How Invasive Is a Discectomy?

When it comes to spinal surgery, patients often have concerns about the invasiveness of the procedures and their subsequent recovery. One such procedure is a discectomy, which is commonly performed to alleviate symptoms associated with a herniated disc. In this article we will examine the invasiveness of a discectomy, exploring the scope of the procedure, the process involved, and what patients can expect during their recovery.

The Procedure and Its Purpose

A discectomy is a surgical intervention aimed at relieving pressure on the spinal cord or nerves caused by a herniated disc. This condition occurs when the soft, gel-like material within the disc protrudes through a tear or rupture in the outer layer, resulting in the compression of nearby nerves and subsequent pain, numbness, or weakness. The primary goal of discectomy is to alleviate these symptoms by removing all or a portion of the damaged disc, thereby reducing pressure on the affected nerves and restoring normal function to the spine.

The invasiveness of a discectomy can vary depending on the technique used, and understanding these differences is crucial for patients considering this surgery.

Traditional Open Discectomy

A traditional discectomy is performed as an open surgery. This method requires a larger incision in the back through which the surgeon accesses the spine. Muscles are pulled aside, and a portion of the bone may be removed to reach the damaged disc. While effective, this approach is considered more invasive due to the larger incision and the potential for more significant muscle and tissue disruption.

Minimally Invasive Discectomy

Advancements in medical technology have led to the development of minimally invasive discectomy procedures. These techniques require smaller incisions and cause less damage to the surrounding tissues. Surgeons use specialized instruments and sometimes guidance from imaging technology to remove the herniated disc material with greater precision. 

Microdiscectomy

A microdiscectomy is a type of minimally invasive surgery that utilizes a microscope or magnifying instrument to view the disc and nerves. This allows for a smaller incision and less muscle retraction.

Endoscopic Discectomy

Endoscopic discectomy goes a step further by using a tiny camera (endoscope) to guide the surgery through even smaller incisions. This technique can significantly reduce back surgery recovery time and postoperative pain.

The Surgical Process

• Preparation – Prior to undergoing discectomy surgery, a patient typically undergoes a comprehensive preoperative evaluation, which may include a review of medical history, physical examination, and diagnostic imaging studies such as magnetic resonance imaging (MRI) or computed tomography (CT) scans. These assessments help the surgical team determine the appropriateness of the procedure and identify any potential anatomical abnormalities or risk factors that may influence the surgical approach.
• Anesthesia – Discectomy surgery is performed under either general anesthesia, which induces a temporary state of unconsciousness, or local anesthesia, which numbs the surgical site while allowing the patient to remain awake. The choice of anesthesia depends on various factors, including the patient’s overall health status, preferences, and the surgeon’s recommendation.
• Incision – Once the patient has been anesthetized, the surgeon makes a small incision over the affected area of the spine, typically using a minimally invasive approach whenever feasible. 
• Discectomy – With access to the spinal disc achieved, the surgeon carefully removes the portion of the herniated disc that is compressing the nerves or spinal cord. Specialized surgical instruments, such as microscopes or endoscopes, may be used to enhance visualization and precision during this step of the procedure.
• Closure – Once the discectomy is complete, the surgical incision is closed using sutures, staples, or adhesive strips. The wound is then dressed, and the patient is monitored in the recovery area before being transferred to a hospital room or discharged home, depending on the individual’s postoperative condition and the surgeon’s recommendations.

Weighing the Pros and Cons

While any surgical procedure inherently involves some degree of invasiveness, advancements in medical technology and surgical techniques have significantly reduced the trauma associated with discectomy surgery. Minimally invasive approaches, characterized by smaller incisions and specialized instrumentation, have become increasingly popular for treating herniated discs due to their potential benefits, including:

• Reduced tissue trauma – Minimally invasive discectomy techniques typically result in less disruption to surrounding tissues and muscles compared to traditional open surgery. This can lead to decreased postoperative pain, shorter hospital stays, and quicker recovery times for patients.
• Enhanced precision – Minimally invasive surgical instruments, such as endoscopes and microscopes, allow surgeons to visualize the surgical site with greater clarity and magnification. This enables precise removal of the herniated disc material while minimizing damage to adjacent structures, such as nerves and blood vessels.
• Faster recovery – Due to the reduced tissue trauma and smaller incisions associated with minimally invasive discectomy, patients often experience faster recovery times and can return to their normal activities sooner than those undergoing traditional open surgery. This can have significant quality-of-life implications for individuals seeking relief from debilitating symptoms caused by herniated discs.

