Diskectomy

Answer 1

Definition

Diskectomy is surgery to remove all or part of a cushion that helps protect your spinal column. These cushions, called disks, separate your spinal bones (vertebrae).

When one of your disks herniates (moves out of place), the soft gel inside pushes through the wall of the disk. The disk may then place pressure on the spinal cord and nerves that are coming out of your spinal column.

Alternative Names

Spinal microdiskectomy; Microdecompression; Laminotomy; Disk removal; Spine surgery - diskectomy

Description

A surgeon may perform disk removal (diskectomy) in different ways.

• Microdiskectomy: When you have a microdiskectomy, the surgeon does not need to do much surgery on the bones, joints, ligaments, or muscles of your spine.
• Diskectomy in the lower part of your back (lumbar spine) may be part of a larger surgery that also includes a laminectomy, foraminotomy, or spinal fusion.
• Diskectomy in your neck (cervical spine) is most often done along with laminectomy, foraminotomy, or fusion.

Microdiskectomy is done in a hospital or outpatient surgical center. You will be given spinal anesthesia or general anesthesia (asleep and pain-free).

• The surgeon makes a small (1 to 1-1/2 inch) incision (cut) on your back and moves the back muscles away from the spine. The doctor uses a special microscope to see the problem disk or disks and nerves during surgery.
• The surgeon finds the nerve root and moves it away. Then the surgeon removes the injured disk tissue and pieces. The surgeon puts the back muscles back in place, and closes the wound with stitches or staples.
• The surgery takes about 1 to 2 hours.

Diskectomy and laminotomy is done in the hospital, using general anesthesia (asleep and pain-free).

• The surgeon makes a larger cut on your back over the spine. Muscles and tissue are moved to expose your spine.
• A small part of the lamina bone (part of the vertebrae that surrounds the spinal column and nerves) is cut away. The opening may be as large as the ligament that runs along your spine. The surgeon cuts a small hole in the disk that is causing your symptoms and removes material from inside. Other fragments of the disk may also be removed.

Why the Procedure Is Performed

Diskectomy is done when a herniated disk makes you have:

• Leg pain or numbness that is very bad or is not going away, making it hard to do daily tasks
• Weakness in muscles of your lower leg or buttocks
• An inability to control bowel movements or urination

If you are having problems with your bowels or bladder, or the pain is so bad that strong pain drugs do not help, you will probably have surgery right away.

Most other people with low back or neck pain, numbness, or even mild weakness are often first treated without surgery. Anti-inflammatory medications [such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn)], physical therapy, and exercise are often first treatments. Over time, many of the symptoms of low Back pain caused by a herniated disk often get better or go away without surgery.

You should talk with your doctor about what is right for you.

Risks

Risks for any anesthesia are:

• Reactions to medications
• Breathing problems

Risks for any surgery include are:

• Bleeding
• Infection

Risks for this surgery are:

• Damage to the nerves that come out of the spine, causing weakness or pain that does not go away.
• Your back pain does not get better or comes back again later.
• Because of the small surgical cut used in a microdiskectomy, the doctor may miss some disk fragments. This could cause you to continue having pain after surgery.

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.

During the days before the surgery:

• Prepare your home for when you come back from the hospital.
• If you are a smoker, you need to stop. Your recovery will be slower and possibly not as good if you continue to smoke. Ask your doctor for help.
• Two weeks before surgery, you may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and other drugs like these.
• If you have diabetes, heart disease, or other medical problems, your surgeon will ask you to see your regular doctor.
• Talk with your doctor if you have been drinking a lot of alcohol.
• Ask your doctor which drugs you should still take on the day of the surgery.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illnesses you may have.
• You may want to visit the physical therapist to learn some exercises to do before surgery and to practice using crutches.

On the day of the surgery:

• You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Take your drugs your doctor told you to take with a small sip of water.
• Bring your cane, walker, or wheelchair if you have one already. Also bring shoes with flat, nonskid soles.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Your doctor or nurse will ask you to get up and walk around as soon as your anesthesia wears off. Most people go home the day of surgery. Do NOT drive yourself home.

Outlook (Prognosis)

Most people have pain relief and can move better after surgery. Numbness and tingling should get better or disappear. Your pain, numbness, or weakness may NOT get better or go away if your disk damaged your nerve before surgery.

Talk with your doctor about how to prevent future back problems.

References

Chou R, Loeser JD, Owens DK, Rosenquist RW, et al; American Pain Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine. 2009;34(10):1066-77.

Chou R, Qaseem A, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-491.

Gregory DS, Seto CK, Wortley GC, Shugart CM. Acute lumbar disk pain: navigating evaluation and treatment choices. Am Fam Physician. 2008;78(7):835-842.

Williams KD, Park AL. Lower back pain and disorders of intervertebral discs. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 39.

Answer 2

Definition

Diskectomy is surgery to remove all or part of a cushion that helps protect your spinal column. These cushions, called disks, separate your spinal bones (vertebrae).

