Open lumbar discectomy is a surgical procedure used to treat herniated discs in the lower back. This technique has been the gold standard for treating lumbar radiculopathy or sciatica for decades. In this comprehensive guide, you will learn about the intricacies of open lumbar discectomy, its benefits, risks, and what patients can expect during the recovery process.
What Is Open Lumbar Discectomy?
Open lumbar discectomy is a surgical procedure that involves making an incision in the lower back to remove herniated disc material. This technique allows surgeons to directly visualize and access the affected area of the spine. The primary goal of this surgery is to alleviate symptoms such as leg pain, numbness, and weakness associated with lumbar radiculopathy or sciatica.
The Anatomy of the Spine
To understand open lumbar discectomy, it is essential to have a basic knowledge of spinal anatomy:
- Vertebrae - The backbone consists of a chain of bones called vertebrae.
- Spinal cord - This crucial component of the nervous system runs through the spinal column.
- Intervertebral discs - These cushions sit between each vertebra, providing support and shock absorption.
- Nerve roots - Large nerves exit the spinal cord through small openings between the bones, transmitting signals to and from the body.
Indications for Open Lumbar Discectomy
Not all cases of back pain or herniated discs require surgery. Open lumbar discectomy is typically recommended when:
- Conservative treatments have failed to provide relief
- Symptoms persist for an extended period (usually 6 to 12 weeks)
- There is severe weakness or neurological deficits
- The patient experiences cauda equina syndrome, a rare but serious condition affecting bladder and bowel function
The Surgical Procedure
Open lumbar discectomy is performed under general anesthesia. Here is a step-by-step overview of the procedure:
- Positioning - The patient lies face down on the operating table.
- Incision - A 2–3 cm longitudinal midline incision is made over the affected interspace.
- Muscle retraction - The paraspinal muscles are separated to access the spine.
- Laminectomy - A small part of the lamina (bony arch of the vertebra) is removed.
- Ligament removal - The ligamentum flavum is removed to expose the nerve roots and intervertebral disc.
- Disc removal - The herniated portion of the disc is carefully removed under direct vision.
- Additional procedures - Bone spurs may be removed, and the spinal canal may be widened if necessary.
- Closure - The incision is closed in layers.
Advantages of Open Lumbar Discectomy
Open lumbar discectomy offers several benefits:
- Direct visualization - Surgeons can clearly see the affected area, allowing for precise removal of herniated disc material.
- Shorter operation time - Compared to minimally invasive techniques, open discectomy typically has a shorter duration.
- Versatility - The open approach allows for additional procedures if needed, such as removing bone spurs or widening the spinal canal.
Comparison with Microdiscectomy
While open discectomy has been the traditional approach, microdiscectomy has gained popularity in recent years. Here is a comparison of the two techniques:
- Incision size - Open discectomy requires a larger incision compared to microdiscectomy.
- Muscle trauma - Microdiscectomy causes less trauma to the paraspinal muscles.
- Visualization - Microdiscectomy uses a microscope for enhanced visualization.
- Operation time - Open discectomy is generally faster compared to microdiscectomy.
- Postoperative pain - Patients typically experience less back pain after microdiscectomy.
- Complications - Microdiscectomy is associated with fewer complications, such as dural tears and nerve root injuries.
Recovery and Postoperative Care
Recovery from open lumbar discectomy varies from patient to patient. Here are some general guidelines:
- Hospital stay - Patients may stay overnight for observation or be discharged the same day.
- Pain management - Postoperative pain is managed with medications.
- Mobility - Early mobilization is encouraged to promote healing and prevent complications.
- Physical therapy - A structured rehabilitation program may be recommended to increase strength and flexibility.
- Return to activities - Gradual return to normal activities is typically allowed within 4–6 weeks, depending on the patient’s progress.
Potential Risks and Complications
As with any surgical procedure, open lumbar discectomy carries some risks:
- Infection - Although rare, surgical site infections can occur.
- Bleeding - Excessive bleeding during or after surgery is a potential complication.
- Nerve root injury - Damage to nerve roots can lead to persistent pain or neurological deficits.
- Dural tear - A tear in the protective covering of the spinal cord may occur.
- Recurrent disc herniation - There is a small risk of the disc herniating again in the future.
Long-Term Outcomes
Open lumbar discectomy has shown favorable long-term outcomes for many patients. Studies have reported:
- Significant improvement in leg pain and function
- High patient satisfaction rates
- Successful return to work and daily activities for most patients
However, it is important to note that some patients may experience persistent or recurrent symptoms, and the success of the surgery can depend on various factors, including the severity of the herniation and the patient’s overall health.
Choosing between Surgical Options
The decision between open discectomy and minimally invasive techniques like microdiscectomy depends on several factors:
- Surgeon expertise - The surgeon’s experience and comfort level with each technique play a crucial role.
- Patient’s specific condition - The location and extent of the disc herniation may influence the choice of procedure.
- Patient preferences - Some patients may prefer a minimally invasive approach, while others may feel more comfortable with the traditional open technique.
Open lumbar discectomy remains an effective surgical option for treating herniated discs in the lower back. While minimally invasive techniques have gained popularity, the open approach still offers advantages in certain situations. The choice between surgical techniques should be made in consultation with a qualified spine surgeon, taking into account the patient’s specific condition, the surgeon’s expertise, and the potential benefits and risks of each approach.
As with any medical procedure, it is essential for patients to have a thorough understanding of the surgery, its potential outcomes, and the recovery process. By working closely with their healthcare teams, patients can make informed decisions about their treatment and achieve the best possible outcomes in managing their spinal health.
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 timeframe.
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.