Discectomy is surgery to remove lumbar (low back) herniated disc material that is pressing on a
nerve root or the spinal cord.
It tends to be done as microdiscectomy, which uses a special microscope to view the disc and nerves. This larger view allows the surgeon to use a smaller cut (incision). And this causes less damage to surrounding tissue.
Before the disc material is removed, a small piece of bone (the lamina) from the affected
vertebra may be removed. This is called a
laminotomy or laminectomy. It allows the surgeon to
better see the herniated disc.
Discectomy is usually done in a hospital. You are asleep or numb during the surgery. You will probably stay in the hospital overnight.
After surgery, you will be
encouraged to get out of bed and walk as soon as the numbness wears off. You
can use prescription medicines to control pain while you recover. You can slowly resume exercise and other activities.
to think about include the following:
Surgery is done to decrease pain and allow you to regain normal movement and function.
You and your doctor may consider surgery if:
Surgery is considered an emergency if you have
cauda equina syndrome. Signs include:
Although surgery for a lumbar herniated disc doesn't work for everyone, it works well for many people.
A study called SPORT randomly assigned about 500 people to two groups. Some had surgery, and some did not. The study found that after 2 years most people felt better and were able to be active, whether they had surgery or not. People who had surgery were slightly more likely to feel better. But the difference wasn't big enough to prove that one treatment is better than the other.1
Another study followed about 500 people over 10 years. Some had surgery, and some did not. This study showed that people who started with medium to very bad pain tended to feel better sooner if they had surgery. But after 5 to 10 years, the number of people in both groups who were able to do their daily activities was about the same whether they had surgery or not.2
As with any surgery, there are some risks.
Discectomy for a lumbar herniated disc may provide faster
pain relief than nonsurgical treatment. But it is unclear whether surgery
makes a difference in what treatment may be needed later on.
People who have had either standard discectomy or
microdiscectomy have reported similar improvements one year after surgery.3
Spinal fusion is a procedure
that joins together bones in the back. For the low back (lumbar
spine), spinal fusion is controversial and complex and is not commonly
done with a discectomy. If a doctor suggests that you get a lumbar spinal
fusion with a discectomy, get a second medical opinion to help you decide
whether fusion is needed.
A newer form of discectomy
using laser beams (laser discectomy) is still in the research stage.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
Weinstein JN, et al. (2006). Surgical vs nonoperative
treatment for lumbar disk herniation: The spine patient outcomes research trial
(SPORT): A randomized trial. JAMA, 296(20):
Atlas SJ, et al. (2005). Long-term outcomes of
surgical and nonsurgical management of sciatica secondary to a lumbar disc
herniation: 10-year results from the Maine Lumbar Spine Study. Spine, 30(8): 927–935.
Jordan J, et al. (2011). Herniated lumbar disc, search date June 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
March 12, 2012
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
& Robert B. Keller, MD - Orthopedics
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