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Types of Discectomy Surgery

Considering surgical treatment options for a herniated disc? There are various types of disc removal surgeries available to you. The physicians at United Spine & Joint will gladly cover each procedure with you to determine the best fit for your needs. Discectomy is a surgical procedure carried out to treat herniated disc. The condition arises due to compression of nerve root by prolapsed or protruded disc. Based on the function of the nerve under pressure, pain will be more severe and can spread to different parts of body.

Surgery is considered as the final treatment for back pain. It is better
 to select a procedure which is minimally invasive and with least risk factors. Advancement in medical field and technologies resulted in modern versions of disc removal surgery. There are various types of discectomy that can be used based on the region and type of surgery needed. If you are interested in learning more  please contact us to determine what option is best for you, what your insurance will cover and any additional surgery costs.

What is a Discectomy (open)?

This procedure is generally mentioned as discectomy and is the traditional method to treat pain due to herniated disc. In this operation, surgeon cut open the region through a small incision to reach the area and removes the herniated disc and associated bones to relieve the pressure. As lumbar region of spinal cord is responsible for certain range of lower back pain, the surgery is also known as lumbar discectomy.

What is MicroDiscectomy?

Microdiscectomy is a procedure performed to remove a ruptured or herniated portion of a disc. A herniated disc occurs when the outer portion of the disc tears and releases internal disc material out into the spinal canal. The displaced disc material can press against adjacent spinal nerves, which can cause a number of painful and bothersome symptoms. These symptoms include back pain and numbness, tingling, and weakness in the extremities. Since herniated discs most frequently occur in the lumbar (lower) spine, the symptoms are usually felt in the low back, buttocks, legs, and feet.

The goal of a microdiscectomy and arthroscopic microdiscectomy is to remove any disc material placing pressure on the nerves, thereby alleviating symptoms. During the procedure, a surgeon removes a portion of bone necessary to access the herniated disc, and then uses tiny tools to remove any disc material and tissues required for the decompression. The aim of the procedure is the same as that of a discectomy, except a microdiscectomy is a minimally invasive procedure performed with aid of microscopic magnification. With a microdiscectomy, the tissue and muscle damage is minimal, so scarring is reduced and recovery time is much quicker than that of traditional open back surgery.

Most cases of a bulging or herniated disc can be treated with conservative therapies, and surgery is only considered if conservative treatment has failed as an option for relief. Herniated disc treatment usually begins with bed rest, hot and cold compression, over-the-counter medication, or physical therapy. The next step in treatment often involves prescription pain medication or epidural steroid injections.

Patients who try several months of conservative herniated disc treatment but still feel severe and limiting pain often are candidates for microdiscectomy. United Spine & Joint offers a microdiscectomy alternative that has an extremely high success rate and leaves most patients with improved symptoms in as little as a few days. To learn more about our revolutionary procedures, contact us today.

Endoscopic Microdiscectomy

Endoscopic microdiscectomy is a minimally invasive surgery used to treat symptoms of a herniated disc. During this procedure, surgeons use an endoscope (a magnifying camera that can be inserted directly into the body through a tiny incision) to see and remove herniated disc material in the spinal column. By removing tiny bits of material pressing on spinal nerves, the surgeons at United Spine & Joint often are able to relieve nerve irritation and painful symptoms in the patient.

A herniated disc occurs when the outer layer of a disc, the annulus fibrosus, ruptures and expels a portion of the discís interior matter, the nucleus pulposus. The displaced disc material can press against neighboring nerve roots and the spinal cord, causing a range of symptoms including neck pain, back pain, and tingling, numbness, and weakness in the extremities. The severity of the symptoms, as well as the location of the body experiencing the symptoms, is determined by the location of the herniated disc and the amount of displaced disc material. The purpose of an endoscopic microdiscectomy, therefore, is to decompress the nerve by removing the displaced portion of the disc.

