A discectomy, a surgical procedure aimed at relieving pain caused by a herniated disc, can significantly enhance a patient’s quality of life. Discectomies have traditionally been performed under general anesthesia, but advances in medical technology have introduced the option of staying awake during the surgery. In this article you will learn about the possibilities and implications of remaining conscious during a discectomy, shedding light on the benefits, risks, and considerations associated with this alternative approach.
Types of Discectomy
There are different types of discectomy, depending on how the surgeon accesses the spine and removes the disc material. Some of the common types are:
- Open discectomy – This is the traditional method of discectomy, where the surgeon makes a large incision in the back or neck and cuts through the muscles, bones, and ligaments to reach the spine. The surgeon then uses a microscope and special tools to remove the herniated disc. This type of discectomy requires general anesthesia, which means you will be asleep and not feel any pain during the surgery.
- Minimally invasive microdiscectomy – This is a newer method of discectomy, where the surgeon makes one or more small incisions in the back or neck and inserts a thin tube with a camera and instruments to reach the spine. The surgeon then uses the camera and tools to remove the herniated disc. This type of discectomy can be done with general anesthesia or local anesthesia, which means you will be awake but not feel any pain in the area of the surgery.
- Endoscopic discectomy – This is a variation of minimally invasive discectomy, where the surgeon uses an endoscope, which is a flexible tube with a light and a camera, to access the spine through a small incision. The surgeon then uses tiny instruments to remove the herniated disc. This type of discectomy can also be done with general anesthesia or local anesthesia.
The Emergence of Awake Discectomies
In recent years, an increasing number of surgeons have begun to explore the option of awake discectomies. This procedure enables patients to remain awake and alert while local anesthesia numbs the operative area to minimize pain and discomfort. By avoiding general anesthesia, awake discectomies offer potential advantages such as reduced risks associated with the use of sedation, avoidance of potential complications, and faster recovery times.
Benefits of Remaining Awake
The choice of being awake or asleep for a discectomy depends on your medical condition, the type of discectomy, and your personal preference. One of the most significant advantages of opting for an awake discectomy is the patient’s ability to communicate with the surgical team during the procedure. This open line of communication allows surgeons to accurately assess pain levels and guide their surgical techniques in real time.
Additionally, awake patients experience reduced postoperative nausea, a common side effect of traditional anesthesia. Shortened hospital stays, cost savings, and increased patient satisfaction are additional benefits observed in awake discectomy cases.
Patient Selection and Surgical Considerations
Selecting the appropriate candidates for awake discectomies is crucial. Factors such as the patient’s overall health, pain tolerance, anxiety levels, and ability to comply with instructions are taken into consideration. The complexity of the surgery and risks associated with certain medical conditions may influence the decision to proceed with an awake or a traditional discectomy. Thorough pre-operative assessments and discussions between the surgical team and the patient are essential for informed decision-making.
Preparing for an Awake Discectomy
For patients considering an awake discectomy, adequate preparation is pivotal. Communication with the surgical team is of utmost importance to ensure expectations, goals, and anxieties are discussed. Proper education on the procedure, potential risks, and realistic outcome expectations is critical. Developing coping strategies, including relaxation techniques, can also help patients manage anxiety. Close collaboration among the patient, surgeon, and anesthesiologist is fundamental in creating a safe and comfortable experience.
The Role of Anesthesia in Awake Discectomies
While the patient remains conscious during an awake discectomy, local anesthesia is administered to numb the operative area and prevent pain. The administration of local anesthesia is performed under the supervision of an anesthesiologist or a skilled member of the surgical team. In certain cases, conscious sedation may be utilized to help patients relax without using general anesthesia. The anesthesia approach is tailored to each patient’s needs and surgical requirements.
What to Expect Post-Surgery
After the discectomy, you will be moved to a recovery room, where the medical staff will monitor your vital signs and check for any complications. You may feel some pain, soreness, or stiffness in the area of the surgery, which can be managed with pain medication. You may also have some numbness, tingling, or weakness in the affected nerve, which usually improves over time. You will be given instructions on how to care for your wound, prevent infection, and manage your pain. You will also be advised on when to resume your normal activities, such as walking, driving, working, or exercising. Depending on the type of discectomy and your condition, you may be able to go home the same day or stay in the hospital for one or more nights.
The option of staying awake during a discectomy procedure offers certain advantages, including reduced risks associated with general anesthesia and improved patient engagement. However, it is vital to weigh the potential risks and suitability on a case-by-case basis. With proper patient selection, diligent preparation, and effective communication, an awake discectomy can be a valuable alternative that enhances patient outcomes and satisfaction in appropriate cases.
The type of anesthesia used during a discectomy will vary according to each patient’s specific needs. Back surgery recovery time also varies among individuals and depends on factors such as whether the patient has a large hole in the outer ring of the disc after surgery. If the hole in the disc is larger than a standard pencil eraser, the patient has a significant risk of experiencing a reherniation. Patients with a large hole in the outer ring of the disc are more than twice as likely to reherniate after surgery. These reherniations often require additional surgery or even a larger spinal fusion operation. Barricaid is a bone-anchored device shown to reduce reherniations by closing the hole in the disc after a discectomy, and 95 percent of Barricaid patients did not undergo a reoperation due to reherniation in a 2-year study timeframe. This treatment is done immediately following the discectomy—during the same operation—and does not require any additional incisions or time in the hospital.
If you have any questions about the Barricaid treatment or how to get access to Barricaid, you may ask your doctor or contact us directly.
For full benefit/risk information, please visit: https://www.barricaid.com/instructions.
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