Discectomy for Lumbar Herniated Discs: What is it?
A discectomy for a lumbar herniated disk may be quite the mouthful, but it's actually one of the most common and effective back surgeries. For those with lower back pain, a lumbar herniated disk may be the root cause of your symptoms.
What is a Lumbar Herniated Disk?
Medical jargon is confusing. To break it down simply, "lumbar" refers to the lower part of the spine (about 6 inches below the shoulder blades). Spinal disks are the rubbery, soft cushions between each vertebrae in the spine (there are five vertebrae in the lower the back). These rubbery disks act as shock absorbers. Each disk has a fairly hard exterior with an inner core (nucleus) that is made of loose fibers that are gel-like.
Therefore, a disk becomes herniated or ruptured when the exterior of the disk breaks down or cracks and the interior gel pushes out. This ruptured portion then rubs against the nerves and vertebrae causing pain and other symptoms. A lumbar herniated disk is when the disk ruptures in the lower back region. A lumbar herniated disk is very painful, and can cause feelings of numbness, tingling, sciatica symptoms (like electric "shooting" pain down the leg).
A herniated disk is sometimes called a "bulging disk" or a "ruptured disk". A disk can be herniated anywhere along the spinal column.
If you prefer that medical lingo, here's a more scientific explanation: "Disc herniation occurs when the annulus fibrous breaks open or cracks, allowing the nucleus pulposus to escape."
What Causes a Lumbar Disk Herniation?
For the most part, those with herniated disks (and the laundry list of symptoms that follow) cannot pinpoint an event that triggered it all. In other words, herniated disks aren't usually caused by an accident or one incident of major stress on the body. Rather, disk degeneration (long-term wear and tear) is the most common cause of disc herniation.
Who is more likely to develop a herniated disk?
Adults who are 50+ years
Professional or former pro-athletes (e.g. those with accelerated wear and tear on their spine)
Those with physically demanding jobs (e.g. people who have worked in trades like construction)
Those with an unhealthy lifestyle (e.g. people who smoke, have a history of drug abuse, have poor diet/ nutrition etc.)
Those with bad posture (people who slouch, look down at the computer all day etc.)
Lumbar Discectomy Surgery 101
A lumbar discectomy is considered a "decompression" spine surgery. A discectomy is sometimes called "herniated disc surgery". If you have a herniated lumbar disk (a ruptured disk in your lower spine) and your surgeon has recommended surgery, chances are you will be having a lumbar discectomy. A lumbar discectomy involves removing the ruptured portion of your disk that is rubbing against nerves/vertebrae in your spine. By removing this pressure, you can target the pain, tingling, numbness, feelings of sciatica etc., that is troubling you.
A discectomy is performed to:
Address leg and/or buttocks pain caused by nerve compression from a herniated/ ruptured disk.
Treat leg weakness, numbness.
Relieve pressure on the spinal nerves or cord.
Dr. Param Singh, orthopedic surgeon in San Francisco explained that "decompression surgeries are among the most successful" at treating back pain. When there is a structural issue, like a herniated lumbar disk, your surgeon can pinpoint and better address what is causing pain and other symptoms.
What Does Lumbar Discectomy Surgery Look Like?
In a lumbar discectomy, the ruptured material (nucleus pulposus) that is rubbing against your spine and vertebrae is removed. This means that during the procedure, your orthopedic surgeon will need access to your lower spinal column. This procedure is fairly simple, and is often done in an outpatient (same-day surgery) setting.
During an outpatient lumbar discectomy, you may have a microdiscectomy (the minimally invasive version of the procedure) where the nucleus pulposus is removed with a laser through a small 1 inch incision. With the aid of fluoroscopic x-raying, the surgery is performed with such a small incision, and little tissue or muscle damage. This aids in a shorter, less painful recovery.
A percutaneous lumbar discectomy (also called an endoscopic discectomy) involves removing part of the disk using a laser or suction through a small incision and one or more probe/tubes. The incision for each tube is about a centimeter in length. Being minimally invasive, the pain levels and recovery should be quite tolerable.
What Do you Do with a Herniated Disc? When Should I Have a Discectomy?
Do herniated discs heal on their own?
Not everyone with a ruptured disk will require surgery. In fact, a discectomy is a "last resort" treatment option only for those who've gone through less invasive treatment options like physical therapy, injections, oral medications etc.
Your physician may recommend a lumbar discectomy to resolve your back pain and symptoms if:
You've worked through less invasive treatments and they are no longer as effective. In other words, injections, physical therapy, or massage therapy are not offering the relief you need.
Your symptoms match clinical findings. Your pain and symptoms can be pinpointed to a herniated disc in your lower spine.
You have more than just "pain". If you have lower back pain but x-rays do not show a structural issue, your surgeon may not be confident that a lumbar discectomy will treat your pain.
Your in good overall health. In order for an elective surgery to be recommended, you must be in good physical and mental health. If you have secondary conditions that add risk to surgery, a discectomy may not be recommended.
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