Discectomy surgeries have been used to treat symptoms of herniated discs for years. But in the past, these procedures involved removing the entire disc through large incisions, which means substantial muscle and tissue damage, long hospital stays, and lengthy recovery times. Endoscopic surgery options such as endoscopic microdiscectomy drastically reduces all of these side effects because itís performed through a tiny incision about the size of a dime. Using mirco-instruments and an endoscope, the surgeon carefully suctions out disc material and irrigates the area, effectively decompressing the irritated nerve with minimal damage to surrounding tissues and muscles. Compared to a full discectomy and spinal fusion, the endoscopic method shortens recovery time, minimizes scarring, and allows most patients to be up and walking the same day of the endoscopic microdiscectomy.

If you have a herniated disc or bulging disc, itís unlikely that youíll have to resort to back surgery to treat your symptoms. Most cases of herniated discs are treated using conservative therapies, such as hot and cold compresses, bed rest, physical therapy, and over-the-counter medication. Steroid injections and prescription pain medication can also be helpful for those with severe and recurring pain, but both of those options can have significant side effects.

If youíve been suffering from debilitating and painful symptoms of a herniated disc and have tried conventional treatments, you may be a candidate for an endoscopic microdiscectomy. The experienced surgeons at United Spine & Joint have performed tens of thousands of these procedures with an extremely high success rate. For more information, contact us today.

Automated Percutaneous Lumbar Discectomy

Automated percutaneous lumbar discectomy is a minimally invasive procedure used to treat symptoms of a bulging disc or small herniated disc in the lower back. A bulging disc occurs when the nucleus of the disc protrudes outward, but doesnít completely rupture the outer layer (annulus fibrosus) of the disc. Bulging discs can press against neighboring nerves and cause symptoms including pain, numbness, and weakness in the back or limbs, depending on the location of the affected disc. Thus, the aim of any discectomy is to decompress the nerves by removing deviated disc material and disc fragments.

Percutaneous discectomy is different from microdiscectomy or other types of discectomy, because itís performed through a tiny needle in the skin instead of an incision. In some types of percutaneous discectomy, an automated suction-cutting device inserted through the needle is used to extract the disc material.

This procedure is sometimes an effective alternative to traditional open back surgery, but it canít be used in cases where the lumbar disc has completely herniated. Since itís a minimally invasive procedure, it is performed using only local anesthesia and in some cases, mild sedation. Scarring is minimal, and recovery time is substantially shorter than that of open back surgery.

Itís important to understand that most bulging discs can be treated with conservative therapy such as bed rest, exercise, a heating pad, and medication. Also, there are several lifestyle modifications you can make to reduce your symptoms. These include using good posture, maintaining a healthy weight, and protecting your back while lifting. If youíve tried conservative treatments but are still experiencing painful and debilitating bulging disc symptoms, call the specialists at United Spine & Joint. We offer a type of minimally invasive discectomy that has been successful in treating thousands of patients with bulging and herniated discs. For more information, contact us today.

Anterior cervical discectomy (ACD)

 This type of surgery is meant for pain due to large bone spurs. General anesthesia is given for patients as it is an open type of surgery. During ACD, the region is cut open from front of neck which makes the C2 region exposed under cervico-thoracic junction. This path is less complicated compared to other open surgical procedures. In this method, only a thin layer of muscle has to be cut open leading to the plane. This helps to reduce post operative pain and other complications during surgery.

Anterior cervical fusion (ACF)

 Anterior cervical discectomy and fusion or anterior cervical fusion are mainly performed on patients with spinal instability (with subluxations or spondylolisthesis). The situation is confirmed based on various radio-diagnostic tests. The herniated disc or bone spurs are removed and a bone graft is replaced taken from the hip of patient or from a donor.

Laser discectomy

 This type of laser assisted surgical procedure is emerging as an effective method to treat back pain due to herniated discs. This is an out patient protocol and takes less than one hour to complete. Surgical procedure include incision of a needle to the herniated disc and the herniated part of nucleus pulpous alone is burned.

What To Expect After Surgery

After a discectomy, you will be encouraged to get out of bed and walk as soon as the anesthetic wears off. You can use prescription medicines to control pain during the recovery period and will be advised to resume exercise and other activities gradually. Other things to think about include the following:

  • You can sit as long as you are comfortable, but most people avoid sitting for longer than 15 to 20 minutes. After surgery, sitting can be uncomfortable for a while.
  • Use walking as your primary form of exercise for the first several weeks. Getting up frequently to walk around will help decrease the risk that excess scar tissue will form. Scar tissue can keep the nerve root from gliding freely as you move, and can press on the nerve root. Walking will also provide exercise for your heart and lungs without stress to your back or the incision line (scar).
  • Avoid any activities that cause pain.
  • You may begin bicycling and swimming about 2 weeks after surgery as directed by your doctor or physical therapist.
  • If you work in an office, you may return to work within 2 to 4 weeks. If your job requires physical labor (such as lifting or operating machinery that vibrates) you may be able to return to work 4 to 8 weeks after surgery.

