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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.
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;
The introduction of intradiscalchymopapain injections also led to the lateral approach. Laser nucleolysis and transdiscoscopy discectomy were later introduced as well.
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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.
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.
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.
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;
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;
Education and training- A physiotherapist will provide sessions on physical therapy, the right way to executing the exercises and postures to maintain after surgery
After undergoing lumbar discectomy, a person is expected to undertake certain precautionary measures like:
There are few complications that follow a lumbar surgery, these include but not limited to the following;
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.