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  • Intervertebral Diskectomy

    (Microdiskectomy; Microcompression Spine Surgery)

    Definition

    Intervertebral discs are located between each backbone (vertebra). When damaged, these discs can put pressure on nerves as they leave the spinal cord. An intervertebral diskectomy is a back surgery that removes all or part of these discs. The procedure is most often done on lumbar discs (located in the lower back). It may also be done on cervical discs in the neck. There are two methods for this surgery:
    • Open procedure—A large incision is made.
    • Microdiskectomy—Small incisions are made, and the doctor inserts tiny instruments through these incisions.

    Reasons for Procedure

    These discs normally serve as cushions between the bones. The discs can become damaged or dry with age. Injury can also cause a disc to bulge (or herniate ). These changes can create pressure on nerves leaving the spine. This can cause pain, numbness, and weakness.
    Laparoscopic Diskectomy
    laparoscopic discectomy small
    Copyright © Nucleus Medical Media, Inc.
    The best time to have this surgery is debatable. This is because—for some patients—having early surgery may not result in less pain or disability. In most cases, surgery is only done after other treatments have failed. Other treatments typically include:
    • Rest
    • Physical therapy
    • Medicines
    The goal of surgery is to eliminate pain, weakness, and numbness caused by the disc pressing on a nerve. You may feel relief right away, or it may take months for the nerve root to heal. In some cases, your symptoms may not improve. Your doctor will carefully evaluate you before surgery to determine what the best option is.

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have intervertebral diskectomy, your doctor will review a list of possible complications, which may include:
    • Bleeding
    • Infection
    • Nerve damage
    • Bladder or bowel incontinence
    • Leakage of spinal fluid
    • Another herniated disk (may happen within the first three months after surgery)
    Factors that may increase the risk of complications include:
    • Chronic conditions (eg, diabetes )
    • Prior spine surgeries
    • Advanced age
    • Smoking
    Be sure to discuss these risks with your doctor before the surgery.

    What to Expect

    Prior to Procedure

    Your doctor will likely do the following:
    • Physical exam
    • Ask about the pain and when it started
    • Obtain an MRI scan —a test that uses magnetic waves to make pictures of structures inside the back
    • Discography —an imaging test used to detect a herniated disk; involves injecting dye into a disc in the spine and taking an x-ray to determine if there are any leaks
    Leading up to your procedure:
      Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Anti-inflammatory drugs (eg, aspirin )
      • Blood thinners, like clopidogrel (Plavix) or warfarin (Coumadin)
    • Arrange to have someone drive you home. Also, arrange for someone to help you at home.
    • Eat a light meal the night before the surgery. Do not eat or drink anything after midnight.
    • Wear comfortable clothing to the hospital.

    Anesthesia

    General anesthesia will be used. It will block any pain and keep you asleep during surgery.

    Description of the Procedure

    There are different types of surgical procedures, including:
    Anterior Cervical Diskectomy
    A cut will be made in the skin on the left or right side of the neck. The doctor will go through a muscle to reach the spine. The disc material will be removed after the doctor uses an x-ray to confirm that it is the correct disc. A portion of the bone may be removed to give the nerve more space. A bone graft may be placed to fuse the vertebrae.
    Posterior Cervical Diskectomy
    A cut will be made in the skin at the back of the neck. The muscles will be pushed aside. A small piece of bone will be removed to get to the disc space ( laminectomy ). Next, the doctor will gently push the nerve aside and remove the disc material.
    Lumbar Diskectomy
    The doctor will make a 1-1½ inch cut in the skin on the lower back. The muscles will be moved out of the way. A small part of the bone may need to be removed to gain access to the nerve and disc. The disc or disc fragments will then be removed.
    Diskectomy
    Sagittal Discectomy
    The disc is removed from between the vertebrae.
    Copyright © Nucleus Medical Media, Inc.

    How Long Will It Take?

    This depends on:
    • Which method your doctor uses (open or minimally invasive)
    • Which procedure you need
    For example, the minimally invasive surgery may take longer, but the recovery is faster.

    How Much Will It Hurt?

    You will have pain while recovering. Your doctor will give you pain medicine.

    Average Hospital Stay

    This surgery is most commonly done in a hospital setting. It may be possible to go home on the same day of the surgery. If you have a cervical diskectomy, you may have to stay in the hospital for a few days.

    Post-procedure Care

    Follow your doctor’s instructions . Bending, lifting, or twisting may be limited for six weeks. You will work with a physical therapist to stretch and strengthen your muscles. This will help to decrease the risk of future back problems. Ask your doctor about when it is safe to shower, bathe, or soak in water.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
    • Numbness or tingling
    • Pain that you cannot control with the medicines you have been given
    • Pain, burning, urgency or frequency of urination, or bleeding in the urine
    • Cough, shortness of breath or chest pain
    • Loss of bladder or bowel control
    In case of an emergency, call for medical help right away.

    RESOURCES

    National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/

    North American Spine Society http://www.spine.org/

    CANADIAN RESOURCES

    Canadian/American Spinal Research Organization http://www.csro.com/

    Spinal Injury Foundation http://www.spinalinjuryfoundation.org/

    References

    Bach HG, Lim RD. Minimally invasive spine surgery for low back pain. Dis Mon. 2005;51:34-57.

    Canale S. Campbell's Operative Orthopaedics. 10th ed. St. Louis, MO: Mosby; 2003.

    Lavelle W, Carl A, Lavelle ED. Invasive and minimally invasive surgical techniques for back pain conditions. Anesthesiol Clin. 2007;25:899-911.

    Treatment options: low back (lumbar). University of Southern California, Department of Neurological Surgery website. Available at: http://www.usc.edu/schools/medicine/departments/neurological%5Fsurgery/clinical/spina/treatmentoptions-lumbar.htm . Accessed September 8, 2009.

    Treatment options: neck (cervical). University of Southern California website. Available at: http://www.usc.edu/schools/medicine/departments/neurological%5Fsurgery/clinical/spina/treatmentoptions-cervical.htm . Accessed September 8, 2009.

    6/7/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356:2245-2256.

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