Everything You Need To Know About Lumbar Discectomy
My name is Dr Abdul Salam and I am a practicing ortho doctor in Coimbatore, in this post we are going to discuss on Lumbar discectomy.
If you have experienced a degenerative or herniated disc around your lower spine area, often the surgery required to mend this is called a lumbar discectomy.
Lumbar discectomy is an invasive surgery that requires an incision in your back muscles to reach the disc of your spine that is herniated. This is done to prevent the disc from further damaging any nearby nerves.
A discectomy is not the immediate solution to a herniated disc, but if medication or physical therapy does not improve your condition, then surgery is the best option. It is also recommended if the patient is experiencing a loss of sensation in the legs or nerve damage.
In general, a discectomy is the removal of a spinal disc. There are two main regions of your spine: the cervical, which is the neck area, and the lumbar, which is the lower back area.
Both areas can experience a herniated disc, and a discectomy applies to either area. The procedure can either be minimally invasive or open and needs to cut through some bone and muscle to reach the disc.
Once the disc is reached, part of your lamina, which is the hard exterior of the disc, will have to be removed. The nerves will then be rearranged, and the disc itself may or may not be removed. When this procedure is performed on your lower back, that is called a lumbar discectomy.
Open discectomy requires the surgeon to make a large opening in your back to get a full view of the affected area. The minimally invasive procedure, on the other hand, requires the insertion of an endoscope, or small tube, through a tiny incision in your back.
Dilators, which are winder tubes, are then utilized to create a tunnel through your muscles so that the surgeon has more space to operate. Minimally invasive surgery typically takes less time to recover from. However, either technique is viable depending on your case.
Another surgical option is called fusion, which can go hand in hand with a discectomy. Fusion is the grafting of screws and plates into your bones to connect the vertebrae where a disc was removed.
This helps the entire healing process and is highly recommended for athletes or heavy lifters so that the recovery is smoother and more stable. However, fusion is not a common recommendation for herniated discs.
Likelihood of a lumbar discectomy
The doctor will likely recommend a discectomy once you:
Have a herniated disc in your CT or MRI scan
Are losing feeling in the legs, groin, or genitals
Have not responded well enough to, or recovered using, medication or physical therapy
Are experiencing numbness, pain, or weakness in your lower body
Are experiencing leg pain as well as back pain
Are losing control of bladder and bowel movement
Degenerative disc disease
A possible condition of your disc can occur when bone spurs are forming on your aging discs. The discs will deteriorate, weaken, lose their plasticity and flexibility. The spaces between the discs also decrease, and this too can lead to a herniated disc.
Herniated or bulging disc
The inner softer part of the disc can rupture and bulge out of its hard exterior. This will cause inflammation and irritation, especially if the rupture ends up pressing on a nerve.
Making the decision
In most cases, a herniated disc can repair itself within months if accompanied by physical therapy and some medication.
But even if your doctor recommends surgery, the decision remains with you. The doctor should inform you if the benefits of the procedure, as well as the list of possible risks and side effects that may come with it. But only 1 in 10 people opt for discectomy to relieve their herniated disc.
Either a neurosurgeon or orthopedic surgeon will be in charge of the procedure itself. If it will ease your mind, you can ask the surgeon regarding their history of training. Surgeons who specialize in spine surgery usually have intensive complex training.
You will probably be required to have a few presurgical tests done on you. These would be an X-ray, an ECG, a blood test, etc. You will also be required to sign several forms containing your risks, medical history, and prior and current medications since some of these have to be discontinued as preparation for the surgery.
Other medicines such as Nuprin, Advil, other NSAIDs, and blood thinners should also be discontinued a few weeks before the surgery. You will also have to fast for several hours right before the procedure.
The day of the surgery
On the day itself, we recommend that you use an antibacterial soap during your bath. Wear comfortable and loose clothing.
Also, wear comfortable shoes without heels or open toes. Take whatever medicines or advice the doctor has for the morning before your surgery.
