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What is Lumbar discectomy?

Lumbar discectomy is a surgical procedure where the ruptured disc of the lumbar spine is removed to reduce the stress and pressure on the nerve.

The lumbar spine is also known as the lower back. A herniation or rupture of the lower spine is the common orthopaedic disorder, which can result in significant neurological deficit and handicapped daily routine actives. Such patients and patients that fail conservative treatment such as physical therapy and medications may undergo surgery known as lumbar discectomy.

What are the types of discectomy?

The operative approach should be such that it should lead to satisfactory outcomes, minimal morbidity, and good cosmesis. It should be cost effective, able to adjust to patient factors like obesity, ethnicity, etc.

Based on the size of the incision lumbar discectomy may be done as an opensurgery or a minimally invasive surgery, respectively.

Various types of surgical management include;

  • Laminectomy: Removal of the back of one or more vertebrae also referred to as thelamina.
  • Microdiscectomy: Discectomy using a microscope, with less skin incision and less muscle scarring compared to open discectomy.
  • Percutaneous discectomy:The incision is done through the skin using small instruments under local or general anesthesia. This can be done manually or automated. Percutaneous discectomy is limited only to a condition called contained lumbar disc rupture or herniation, where the nucleus pulposus (center of the disc) is contained within the annulus fibrosis (outer layer of the disc).
  • Micro-endoscopic discectomy (MED):The Micro end system allows the use of micro-instruments through a tube, and performing true discectomy under endoscopic control. The microscope system allows both hands-free and therefore two separate instruments can be used simultaneously as dissection is performed with clear visualization of structures under a microscope. This procedure is beneficial since patients complain of less postoperative pain, resulting in early rehabilitation, and early return to work. This procedure can be used to treat any disc pathology along with elements of bony lateral stenosis. The initial MED system was associated were certain limitations. The endoscope was not reusable, image quality was inconsistent, and the working space within the tubular retractor was limited.
  • Next generation MED system: Also known as METRx. Uses the same procedure as MED but has a better advantage of improved image quality, decreased endoscopic diameter, variable tubular retractor size, increased available working room within the tubular retractor, and decreased per-case cost.Compared to percutaneous approaches, the METRx system allows surgeons to treat not only contained lumbar disc herniations but also sequestered disc fragments

The introduction of intradiscalchymopapain injections also led to the lateral approach. Laser nucleolysis and transdiscoscopy discectomy were later introduced as well.

Why is lumbar discectomy required?

 

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If you suffer severe back pain, tingling or weakness in a nearby body part, for a certain duration of time due to a bulge in the lower back, refer to a physician who may then refer you to a neurologist and a surgeon. Not all back pain will undergo lumbar discectomy; a medical provider will decide if you require a lumbar discectomy or not based on factors like medical condition, age and if conservative treatments such as physical therapy and medications have not shown effective results.

Who can perform lumbar discectomy?

Lumbar discectomy surgery is a highly complicated surgery. It requires sufficient experience and manual dexterity to perform this surgery. Surgeons who are qualified and experienced in orthopedic surgery usually undertake the procedure of lumbar discectomy. A team of medical professionals led by a neurosurgeon and/or an orthopedic surgeon usually perform the surgery.

Adequate training of surgeons and the effective utilization of the technique is of utmost importance for optimum results with minimal complications.

What happens before, during and after lumbar discectomy?

Certain measures are to be taken before, during and after the surgery. These include:

Before surgery:The patient may have to undergo few tests such as blood test, electrocardiogram, chest x-rays, etc. Your medical provider will provide consultation and will review your medical history and current medications. Medications such as blood thinners and non-steroidal anti-inflammatory drugs need to be stopped a week or two before surgery. Smoking, chewing tobacco and drinking are also stopped a week or two before surgery.

During surgery:The procedure is performed under general anesthesia. The patient is positioned on a radiolucent table. Using lateral fluoroscopy imaging on the affectedside, a spinal needle is inserted at the level of the involved disc space. An incision is then made on one side of the back. Depending on the type of surgery the size of the incision can be small for a minimally invasive surgery of larger for an open surgery.

A series of dilators are inserted one over the other to gradually separate the muscles and create a channel to the bony vertebra.

In a minimally invasive surgery, the operating microscope is then brought into the field where the bulge in the disc can be well identified. The soft tissue is separated using a long cautery tip till the lamina can be visualized and the ruptured disc is then probed using a nerve hook and the herniated fragment is removed out using disc forceps.

The retractors holding the muscles are removed and the skin is then sewn together with sutures or staples.

After surgery: The patient is taken to a post-operative recovery center, where blood pressure, heart rate,and respiration are monitored. A single dose of intravenous antibiotic is given on the same night as a standard protocol. The patients are mobilized after the pain subsides and are allowed to be discharged depending on the health status.

What is the rehabilitation process required after lumbar discectomy?

Lumbar discectomy involves removal of a herniated disc, and this can cause pain and soreness after surgery, therefore, a rehabilitation procedure, which includes physiotherapy and exercises, plays a pivotal role in the recovery from surgery and improvement in the lifestyle of the patient. Common rehabilitation process includes;

Pain management- several ways to minimize pain include;

  • Correct movement
  • Correct posture of the spine
  • Electrical devices
  • Ice pack application

Exercises- it is an essential step for fast recovery from the surgery. There are three levels of exercise-initial exercise program (normally 4 to 6 weeks after surgery), intermediate exercise program and advanced exercise program. Common exercises include;

  • Hip and abdomen strengthening the program
  • Leg Raises
  • Press Ups
  • Regular walk
  • Sciatic nerve glide
  • Wall squats

Education and training- A physiotherapist will provide sessions on physical therapy, the right way to executing the exercises and postures to maintain after surgery

What are the precautions taken after a lumbar discectomy?

After undergoing lumbar discectomy, a person is expected to undertake certain precautionary measures like:

  • Avoid taking non-steroidal anti-inflammatory drugs and blood thinners
  • Avoid sexual activity immediately after the surgery
  • Avoid sitting for a long period of time
  • Avoid driving, smoking,and heavy-lifting till your doctor advice to do so
  • Management of pain and constipation- lumbar discectomy is a painful procedure. Often, post-operative pain is managed by giving a narcotic painkiller for some time. This causes constipation and should be managed by drinking a lot of water, high-fiber containing food and a laxative
  • Mild physical activity is usually suggested

What are the complications oflumbar discectomy?

There are few complications that follow a lumbar surgery, these include but not limited to the following;

  • Bleeding
  • Disturbance of daily activities
  • Deep vein thrombosis- Formation of a blood clot inside the leg veins
  • Injury to neural structures and dural tear- The less common, but more serious, complication of neural tissue is an intraoperative tear of the outer layer of the spinal cord or the dura.If the dural injury is unrecognized or untreated, serious neurological deficits may develop.
  • Injury to vascular structures
  • Injury to abdominal contents
  • Infections
  • Persistent pain

 

Disclaimer: The shared article is only for awareness and education purpose. Readers are advised to consult their doctor for proper evaluation of the condition and more information. Do not self-medicate.

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