Herniated Disc Surgery

Anatomy

A herniated disc most often occurs in the lumbar region (low back). This is

because the lumbar spine carries most of the body's weight. Sometimes the

herniation can press on a nerve, causing pain that spreads or radiates to

other parts of the body.

Definition

Very few people with herniated or bulging discs need surgery. However, if you have

tried conservative treatments without relief, your doctor may recommend

herniated disc surgery. Surgery may be necessary if you are experiencing:

Muscle weakness or numbness, loss of sensation

Problems walking or standing

Difficulty controlling your bowels or bladder

Many times, only the portion of the disc that is bulging or herniated is removed. In rare

cases, it is necessary to remove the entire disc. If the entire disc is removed, the bones

(vertebrae) on either side of the damaged disc may need to be permanently joined or

fused together to provide stability for your spine.

Micro Discectomy

Why It's Done

A Microdiscectomy is a surgical procedure that is done to take the pressure off the nerves or spinal cord by removing part or all of the herniated disc. Your physician might advise Microdiscectomy if:

Nerve weakness has progressed to the point you have difficulty walking

or standing

After six weeks of non-surgical treatment, such as physical therapy,

your symptoms are not improving

A fragment of a disc becomes lodged in the spinal cord and is

compressing a nerve The pain radiating into your arms, chest, legs or

buttocks is no longer manageableHow Microdiscectomy Surgery Is Performed

A microdiscectomy is performed through a small (1 inch to 1 1/2 inch) incision in the midline of the low back.

First, the back muscles (erector spinae) are lifted off the bony arch

(lamina) of the spine. Since these back muscles run vertically, they can be

moved out of the way rather than cut.

The surgeon is then able to enter the spine by removing a membrane over

the nerve roots (ligamentum flavum), and uses either operating glasses

(loupes) or an operating microscope to visualize the nerve root.

Often, a small portion of the inside facet joint is removed both to facilitate

access to the nerve root and to relieve pressure over the nerve.

The nerve root is then gently moved to the side and the disc material is removed from under the nerve root.

Risks

MicroDiscectomy is considered to be a safe operation. Just like any surgery, there is a risk of complications

occurring. Possible complications include the following:

•Bleeding

•Infection

•Spinal fluid leaking

•Damage to nerves or blood vessels around and in the spine

•Damage to the protective layer of tissues that surround the spine

Results

Discectomy helps to relieve the symptoms of a herniated disc in most people who have clear indications of nerve

compression, such as pain that radiates from the back into the arms or legs. This surgery may not provide

permanent relief however, because it does not solve the underlying problem that initially caused the disc to

herniate. Your doctor may make some recommendations that will help you avoid injuring your spine again, such as a

routine program of low-impact exercise or weight reduction. It may also be recom- mended that you avoid activities

that require repetitive or extensive lifting, twisting or bending.

Percutaneous Discectomy

An advanced form of percutaneous discectomy developed to date uses a plasma tech- nology to remove tissue from the center of the disc. During the procedure, an instrument is introduced through a needle and placed into the center of the disc where a series of channels are created to remove tissue from the nucleus.

Tissue removal from the nucleus acts to decompress the disc and relieve the pressure exerted by the disc on the nearby nerve root. As pressure is relieved, pain is reduced, consistent with the clinical results of earlier percutaneous discectomy procedures. There is little tissue trauma and recovery times may be improved in many patients.

Laminotomy and Laminectomy

Each back bone or vertebra has two laminae. These laminae are arch-shaped and are located closer

to the internal body than the outside of the body. Other parts of the vertebra are located near the

laminae: the facet joint and the spinal process.

The laminae are made of bone and they rarely cause problems. However, surgery on them can be

helpful in other conditions. Spinal conditions may cause severe pain if the spinal cord or nearby

nerves are compressed. Operations performed on the laminae can help to make the spinal column

wider, which relieves the pressure and pain. Surgery on the laminae is also used to help treat spinal

deformities.

What is the Difference Between Laminectomy and Laminotomy?Sometimes even doctors and nurses interchange these two words, but there is a distinction. In a laminectomy, the lamina is completely removed. Only a portion of the lamina is removed in a laminotomy.

Reasons for a laminectomy or laminotomyThe main reason for either of these procedures is to remove the pressure from the nerves near the spinal cord or from the spinal corditself. Even though a portion of the vertebra is removed, the spinal cord remains protected inside the spinal column which consists of hard backbones, even when a laminectomy or laminotomy is performed. be permanent.