Alternative Names

Spinal microdiskectomy; Microdecompression; Laminotomy; Disk removal; Spine surgery - diskectomy

Description

A surgeon may perform disk removal (diskectomy) in different ways.

• Microdiskectomy: When you have a microdiskectomy, the surgeon does not need to do much surgery on the bones, joints, ligaments, or muscles of your spine.
• Diskectomy in the lower part of your back (lumbar spine) may be part of a larger surgery that also includes a laminectomy, foraminotomy, or spinal fusion.
• Diskectomy in your neck (cervical spine) is most often done along with laminectomy, foraminotomy, or fusion.

Microdiskectomy is done in a hospital or outpatient surgical center. You will be given spinal anesthesia or general anesthesia(asleep and pain-free).

• The surgeon makes a small (1 to 1-1/2 inch) incision (cut) on your back and moves the back muscles away from the spine. The doctor uses a special microscope to see the problem disk or disks and nerves during surgery.
• The surgeon finds the nerve root and moves it away. Then the surgeon removes the injured disk tissue and pieces. The surgeon puts the back muscles back in place, and closes the wound with stitches or staples.
• The surgery takes about 1 to 2 hours.

Diskectomy and laminotomy is done in the hospital, using general anesthesia (asleep and pain-free).

• The surgeon makes a larger cut on your back over the spine. Muscles and tissue are moved to expose your spine.
• A small part of the lamina bone (part of the vertebrae that surrounds the spinal column and nerves) is cut away. The opening may be as large as the ligament that runs along your spine. The surgeon cuts a small hole in the disk that is causing your symptoms and removes material from inside. Other fragments of the disk may also be removed.

Why the Procedure Is Performed

When one of your disks herniates (moves out of place), the soft gel inside pushes through the wall of the disk. The disk may then place pressure on the spinal cord and nerves that are coming out of your spinal column.

Many of the symptoms caused by a herniated disk get better or go away over time without surgery. Most people with low back or neck pain, numbness, or even mild weakness are often first treated with anti-inflammatory medicines, physical therapy, and exercise. Only a few people with a herniated disk need surgery.

Your doctor may recommend a diskectomy if you have a herniated disk and:

• Leg pain or numbness that is very bad or is not going away, making it hard to do daily tasks
• Severe weakness in muscles of your lower leg or buttocks
• Pain that spreads into your buttocks or legs

If you are having problems with your bowels or bladder, or the pain is so bad that strong pain drugs do not help, you will probably have surgery right away.

Risks

Risks for any anesthesia are:

• Reactions to medications
• Breathing problems

Risks for any surgery include are:

• Bleeding
• Infection

Risks for this surgery are:

• Damage to the nerves that come out of the spine, causing weakness or pain that does not go away.
• Your back pain does not get better or comes back again later.
• Because of the small surgical cut used in a microdiskectomy, the doctor may miss some disk fragments. This could cause you to continue having pain after surgery.

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.

During the days before the surgery:

• Prepare your home for when you come back from the hospital.
• If you are a smoker, you need to stop. Your recovery will be slower and possibly not as good if you continue to smoke. Ask your doctor for help.
• Two weeks before surgery, you may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and other drugs like these.
• If you have diabetes, heart disease, or other medical problems, your surgeon will ask you to see your regular doctor.
• Talk with your doctor if you have been drinking a lot of alcohol.
• Ask your doctor which drugs you should still take on the day of the surgery.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illnesses you may have.
• You may want to visit the physical therapist to learn some exercises to do before surgery and to practice using crutches.

On the day of the surgery:

• You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Take your drugs your doctor told you to take with a small sip of water.
• Bring your cane, walker, or wheelchair if you have one already. Also bring shoes with flat, nonskid soles.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Your doctor or nurse will ask you to get up and walk around as soon as your anesthesia wears off. Most people go home the day of surgery. Do NOT drive yourself home.

Outlook (Prognosis)

Most people have pain relief and can move better after surgery. Numbness and tingling should get better or disappear. Your pain, numbness, or weakness may not get better or go away if your had nerve damage before surgery or if you have symptoms caused by other spinal conditions.

Further changes may occur in your spine over time and new symptoms may occur.

Talk with your doctor about how to prevent future back problems.

References

Chou R, Loeser JD, Owens DK, Rosenquist RW, et al; American Pain Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine. 2009;34(10):1066-77.

Chou R, Qaseem A, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-491.

Gregory DS, Seto CK, Wortley GC, Shugart CM. Acute lumbar disk pain: navigating evaluation and treatment choices. Am Fam Physician. 2008;78(7):835-842.

Williams KD, Park AL. Lower back pain and disorders of intervertebral discs. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 39.

Jegede KA, Ndu A, Grauer JN. Contemporary management of symptomatic lumbar disc herniations. Orthop Clin North Am. 2010 Apr;41(2):217-24.

Reviewed By

Review Date: 06/04/2011

David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery.