What is a discectomy?
In broad terms, a discectomy is the procdure that removes the prolapsed disc in order to take pressure off the nerve, relieve pain, and improve function of that nerve, and avoid long term damage to the nerve.
Typically, a patient will present with pain down one leg, which may radiate from the buttock to below the knee. The usual pain is either to the back of the calf and to the sole of the foot, or to the outside of the shin and top of the foot. Back pain is not usually a feature, however it may initially occur.
When is a discectomy recommended?
If there is evidence of severe weakness, surgery may be offered, and also if the leg pain is so severe that narcotic painkillers are not controlling the pain.
If there are problems with the nerves that supply the bladder or bowel, early surgery is advised. In this situation, an inability to pass urine may be evident, or there may be numbness in the crotch area, buttocks or when passing urine.
Surgery may not be recommended if a patient has pain that is not too severe, and if improvements are noted at 6 weeks and there is minimal or no weakness. After 6 weeks, if symptoms are not improving and weakness occurs, surgery is usually offered.
How is discectomy performed?
- ther surgery is done under general anaesthesia
- the skin cut is approx 3-6cm
- a 'window' is made on one side of a spinous process through the removal of some bone and ligament to allow visualisation of the disc bulge and involved root
- only a small portion of disc is removed, not the whole disc
- the hole in the disc is not repaired. After the nerve is freed completely the operation is completed
- the operation takes around 1 hour to perform
- patients can expect a hospital stay of 2-4 days
What is the expected outcome?
- in uncomplicated cases, the likelihood of good/excellent relief of leg pain is 80- 90%
- numbness may be slow to improve, particularly if you have had symptoms for a long period prior to the surgery
- weakness may also take time to recover although this can at times be incomplete particularly if the weakness was severe and prolonged before surgery
- pins and needles usually start to improve immediately
- often, there is some degree of back pain following surgery. If you had significant back pain prior to surgery it is unlikely to be made better by the surgery as this is NOT an operation for back pain
- occasionally you may experience resurgence in pain, which is often transient following initial surgery, which may reflect nerve root irritation and the fact that you have increased your activity level. In most cases, this is treated with painkillers (and very occasionally with an epidural steroid)
- Occasionally epidural steroid is given to control pain but this is uncommon.
....and how about recovery following a discectomy?
- patients who have a lumbar discectomy are typically in hospital for 2-4 nights
- you may not be able to drive or return to light work for 3-6 weeks
- you should try to do plenty of walking. You will be given information from the physiotherapist about appropriate back exercise
- it is important to remember that the back is not normal after disc surgery and that care needs to be taken in the future. Bending, lifting and twisting need to be avoided - particularly in the first 3 months following surgery - as these activities ultimately may have caused the initial problem
- good back care is the rule for life
- no surgeon can guarantee risk-free surgery or a 100% good outcome.
What are the potential risks and side effects of discectomy?
Generally, the majority of patients are happy with the outcome. Regarding the specific risks of surgery, they include:
- infection (less than 1%risk)
- deep vein thrombosis (less than 1% risk)
- cauda equina syndrome (less than 1% risk) – this can be due to development of a clot. This causes weakness and bladder symptoms and will require return to theatre for removal of the clot
- neural injury/dural tear (1-5% risk) – usually transient bruising of nerve which settles. Very rare for permanent weakness to occur
- disc recurrence (approximately 5% risk)
Summary of the discectomy procedure
Lumbar discectomy is a good operation for leg and buttock pain, but NOT back pain.
In general, after the onset of symptoms, if they still persist in a way that interferes with a patient’s quality of life after 6-12 weeks and do not respond to conservative/simpler treatment, or numbness/weakness occurs and is persist, then surgery is a definite treatment option.
Return to treatments and operations.