What Are the Contraindications for Discectomy?

Discectomy is a surgical procedure that involves the removal of a portion of an intervertebral disc that is pressing on nerve roots or the spinal cord. It is typically performed to relieve pain, numbness, and weakness associated with disc herniation or degeneration. 

While discectomy can offer significant relief for individuals suffering from disc-related issues, not everyone is a suitable candidate for it. Identifying contraindications is crucial to prevent complications and ensure optimal outcomes for patients undergoing this procedure. This article discusses the circumstances in which the risks may outweigh the potential benefits. 

Common Contraindications for Discectomy Procedures

Certain conditions may preclude patients from undergoing discectomy due to the risk of serious complications or adverse outcomes. These include:

• Uncontrolled medical conditions – Patients with uncontrolled medical conditions such as diabetes, hypertension, or heart disease may not be suitable candidates for discectomy due to the increased risk of surgical complications. These conditions can impair wound healing, increase the risk of infection, and complicate anesthesia management.
• Active infections – Active infections in the body, including urinary tract infections, respiratory infections, and skin infections, can increase the risk of postoperative complications and may contraindicate discectomy until the infection is resolved. Surgery in the presence of an active infection can lead to systemic spread of the infection, delayed wound healing, and an increased risk of implant-related infections.
• Severe obesity – Obesity can pose challenges during surgery and increase the risk of complications, such as wound healing problems, infections, and blood clots. In some cases, severe obesity may contraindicate discectomy unless weight loss measures are implemented. The excess weight can make surgical access difficult, prolong operative times, and strain the cardiovascular and respiratory systems.
• Spinal instability – Patients with significant spinal instability, such as spondylolisthesis or spinal fractures, may not be suitable candidates for discectomy alone. Additional spinal stabilization procedures such as spinal fusion surgery may be necessary to address the underlying instability before or concurrently with discectomy. Performing a discectomy without addressing spinal instability can lead to recurrent disc herniation, worsening of symptoms, and spinal deformity.
• Inadequate symptom relief – In cases where the patient’s symptoms are not primarily attributed to disc herniation or where conservative treatments have been effective in managing symptoms, discectomy may not be recommended. It is important for patients and healthcare providers to thoroughly evaluate the underlying cause of symptoms and consider alternative treatment options before proceeding with surgery.
• Psychological factors – Mental health conditions can significantly impact recovery and the perception of pain post-surgery. Conditions such as depression and anxiety need to be managed before considering surgery.

Situational Contraindications

Some situations temporarily contraindicate discectomy until the condition changes or resolves:

• Pregnancy – Due to the risks to the fetus and the anatomical changes that occur during pregnancy, elective spinal surgery is generally avoided.
• Age – Very young patients or those of advanced age may face increased risks from surgery and anesthesia due to developing or declining physiological reserves.

Individualized Assessment

It is important to note that the decision to undergo discectomy surgery should be based on a thorough evaluation of each patient’s unique circumstances. A comprehensive assessment by a qualified healthcare professional, including a review of medical history, imaging studies, and physical examination, is essential to determine the appropriateness of a discectomy and identify any contraindications. Consultations with specialists in cardiology, pulmonology, or hematology may be necessary for patients with underlying conditions.

Consultation with a Spine Specialist

A patient considering discectomy should consult with a spine specialist, such as an orthopedic surgeon or neurosurgeon, who can provide expert guidance and personalized recommendations based on the individual’s specific condition and medical history. A thorough discussion of the potential risks, benefits, and alternatives to surgery should be part of the decision-making process.

Alternative Treatments

For those who are not candidates for a discectomy, alternative treatments may provide relief. These can include pain management strategies, chiropractic care, acupuncture, and, in some cases, less invasive surgical options, such as microdiscectomy.

Postoperative Considerations

Even when a discectomy is successfully performed, postoperative care is crucial. Patients need to be aware of the signs of infection, the importance of following rehabilitation protocols, and the need for regular follow-up appointments.

A discectomy can be a life-changing procedure for those suffering from the pain of a herniated disc. However, it is not a one-size-fits-all solution. Careful evaluation of contraindications is a critical step in the surgical process, ensuring patient safety and optimizing surgical outcomes. Patients should openly converse with their healthcare providers to fully understand the risks and benefits before proceeding with surgery.

Although discectomy surgery is generally a very successful procedure, patients with a larger hole in the outer ring of the disc have a significantly higher risk of reherniation following surgery. Often, the surgeon will not know the size of the hole until he or she begins surgery. A new treatment, Barricaid, which is a bone-anchored device proven to reduce reherniations, was specifically designed to close the large hole often left in the spinal disc after discectomy. This treatment is done immediately following the discectomy—during the same operation—and does not require any additional incisions or time in the hospital. In a large-scale study, 95 percent of Barricaid patients did not undergo a reoperation due to reherniation in the 2-year study time frame. 

If you have any questions about the Barricaid treatment or how to get access to Barricaid, ask your doctor or contact us today.

For full benefit/risk information, please visit: https://www.barricaid.com/instructions.