Many people are able to resume work and daily activities soon after surgery. In some cases, your doctor may recommend a rehabilitation program after surgery, which might include physical therapy and home exercises.

Why Is Discectomy Surgery Performed?

When surgery is used to treat a herniated disc, it is done to decrease pain and allow for more normal movement and function.

Surgery is considered an emergency if you have cauda equina syndrome. Signs include:

  • New loss of bowel or bladder control.
  • New weakness in the legs (usually both legs).
  • New numbness or tingling in the buttocks, genital area, or legs (usually both legs).

Surgery may be considered if tests show that your symptoms are due to a herniated disc and your doctor thinks surgery may help relieve the symptoms. In deciding whether to have surgery, you and your doctor will consider factors such as:

  • A history of persistent leg pain, weakness, and limitation of daily activities that has not gotten better with at least 4 weeks of nonsurgical treatment.
  • Results of a physical examination that show you have weakness, loss of motion, or abnormal sensation (feeling) that is likely to get better after surgery.
  • Diagnostic testing, such as magnetic resonance imaging (MRI), computed tomography (CT), or myelogram, that indicates your herniated disc would respond to surgery.

Should I have surgery for a herniated disc?

People with milder symptoms tend to do well without surgery. People with prolonged symptoms that are severe enough to interfere with normal activities and work and require strong pain medicines may gain relief from surgery. A study begun in 1990 followed about 500 people with low back pain caused by a herniated disc. Some had surgery and some did not. Follow-up information was gathered 5 years and 10 years after the beginning of the study.

  • People with moderate to severe pain who had surgery noticed a greater improvement than those who did not have surgery.
  • Those who had surgery noted more relief from the symptoms they considered most important than those who did not have surgery.
    • At 5 years, 70% of those who had surgery reported improvement in their most important symptom, as compared with 56% of those who received nonsurgical treatment.
    • At 10 years, 71% of people who had surgery were satisfied with their current situation, compared with 56% of those treated non-surgically.
  • But the type of treatment did not make a significant difference with regard to work and disability. The percent of people working at the time of the 10-year follow-up was similar, regardless of whether they had chosen surgical or nonsurgical treatment.

Risks of Discectomy Surgery

As with any surgery, there are some risks. There is a risk of damaging the nerve roots or spinal structures during surgery. There is also some risk of infection following surgery, which may require antibiotics and additional surgery. Some people may get a vein thrombosis (blood clot) or embolus (the clot breaks away and causes a blockage of blood flow in the lung). These conditions can lead to death, but dying from these conditions is rare.

Because there are risks with general anesthesia, your doctor and medical staff will carefully monitor you during your surgery and recovery.

Before the surgery, there is no sure way that your surgeon can know how your nerves will respond after the pressure of the disc herniation is removed. So there is a risk that your pain may not improve with surgery, or your pain may only partly improve.

Considerations for Surgery

Discectomy may provide faster pain relief than nonsurgical treatment, although it is unclear whether surgery makes a difference in what treatment may be needed later on. When comparing conventional open discectomy with microdiscectomy, people have reported being equally satisfied with both techniques.

Spinal fusion is a procedure that joins together bones in the back. It is sometimes effective for neck problems, and can be combined with a discectomy. But for the low back (lumbar spine), the procedure is controversial and complex and is not commonly performed with a discectomy. If a doctor suggests that you get a lumbar spinal fusion with a discectomy, get a second medical opinion to help you decide whether fusion is necessary.

Percutaneous discectomy is a procedure using a special tool through a small incision in the back to cut out or drain the herniated disc, thereby reducing its size. Percutaneous discectomy is considered less effective than open discectomy.

A newer form of discectomy using laser beams (laser discectomy) is still in the research stage.




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