Chronic lower back pain and leg pain radiating down the sciatic nerve can significantly diminish quality of life. When conservative treatments fail to provide relief, many patients turn to surgical intervention. Lumbar discectomy, one of the most common spinal procedures performed today, offers hope for those suffering from herniated or ruptured discs in the lower back. In this comprehensive guide, we take a closer look at how this surgical procedure is performed, what patients can expect, and how it restores mobility and comfort.
The lumbar spine consists of five vertebrae in the lower back, separated by intervertebral discs that act as cushions between the bones. These discs have a tough outer layer called the annulus fibrosus and a soft, gelatinous center known as the nucleus pulposus. When a disc herniates or ruptures, the inner material can push through the outer layer and compress nearby spinal nerves.
This compression often results in debilitating symptoms, including severe lower back pain, leg pain, numbness, tingling, and weakness. The sciatic nerve, which runs from the lower back down through the legs, is frequently affected by lumbar disc herniation. When physical therapy, medications, and injections do not adequately address these symptoms, a lumbar discectomy becomes a viable treatment option.
Before the surgical procedure begins, patients undergo thorough evaluation and preparation. The surgeon reviews imaging studies such as MRI or CT scans to pinpoint the exact location and severity of the disc herniation. These images help surgeons determine which disc or discs require intervention and whether any additional spinal issues need addressing.
On the day of surgery, patients receive general anesthesia, which means they will be completely unconscious throughout the procedure. In some cases, spinal anesthesia may be used instead. The anesthesia team monitors vital signs continuously to ensure patient safety. The surgical site is carefully cleaned and sterilized to minimize infection risk.
Surgeons typically perform lumbar discectomy using one of two main approaches: traditional open discectomy or minimally invasive microdiscectomy. Both methods achieve the same goal but differ in incision size and recovery time.
In a traditional open discectomy, the surgeon makes an incision approximately one to two inches long over the affected area of the spine. The length of the incision depends on the number of levels being addressed and the patient’s body type. The surgeon carefully moves aside the back muscles to access the spine. Special retractors hold the muscles and soft tissues out of the way during the procedure.
The minimally invasive approach has become increasingly popular due to its benefits. The surgeon makes a much smaller incision, often less than one inch in length. A tubular retractor creates a tunnel to the spine, and the surgeon uses a specialized microscope or endoscope to visualize the surgical area. This technique causes less disruption to surrounding muscles and tissues.
Regardless of the approach chosen, the next critical step involves accessing the herniated disc. To reach the disc, the surgeon must first remove a small portion of the lamina, the bony arch on the back of the vertebra. This step is called a laminotomy or partial laminectomy.
The surgeon uses specialized instruments such as rongeurs and drills to carefully remove just enough bone to create adequate space for accessing the disc and relieving pressure on the nerve. The goal is to remove the minimum amount of bone necessary while ensuring complete visualization and access to the herniated disc material.
Once the lamina has been partially removed, the surgeon can see the compressed nerve root. Using delicate instruments, the surgeon gently moves the nerve root aside to expose the herniated disc beneath it. This step requires extreme precision and care to avoid damaging the nerve, which could result in additional neurological problems.
Proper retraction is essential for both accessing the disc material and ensuring the nerve has adequate room once the compression is relieved. The surgeon may use small nerve root retractors designed specifically for this delicate task.
The core of the lumbar discectomy procedure involves removing the portion of the disc that is pressing on the nerve. The surgeon uses special instruments such as pituitary rongeurs and curettes to extract the herniated disc fragments. These instruments allow for precise removal of disc material while minimizing trauma to surrounding structures.
The surgeon removes not only the portion of the disc that has herniated but also any loose fragments within the disc space that could potentially herniate in the future. However, the surgeon leaves as much healthy disc material as possible to maintain spinal stability and function.
In some cases, the surgeon may also remove small bone spurs called osteophytes if they are contributing to nerve compression. The amount of tissue removed varies depending on the severity of the herniation and the individual patient’s anatomy.
After removing the herniated disc material, the surgeon carefully inspects the nerve root to ensure it is completely decompressed and can move freely. The nerve should appear healthy and no longer compressed or irritated. The surgeon may gently touch the nerve to confirm it has adequate space and mobility.
If any remaining disc fragments or tissue continue to compress the nerve, the surgeon removes them at this stage. Complete decompression is crucial for symptom relief and optimal surgical outcomes.
Once the surgeon confirms the nerve is adequately decompressed, the surgical site is thoroughly irrigated with sterile saline solution to remove any debris and reduce infection risk. The surgeon may place a small drain to prevent fluid accumulation, though this is not always necessary.
The muscles and soft tissues are allowed to fall back into their natural position. The surgeon closes the incision in layers using absorbable sutures for the deeper tissues. The skin is closed with either sutures or surgical staples, and sterile dressings are applied to the wound.
A typical lumbar discectomy procedure takes between one and two hours to complete, depending on the complexity of the case and the number of disc levels involved. Most patients can go home the same day or after an overnight hospital stay.
The success rate for lumbar discectomy is quite high, with studies showing that 80 to 90 percent of patients experience significant improvement in leg pain. Back pain relief may be less dramatic but still substantial. Most patients notice immediate relief from the sharp, shooting leg pain that characterized their preoperative symptoms.
Recovery from lumbar discectomy typically progresses faster than recovery from more extensive spinal surgeries. Patients can usually walk within hours of the procedure and return to light activities within a few weeks. Physical therapy plays an important role in rehabilitation, helping patients regain strength, flexibility, and proper body mechanics.
Full recovery generally takes between six weeks and three months, though individual experiences vary. Patients gradually resume normal activities under their surgeons’ guidance, with most returning to work within several weeks depending on the physical demands of their occupation.
Lumbar discectomy represents a well-established, effective surgical solution for patients suffering from herniated discs that have not responded to conservative treatment. Through careful removal of problematic disc material and decompression of affected nerves, this procedure offers significant pain relief and increased function for the vast majority of patients. While all surgeries carry risks, the benefits of lumbar discectomy often far outweigh these concerns for appropriately selected candidates. Understanding how the procedure is performed can help patients make informed decisions about their spinal health and approach surgery with greater confidence.
Although discectomy surgery is a common and generally quite successful procedure, patients with a large hole in the outer ring of the disc have a significantly higher risk of herniation following surgery. Fortunately, there is a new treatment specifically designed to close the large holes that are often left in spinal discs after discectomy surgery. Barricaid is a bone-anchored device shown to reduce reherniations, and 95 percent of Barricaid patients did not undergo a reoperation due to reherniation in a 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 today.
For full benefit/risk information, please visit: https://www.barricaid.com/instructions.