would be best if you put on fresh, loose-fitting clothes and flat shoes.
- You should arrange for transportation from the hospital because it is not safe to drive home.
The Surgical Procedure
Before you undergo a percutaneous lumbar discectomy, the doctor must first corroborate that the symptoms you are experiencing are due to intervertebral disc rupture or bulging. Once it is confirmed that the ruptured disc is compressing the nerve roots, you will be scheduled for treatment.
On the day of the procedure, you should come in early to complete the relevant documents and prepare for the treatment. The surgery is an outpatient treatment, so you should expect to return home the same day.
After the preparations, you will be taken to the surgical room, where you will be sedated using local anesthesia. Once you are sedated, an anesthesiologist will monitor your vital signs throughout the surgery. The operation begins with your doctor making a cut or incision on the lower back directly to the ruptured disc.
The doctor then uses the images from the X-ray scan to insert a cable into the middle of the bulging intervertebral disc. The tissue is then pushed apart utilizing a sequence of tubes. The smaller tubes are removed to make room for the largest tube, creating enough space to insert small tools. With the space created by the largest tube, the doctor can insert tiny needles to suction the damaged disc material. Alternatively, they can use a laser to burn and destroy the disc material.
When the targeted material is removed and repairs are done on the intervertebral space, the compression on the nerve roots is removed. As the pressure is relieved, the pain you are experiencing in the lower back, legs, buttocks, and neck is reduced. Once the pressure and pain are gone, the tubing is pulled out, and the cut is closed. The entire process takes approximately thirty to forty-five minutes. And because it is minimally invasive, you will be free to go home a few hours after the treatment, but only if your vitals are stable and the operation is successful.
Recovery from the Surgery and Aftercare
Postoperative recovery is less demanding than in open surgery. The doctor will transfer you to the post-surgery room for vital sign monitoring. If the treatment is successful, you will be free to go home the same day. However, if you need further tracking, you will remain in the hospital for one or two days before going home.
Healing will take about one to four weeks, depending on the cause of the surgery and your overall health. During recovery, you will have medication to help with the pain. You can resume work after two weeks, but if the work involves heavy lifting, twisting, or bending, you must stay home for approximately twelve weeks before you can resume work.
Also, your doctor will give you postoperative instructions to help you during recovery. These instructions include:
- Steer clear of bending or twisting your back.
- Refrain from lifting objects heavier than five pounds.
- Avoid strenuous activities.
- Refrain from sex after surgery.
- Unless your discomfort is adequately managed, avoid driving within at least two days of the operation.
- Refrain from alcohol consumption after the treatment as it causes blood thinning. Also, alcohol consumption when under pain medication is prohibited.
- Avoid cleaning the incision area within days of the surgery. And when it is time to clean, smoothly wash the cut using soap and water, then dry it thoroughly.
- In the event of drainage, cover the cut with a gaze. Nonetheless, when you use two or three pieces of gauze for the incision in a day, something is wrong, and you should see your doctor for an examination.
- Do not apply ointment to the cut.
- Wear clean garments after showing, and do not allow pets in your bed to avoid contaminating the cut.
- Refrain from removing whatever is used to close the incision, whether glue, stipples, or sutures.
- Avoid sitting for extended durations to steer clear of stiffness and pain. Take five to ten-minute walks in four-hour intervals, and extend the walk length gradually.
- Use your pain meds as prescribed by your doctor.
- Stay hydrated and eat food rich in fiber to avoid dehydration.
You should note that aching is common after the treatment, but it will subside as you recuperate. However, if you experience any of the following warning signs, you must talk to your doctor:
- Your body temperatures are above 101.5 degrees Celsius and are unresponsive to medication.
- Constant revulsion and vomiting.
- An infected cut.
- Burning sensation at the cut area.
- Swelling in the calf area of the leg.
- Numbing and tingling of the limbs.
- Excessive sleepiness.
Even after you have recuperated from the operation, it does not mean you cannot develop the lumbar spine disease again. The condition can reoccur if you do not take care of your spine. Some of the techniques you can utilize to prevent the return of the disease are:
- Stress management.
- Take part in correct exercise programs.
- Avoid straining your back through proper lifting techniques.
- Perform your work duties in an ergonomic setting.
- Maintain an upright posture while walking, sitting, standing, or sleeping.
Risks Associated with the Surgery
Although percutaneous lumbar discectomy has proven to be safe and efficacious in treating spinal problems, it has its risks, although they are rare. The dangers of the treatment are:
- Failure to relieve the pressure on the nerves and reduce the pain.
- Recurring symptoms triggered by scarring on the nerve area, another bulging disc, or a weakened spinal cord; if the relapse of the symptoms persists, you should try nonsurgical treatment and if it is unresponsive, try another surgery.
- Postoperative infections around the incision, although they can be treated using antibiotics.
- Growth of limb blood clots. You should wear a compression stocking or stay active during recovery to avoid blood clotting on the legs.
- Leakage of cerebral-spinal fluid due to tear of the Dural during surgery.
- Nerve root injury and, in some cases, paralysis.
- Allergic reaction to anesthesia which sometimes can be life-threatening.
Advantages of Undergoing the Surgery
Undergoing percutaneous lumbar discectomy has several benefits. The procedure is safe and provides rapid relief for most patients. Again, the treatment is minimally invasive, so you will only be left with a minor scar. Some of the significant benefits of the treatment are:
- It offers tissue for biopsy.
- It does not cause heat damage to the nerves.
- Each procedure is tailor-made.
- Allows for rapid recovery.
Alternatives to the Treatment
Your doctor will not rush to perform a percutaneous lumbar discectomy unless conservative treatment options like physical therapy and medication are unsuccessful. If these nonsurgical procedures fail and the symptoms, like loss of bowel function, become severe, the doctor will perform the surgery.
Find an Experienced Los Angels Spine Surgeon Near Me
A ripped or bulging intervertebral disc can cause multiple health complications, like loss of bowel or bladder control, numb limbs, and severe neck and lower back pain. If you have tried the conventional treatment without success, it is time for surgery. Dr. George Rappard provides minimally invasive percutaneous lumbar discectomy to patients in Los Angeles. Call us today at 424-777-7463 to speak to our lumbar discectomy experts.