Posterior Lumbar Discectomy Explained
Back pain affects up to 80 percent of adults at some point in their lives. When conservative treatments fail to provide relief, surgical intervention may become necessary. Posterior lumbar discectomy is a surgical procedure that helps patients find relief from debilitating back and leg pain caused by herniated discs in the lower back. In this article, you will learn what a posterior lumbar discectomy involves, why it is performed, how the procedure works, its benefits and risks, and what to expect during recovery.
Herniated Discs Explained
The spine consists of vertebrae (bones) stacked on top of each other, with discs between them that act as shock absorbers. Each disc has a tough outer layer (annulus fibrosus) and a gel-like center (nucleus pulposus). A herniated disc occurs when the soft inner material pushes through a tear in the exterior ring.
This protrusion can press on nearby nerves, causing pain, numbness, or weakness in the back and extremities. In the lumbar spine (lower back), herniated discs commonly affect the sciatic nerve, leading to sciatica, which is characterized by pain radiating down the leg.
When Posterior Lumbar Discectomy Is Considered
Doctors typically recommend posterior lumbar discectomy after nonsurgical treatments have proven ineffective, including:
- Rest and activity modification
- Physical therapy
- Anti-inflammatory medications
- Epidural steroid injections
Surgery becomes a consideration when:
- Pain persists despite several weeks of conservative treatment
- Neurological symptoms, such as progressive muscle weakness, worsen
- Bladder or bowel function is affected (cauda equina syndrome, which requires emergency surgery)
- Daily activities are significantly impaired by pain
MRI scans confirm a herniated disc is indeed the source of symptoms and locate the affected area.
What “Posterior Lumbar Discectomy” Means
Breaking down the term:
- Posterior - The surgical approach is from the back of the spine.
- Lumbar - The operation focuses on the lower back region.
- Discectomy - All or part of an intervertebral disc is removed.
Procedural Steps
A posterior lumbar discectomy typically follows these steps:
- Anesthesia - The patient receives general anesthesia and is positioned face down.
- Incision - The surgeon makes a small incision (1–2 inches) in the midline of the lower back.
- Tissue retraction - Muscles are carefully moved aside to create a pathway to the spine.
- Lamina exposure - The surgeon may remove a small portion of the lamina to access the disc space (laminotomy). Some situations require the removal of the entire lamina (laminectomy).
- Nerve root retraction - The protective covering of the spinal cord and nerve roots are gently moved aside.
- Disc removal - The surgeon removes the herniated portion of the disc that is pressing on nerve roots.
- Closure - The incision is closed with sutures or surgical staples.
The entire procedure typically takes 1–2 hours.
Microdiscectomy: A Modern Variation
A microdiscectomy is a minimally invasive variation of the traditional posterior discectomy. It utilizes a surgical microscope or magnifying instrument to provide enhanced visualization of the surgical field through a smaller incision.
Benefits of microdiscectomy include:
- Smaller incisions (often less than an inch)
- Less tissue trauma
- Reduced blood loss
- Faster recovery times
Studies suggest outcomes for traditional and microdiscectomy approaches are comparable over the long term, though the recovery process may be more comfortable with the minimally invasive technique.
Recovery and Rehabilitation
Hospital stay and immediate recovery
Most patients can return home the same day or after a single overnight stay. Before discharge, patients typically:
- Begin walking with assistance
- Receive education on proper body mechanics
- Learn wound care techniques
- Get prescriptions for pain management
Early recovery phase (first few weeks)
During the initial recovery period, patients should:
- Gradually increase walking distance
- Avoid prolonged sitting (more than 30 minutes)
- Abstain from bending, lifting (anything over five pounds), or twisting
- Begin gentle physical therapy exercises as directed
Long-term recovery (first few months)
As healing progresses, patients typically:
- Return to light work duties (often within a number of weeks)
- Begin more intensive physical therapy focusing on core strengthening
- Gradually resume daily activities
Most patients can return to full activities, including sports and exercise, within the first several months post-surgery, though individual recovery timelines vary considerably based on age, overall health, and adherence to rehabilitation protocols.
Risks and Potential Complications
As with all surgical procedures, posterior lumbar discectomy carries certain risks, including:
- Infection - Occurs in approximately 1–3 percent of cases
- Bleeding - Usually minimal
- Dural tear - May lead to cerebrospinal fluid leakage
- Nerve damage - Could result in numbness, weakness, or pain
- Recurrent disc herniation - Studies suggest recurrence rates of 5 to 15 percent
- Inadequate symptom relief - Not all patients achieve complete pain resolution.
The overall complication rate for discectomy is relatively low, with serious complications occurring in less than 5 percent of cases when performed by experienced surgeons.
Success Rates and Outcomes
Posterior lumbar discectomy has proven to be highly effective for appropriately selected patients:
- Approximately 85–90 percent of patients experience significant improvement in leg pain
- Success rates are highest when symptoms and imaging findings clearly correlate
- Outcomes are better when surgery is performed within six months of symptom onset
A landmark study published in JAMA found that while both surgical and nonsurgical treatment groups improved, those who underwent surgery reported faster relief of symptoms and greater satisfaction with their care.
Lifestyle Considerations after Recovery
To maintain spine health and reduce the risk of future disc problems, patients are advised to:
- Maintain proper posture during sitting, standing, and sleeping
- Develop core strength through appropriate exercises
- Practice proper body mechanics when lifting objects
- Stay physically active with spine-friendly exercises
- Quit smoking, as nicotine impairs disc nutrition and healing
When to Call Your Doctor after Surgery
Patients should contact their healthcare providers immediately if they experience:
- Fever over 101.5°F (38.6°C)
- Increasing pain not controlled by prescribed medications
- Redness, swelling, or drainage from the incision
- New or worsening weakness, numbness, or tingling
- Difficulty urinating or controlling bowel movements
Posterior lumbar discectomy is a well-established surgical procedure that has provided relief to countless patients suffering from herniated discs in the lower back. With appropriate patient selection, modern surgical techniques, and comprehensive rehabilitation, the vast majority of patients can expect significant improvement in their quality of life.
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.
Comments