Spine surgery has many variations, which are largely based on what applies to each individual patient's particular situation. When it comes to surgery to address nerve pain or sciatica-related symptoms stemming from a herniated disc, two common options are a microdiscectomy and a laminectomy. In some situations, both of these procedures may be performed together. This article discusses the possibilities.
Accessing the Surgical Site
With a herniated disc, the lower back is often the affected area. If the problem disc is in this area, there may be a need to take certain steps to safely access the surgical site. The two most common options are:
• Removing part of a spinal joint called a facet joint
• Removing part of a vertebral bone called the lamina—referred to as a laminectomy—or making a small opening in this bone
In this situation, the main purpose for doing a laminectomy when a microdiscectomy is performed is to have enough room to remove protruding disc material safely and effectively. This added precaution also reduces the risk of unintentional damage to nearby spinal structures or nerve roots.
Creating More Space for Nerves
Another reason a microdiscectomy may be performed with a laminectomy is to reduce the risk of still having nerve-related symptoms after the surgery is performed. This may happen if what is left of the affected disc shifts or moves enough to irritate another nerve. To reduce the risk of this happening, a portion of the back part of a spinal bone may be removed. This creates more space in the spinal canal for nerves and spinal discs to exist in the same space without coming into direct contact with one another.
Doing a Standalone Microdiscectomy
More commonly, a surgeon will recommend a microdiscectomy without also needing a laminectomy. This is more likely to be the case if the nerve irritation is fairly minor or if only a small portion of protruding disc material needs to be removed.
In some instances, disc removal is performed with endoscopic techniques involving specialized instruments and tools. Because of the increased ability to precisely access the affected disc with this approach to a microdiscectomy, there is no need to remove bones and muscles to remove part of the herniated disc. For this reason, an accompanying laminectomy is usually not required if a microdiscectomy is performed endoscopically.
Determining Patient-Specific Needs
Every situation is unique to some extent with spine surgery. For a herniated spinal disc, image tests and other specialized tests are often performed prior to surgery. This is done to determine the most appropriate way to relieve nerve pressure linked to a herniated disc. This could mean only performing a microdiscectomy. However, for other patients, it may make more sense to remove part of the lamina as well.
Although discectomy surgery is generally a very successful procedure, a hole is left in the outer wall of the disc. Patients with a large hole in the outer ring of the disc are more than twice as likely to reherniate after 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 microdiscectomy. In a large-scale study, 95 percent of Barricaid patients did not undergo a reoperation due to reherniation in the 2-year study timeframe. This treatment is performed 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, ask your doctor or contact us at 844-288-7474.
For full benefit/risk information, please visit: https://www.barricaid.com/instructions.