The term lumbar discectomy simply means the removal of a herniated disc in the lower spine which may be pushing on a nerve causing leg pain and dysfunction. For information regarding herniated disc in the lumbar region please visit the appropriate page within this web site.
A herniated disc can cause sever pain, weakness in strength, and numbness. Non-operative treatment is first initiated and is usually successful in relieving the symptoms. When these treatment modalities fail, a surgical management is suggested and is often requested by the patients. The removal of the disc is simply called a discectomy. However, in recent years many new techniques have been developed to enhance the procedure. Most of the procedures accomplish the same task, which is removal of the disc. The newer procedures accomplish this with smaller incisions, less postoperative pain, less dissection, which leads to faster recovery and better overall results. There are several techniques which are newer, each with its own benefits and risks. These include Micro-Discectomy, Micro-Endoscopic Discectomy, Laser Discectomies, IDET procedure, and Chymopapain injections.
We will begin the discussion with Micro-Discectomy procedure. This procedure is the simplest one and uses traditional surgical techniques. A small incision is made and small retractors are placed within the wound which allow the visualization of the spine. Once the bone is visualized, magnification apparatus like a microscope (as shown to the right) is used to perform the operation. This procedure is safe since it allows magnified visualization and the problems within the canal can easily visualized and corrected. However, this procedure requires the greatest amount of dissection of soft tissue which may require a hospital stay after the surgery. Usually, patients are kept in the hospital for one or two days after the operations to ensure good pain control and ability to walk Some surgeons point to the fact that risk of infection is also higher with larger incision and more operative dissection which is utilized with this operation as compared with other options. One must remember that this procedure is a time honored technique which has been proven to be very effective.
The more recently introduced technique is the Micro-Endoscopic Discectomy which has many benefits and a relatively low risk. The trained surgeon is able to utilize this technique to achieve superb results with very little dissection and post-operative pain. The main advantage of this procedure is that it is performed on an outpatient basis. Patients with this operation are able go home on the same day with minimal pain. In fact, the operative pain is much less than the pain produced by the herniated disc. Removal of the herniated disc relieves the excruciating pain, and the operative pain is usually mild enough which leads to very satisfied patients. This technique utilizes an incision which is similar to a size of a dime. The retractors are circular and require very little muscular dissection to approach the area of surgery. The herniated disc can be seen under the microscope as well as the endoscope. The endoscope (which is basically a very small camera) can visualize the area of interest at a different angle and allow the surgeon to see structures that are otherwise hidden. Results of surgery with this technique are similar to the traditional operation. However, patient selection is important since not all patients can benefit from this operation. This subgroup of patients benefit from traditional discectomy rather than the MED (Micro-Endoscopic Discectomy) procedure.
Another technique used to remove a herniated disc is the so called Laser Discectomies. Information regarding these procedures are lacking in the medical literature. Generally, most spine surgeons do not regard these procedures as accepted treatment options. The reason for the negative views regarding this procedure is the poor results obtained. Only few physicians perform this procedures and the written publications regarding this procedure was produced by these same physician. The procedure involves the insertion of the laser catheter into the disc space. The activation of the laser is supposed to “burn” the disc which is producing the symptoms. In short we do not recommend this procedure for any diagnosis or condition.
The IDET (Intra-Discal Electro-Thermal Therapy) procedure has been developed recently. The basic concept includes the insertion of a catheter into the disc, then heating this catheter to specific temperatures. It is theorized that the dissipated heat shrinks and closes gaps in the outer covering of the disc. There are specific indications for this procedures and a herniated disc is not one of these indications. Unfortunately, some physicians choose to perform the IDET procedure for some patients suffering from a herniated disc. We do not believe that the IDET procedure offers enough benefit for the patient suffering from a herniated disc. Our office uses the IDET procedure for patients with discogenic pain (Back pain only without leg pain produced by the disc) not herniated discs.
Finally, Chymopapain was used many years ago as a treatment option for herniated lumbar discs. Even though it was successful in many patients, some cases of sever complications were reported. These reports lead many physicians to abandon this procedure. Legal consequences finally resulted in the abandonment of this treatment options by US physicians. In Europe this treatment option is still available and is used with some success. This procedure is not indicated for all forms of disc herniations. There are specific types of herniations that this technique could be utilized but this information is not important since our office and US physicians do not utilize it.
In summary, the treatment options of a herniated disc are numerous based on patient selection, specific type of herniation, the surgeons surgical skills, and other tactical factors. Make an appointment with our office to discuss your specific case and treatment options.