Avoid applying makeup, hair accessories, contact lenses, and remove your nail polish, body piercings, and jewelry. Avoid bringing valuables with you to the hospital.
Bring your allergy list and medications. Be early for your surgery and arrive a few hours before your schedule so that you can sign all the paperwork. Be ready to talk to the anesthesiologist about the procedure. You will probably be inserted with an IV needle.
The procedure itself takes a couple of hours. First, they will prepare you for the surgery. You will have to lie on the operating table.
You will be administered anesthesia, possibly via IV needle, and then turned over so that your back can be exposed and disinfected.
They will then insert a tiny needle to locate where to make the incision. If this is an open procedure, the incision will be through the center of the back. But if it is minimally invasive, it will be a tiny incision only on one side. From there, the lamina will be opened up and removed.
The nerves might be shifted gently for easier access to the disc. Once the lamina is removed, the damaged part of the herniated disc will also be taken out. Any other growths will be removed as well, and the nerves will be returned appropriately. If a fusion is required, it will be done after the removals. Afterward, the incision will be closed and sewn or stapled together.
You’ll then be transferred to the Postoperative Recovery Area to help you recover from the surgery and anesthesia right after the procedure.
They will continue monitoring your heart rate, respiration, and blood pressure for that duration. As soon as you wake up, they will transfer you into a regular hospital room so that you can recover some mobility, such as sitting or walking.
Many patients can return home on the day of the surgery. Sometimes, however, patients need up to two days before they can be discharged and return home.
Follow the doctor’s orders
Your surgeon is likely to prescribe you pain medication. Use the prescription meds as instructed. If narcotics are recommended, do not be surprised.
However, be exact with the dosage since narcotics are addictive and can interfere with your bowel movements. To supplement this, stay hydrated and eat plenty of foods rich in fiber.
You can also take laxatives such as Colace, Dulcolax, Milk of Magnesia, and Senokot. Be sure to apply ice to your back where the incision was made every day. It is recommended you ice up to 4 times a day for at most 20 minutes.
Things to avoid
You want to reduce motion in your back during the following weeks. You should also avoid heavy lifting and any strenuous physical activity. These include house chores, yard chores, and sexual intercourse.
You are also not allowed to drive after your surgery until your surgeon allows. You are not allowed to smoke since it interferes with your bone healing. You should also avoid alcohol for as long as you are on narcotic medicines.
Avoid any strenuous activities. Your daily activities, however, such as bathing and putting on clothes, may take a lot of effort. The best solution is to ask for assistance. It is normal to feel very tired in the first couple of days following your surgery. It is important to pay attention to your body and be guided by your level of pain.
To avoid stiffness, try standing up at least every 4 hours and walk around for 5 to 10 minutes. You can build this up slowly until you reach a normal level of mobility. However, be sure to still avoid extra strenuous activities, even if you feel that you have recovered your physical capabilities.
Caring for the wound
Post-surgery is the best time to be hygienic since your wound is prone to infection. Be sure to wash hands regularly, and especially when you clean your wound. If skin glue was applied to your incision to help close it, you are likely allowed to bathe the following day. Simply wash with water and soap and make sure to dry it afterward.
However, if staples or stitches were applied, do not wet the area until 2 days post-surgery. You have to remove the bandages and gauze before washing the skin with water and soap.
After drying, replace the bandages. Be sure to examine the incision to make sure there are no negative effects. Wash the wound daily, but do not immerse it in water, such as in a tub, pool, or deep bath.
If the surgeon did not recommend medications or lotions, do not apply any on the wound. If there is mild drainage from your wound, that is to be expected. However, if the drainage begins smelling foul or coming out in excess, consult your surgeon immediately. Also, be sure to schedule the removal of the stitches or staples post-surgery. This is typically done a couple of weeks after the surgery
Unwanted side effects
Call your doctor immediately if any of the following happen:
Puss, infection, inflammation, or irritation appear on your incision
Your leg begins to swell or shows signs of inflammation
Your temperature rises higher than normal and you feel feverish
You experience numbness or tingling in your groin or legs
Extra post-surgical care and recovery
After your surgery, it is advisable to schedule an appointment in about 2 weeks. Patients usually require anywhere from one week up to four weeks of recovery time. This can be accompanied by physical therapy to bring back mobility in a healthier manner. If during this time, you feel slight pain, this is normal. Do not let it hinder the physical therapy exercises though since those exercises will help you recover more smoothly.
If your job is not physically demanding, you may be able to get back to work within 4 weeks after the surgery. However, if your job involves operating machinery and heavy lifting, it is best to wait for 2 to 3 months before going back.
Although it is common to experience recurring back pains, there are ways to prevent this:
Maintain good posture in any position
Begin a gentle exercise regimen
Practice proper techniques when lifting objects
Practice good stress management
Maintain a healthy diet and body weight
Avoid smoking and nicotine
80 to 90 percent of lumbar discectomy patients are satisfied with the results. This was tested in one study which compared the nonsurgical treatment to the surgical procedure for healing herniated discs. Patients reported the following results:
Patients who experienced pain in their legs felt better after surgery compared to those who were experiencing pain in the back.
Patients who were experiencing severe symptoms and pain felt a more significant improvement with surgery compared to those without surgery.
Patients who didn’t display very severe symptoms were able to recover using the nonsurgical treatment.
It should also be noted that patients who underwent minimally invasive discectomy found the effectiveness to be similar to those who underwent open discectomy.
Minimally invasive surgery may be recommended more often to patients for its shorter recovery time, lower blood loss, and lower muscle trauma, but it may not be what the patient needs in their case. If you are concerned about the recovery conditions, you can try asking the surgeon if you can opt for minimally invasive surgery instead of open surgery.
There is not enough research showing the advantages or disadvantages of having a discectomy later rather than earlier. It has been suggested that a discectomy allows quicker pain relief than the non-surgery alternatives. However, up to 15 percent of surgery patients have still experienced recurrences in their spinal disc conditions.
Possible risks and side effects
Although minimal for the most part, surgery always comes with risks. The typical risks would be an infection, blood clotting, internal bleeding, and negative reactions to the anesthetic. The risks do multiply once spinal fusion is involved since it is a more complicated procedure. Other complications that come specifically with a discectomy are:
Recurring pain and nerve damage: Since the operation concerns the spine, there is always a risk of affecting the spinal cord, which is the main body of nerves, or specific nerves. Extreme damage can lead to paralysis, but this is unlikely.
Moderate nerve damage can lead to numbness in the lower half of your body. The patient may also experience recurring pain post-surgery. This is more likely to come from the site of herniation. A herniated disc may already have done permanent damage to the nerve before the surgery.
In cases like these, it might be hard for the surgeon to heal the already damaged nerve. Stimulation and other medical treatments can be attempted to ease the pain. If you want to discuss these risks and conditions beforehand, it is best to consult the doctor or surgeon before you have the surgery done.
DVT or deep vein thrombosis: this is when a blood clot occurs inside your leg veins and becomes dangerous. The clot becomes dangerous to your body if it breaks free from the vein yet remains intact. As an intact clot, it can cause blockages. If that clot moves entirely to your lungs, heart, or any other important organ, this can cause the organ to fail and may even be fatal. DVT is preventable with the proper measures.
For post-surgery precautions, be sure to keep your limbs and blood moving every so often so that it will not clot. There are certain wearable devices such as sleeves or stockings that will lessen the chances of blood build up in your veins and limbs. Blood thinners and other medicines such as Coumadin, Heparin, or aspirin might be prescribed.
Lung complications: Your lungs need to be healthy and working properly after surgery so that recovery goes smoothly. After all, the lungs provide oxygen for your body, which is essential for stimulating recovery. If your lung experiences complications, you might end up with pneumonia. It is best to have this checked so that it can be treated accordingly.
Hopefully, the nerve root and disc wall will heal smoothly within several months post-surgery. There are cases in which the body will not be able to completely heal itself, but if prevention, care, and recovery are done properly, this is less likely.