However, it is important to acknowledge that no surgical procedure is without risks, and patients considering discectomy surgery should weigh the potential benefits against the possible complications and outcomes. Common risks associated with discectomy surgery include:

• Infection – Despite rigorous sterile techniques and preventive measures, there is always a risk of infection following any surgical procedure. This risk can be minimized through proper wound care, antibiotic prophylaxis, and adherence to postoperative instructions.
• Bleeding – While rare, excessive bleeding or hemorrhage can occur during or after discectomy surgery, particularly in patients with preexisting bleeding disorders or those taking blood-thinning medications. Surgeons take precautions to minimize bleeding during the procedure and may use cautery or other hemostatic techniques as needed.
• Nerve damage – Although discectomy is performed to relieve pressure on compressed nerves, there is a small risk of inadvertent injury to nearby nerve structures during the surgical dissection. Surgeons exercise caution and employ meticulous techniques to minimize the risk of nerve damage, but it remains a potential complication that can result in sensory or motor deficits postoperatively.
• Anesthesia complications – General anesthesia carries inherent risks, including adverse reactions, respiratory depression, and cardiovascular complications. Patients undergoing discectomy surgery are carefully screened for underlying medical conditions that may increase their risk of anesthesia-related complications, and anesthesia providers closely monitor vital signs throughout the procedure to ensure patient safety.

Navigating the Path to Healing

Following discectomy surgery, patients typically experience a period of recovery and rehabilitation as they gradually regain strength, mobility, and function in the affected area of the spine. The specific recovery timeline and rehabilitation program may vary depending on factors such as the extent of the surgery, the patient’s overall health status, and any preexisting medical conditions. However, several general principles and guidelines apply to most individuals undergoing discectomy surgery:

• Postoperative care – Immediately following discectomy surgery, patients are closely monitored in the recovery area by nursing staff and anesthesia providers to ensure their safety and comfort. Pain management strategies, including oral medications, intravenous (IV) analgesics, and regional nerve blocks, may be employed to alleviate postoperative discomfort and facilitate early mobilization.
• Activity restrictions – While it is essential for patients to gradually resume their normal activities and daily routines following discectomy surgery, certain precautions and activity restrictions may be necessary to prevent complications and promote healing. Patients are typically advised to avoid heavy lifting, bending, twisting, or strenuous activities for a specified period following surgery to minimize stress on the surgical site and reduce the risk of reinjury or complications.
• Physical therapy – Physical therapy plays a crucial role in the rehabilitation process following discectomy surgery, helping patients restore strength, flexibility, and range of motion in the spine while promoting proper body mechanics and posture. Depending on the individual’s specific needs and postoperative condition, physical therapy may begin shortly after surgery or once the initial postoperative recovery period has passed. Physical therapists work closely with patients to develop personalized exercise programs and rehabilitation protocols designed to address their unique goals and challenges, gradually increasing the intensity and complexity of exercises as tolerated.
• Pain management – While some degree of discomfort and soreness is common following discectomy surgery, effective pain management strategies can alleviate symptoms and improve patient comfort during the recovery process. This may include a combination of prescription medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and opioid analgesics, as well as non-pharmacological interventions, such as ice therapy, heat therapy, transcutaneous electrical nerve stimulation (TENS), and acupuncture.
• Gradual return to activities – As patients progress through the recovery and rehabilitation process, they are encouraged to gradually resume their normal activities and daily routines in a controlled and gradual manner. This may involve returning to work, driving, doing household chores, and enjoying recreational activities with modifications as needed to accommodate any ongoing symptoms or physical limitations. It is essential for patients to listen to their bodies, pace themselves, and avoid overexertion or activities that exacerbate pain or discomfort.
• Long-term follow-up – Following successful recovery from discectomy surgery, patients typically undergo periodic follow-up appointments with their surgeons to monitor their progress, address any concerns or complications, and assess the long-term outcomes of the procedure. These follow-up visits may include physical examinations, imaging studies, and discussions about ongoing pain management, rehabilitation, and lifestyle modifications to maintain spinal health and prevent recurrence of herniated disc symptoms.

Discectomy surgery remains a valuable treatment option for individuals suffering from debilitating symptoms associated with herniated discs. While the procedure is inherently invasive, advancements in surgical techniques and technology have significantly reduced the trauma associated with discectomy, resulting in shorter recovery times, fewer complications, and improved outcomes for patients. However, surgery is not without risks, and patients should carefully consider their treatment options, weighing the potential benefits against the potential risks and complications. Ultimately, the decision to undergo discectomy surgery should be made in collaboration with a qualified healthcare provider, based on a thorough evaluation of the patient’s condition, preferences, and treatment goals. With proper education, guidance, and support, individuals can make informed decisions about their spinal health and take proactive steps to regain control of their lives.

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 discectomy. 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 done 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.