Intervertebral Diskectomy
all information

Intervertebral Diskectomy

(Microdiskectomy; Microcompression Spine Surgery)

Pronounced: Inter-VERT-e-bral disc-ECT-omy

Definition

A diskectomy is a surgical procedure to remove an intervertebral disc that is putting pressure on a nerve as it leaves the spinal column. The procedure is most commonly performed on lumbar discs (located in the lower back). However, it may also be used for cervical discs in the neck.

Parts of the Body Involved

  • Spine

Reasons for Procedure

Discs between vertebrae in the back normally serve as cushions separating the bones. With age, discs may dry and offer less cushioning. Injury can cause a disc to bulge (or herniate), which may result in pressure on a nerve leaving the spinal column. In some cases, this causes severe pain traveling down a leg, a condition known as sciatica . A diskectomy is usually performed only after a trial of conservative treatment has failed, which usually lasts at least six weeks. However, the ideal timing of surgery has been a matter of some controversy.

In a recent trial, 283 patients with severe sciatica were randomly assigned to receive early microdiskectomy (within an average of 2.2 weeks) or conservative treatment (ie, combination of rest, physical therapy, and medications) with delayed surgery if necessary. Although after one year there was no difference in pain or disability between the two groups, those patients receiving early surgery reported significantly faster recovery. It is important to note that these findings do not necessarily apply to other surgical procedures like laminectomy, only microdiskectomy. *

Herniated Disc Pressing on a Nerve

herniated disc nerve

© 2008 Nucleus Medical Art, Inc.

Risk Factors for Complications During the Procedure

Chronic conditions (such as diabetes ), prior spine surgeries, advanced age, and smoking increase surgical risks.

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Physical exam
  • Ask about the pain and when it started
  • Refer you to a neurosurgeon or orthopedic surgeon

Before scheduling the procedure, the surgeon may:

In the days leading up to your procedure:

  • Review your regular medications with your surgeon. You may be asked to stop taking some drugs, such as aspirin.
  • Ask about restrictions to your activities during the postoperative period.
  • Arrange to have someone drive you home.
  • Arrange for help at home after returning from the hospital.

The day before and the day of your procedure:

  • Do not eat or drink anything after midnight unless told otherwise by your doctor.
  • Wear comfortable clothing.

Anesthesia

General anesthesia will be used for larger procedures. Local anesthesia with sedation will be used for more minor procedures.

Description of the Procedure

There are different types of surgical procedures and techniques used for a diskectomy:

Anterior Cervical Diskectomy

The surgeon makes a cut in the skin on the left or right side of the neck. He or she will go through a muscle to reach the spine. The surgeon removes the disc material after confirming by x-ray that it is the correct disc. He or she may also remove a portion of the bone to give the nerve more space. A bone graft may be placed to fuse the vertebrae.

Posterior Cervical Diskectomy

The surgeon cuts the skin at the back of the neck and pushes the muscle aside. A small piece of bone is removed to access the disc space. The nerve is gently pushed aside and the disc material removed.

Lumbar Diskectomy

The surgeon makes a 1-1½ inch cut in the skin on the lower back. He or she will move the muscles out of the way and possibly a small part of the bone to gain access to the nerve and disc. The disc or offending disc fragments are lifted out.

There are a variety of techniques used to perform a diskectomy. Your surgeon will pick the technique that is most appropriate for your particular case. An “open” technique involves a larger skin cut so that the surgeon can directly visualize the area of operation. A “minimally invasive” technique (eg, microdiskectomy or percutaneous approach) uses a smaller skin cut and the assistance of a variety of tools to help the surgeon see the operation site and to help operate in a smaller space.

Minimally Invasive Lumbar Diskectomy

laparoscopic discectomy small

© 2008 Nucleus Medical Art, Inc.

How Long Will It Take?

The time in the operating room depends on the procedure. Microdiskectomy usually takes longer than an open procedure, but recovery is faster.

Will It Hurt?

Anesthesia prevents pain during surgery. Ask your doctor about medications to help with the pain during your recovery.

Possible Complications

  • Bleeding
  • Infection
  • Nerve damage
  • Bladder or bowel incontinence
  • Leakage of spinal fluid
  • In anterior cervical cases, damage to other structures in the neck or hoarseness due to nerve injury

Average Hospital Stay

Many lumbar procedures are done as outpatient surgery. Cervical diskectomy patients may be admitted to the hospital for a short stay.

Postoperative Care

Follow your doctor’s instructions. He or she may limit bending, lifting, or twisting for six weeks. An exercise program will help stretch and strengthen your muscles and decrease the risk of future back problems.

Outcome

The goal is to eliminate pain caused by the disc pressing on the nerve as it leaves the spine. Patients often feel relief almost immediately. Even so, it takes months for the nerve root to heal.

Lumbar patients may suffer another herniation, often within the first three months after surgery. Posterior cervical diskectomy also carries a small risk of repeat herniation.

Call Your Doctor If Any of the Following Occurs

It is essential for you to check your recovery once you leave the hospital. That way, you can alert your doctor about any problems. If any of the following occur, call your doctor:

  • Pain not relieved by medication
  • Fever, chills, or other signs of infection
  • Redness, swelling, increasing pain, bleeding, or discharge from the incision site
  • Numbness and tingling
  • Bowel or bladder incontinence

RESOURCES:

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

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

University of Southern California
http://www.usc.edu

University of Virginia, Department of Neurosurgery
http://www.healthsystem.virginia.edu/internet/neurosurgery

CANADIAN RESOURCES:

Canadian 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. Mosby; 2003.

Treatment options: low back (lumbar). University of Southern California website. Available at: http://www.usc.edu/schools/medicine/departments/neurological_surgery/clinical/spina/treatmentoptions-lumbar.htm . Accessed September 5, 2005.

Treatment options: neck (cervical). University of Southern California website. Available at: http://www.usc.edu/schools/medicine/departments/neurological_surgery/clinical/spina/treatmentoptions-cervical.htm . Accessed September 5, 2005.

Updated Reasons for Procedure section on 6/7/2007 according to the following study, as cited by 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.



Last reviewed February 2008 by Robert Leach, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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