When a damaged or herniated spinal disc requires surgical attention, two procedures are often mentioned—a discectomy and spinal fusion surgery. While these back surgeries are sometimes performed together and within the same general location, they are not the same thing. In fact, a discectomy and a fusion are entirely different procedures, although the goal of both is to ease pain and improve overall quality of life.
Classified as a decompression procedure, the purpose of a discectomy or a less invasive microdiscectomy is to relieve nerve pressure, compression, or irritation. This goal is achieved by removing the portion of the herniated disc that is affecting a nearby nerve. It is more common today for the surgeon to leave as much of the disc material in place as possible when a discectomy is performed.
During a fusion procedure, adjacent vertebrae are permanently joined or "fused" together with bone graft material and specially designed hardware. The main purpose is to restore or maintain spinal stability. A fusion is often performed in conjunction with a decompression procedure like a discectomy, or it may use a spacer to achieve indirect compression. A fusion may also reduce the risk of nerve-related pain by limiting spinal motion in a certain area.
When These Surgeries Are Combined
It is possible to have a discectomy as a standalone procedure, and vice versa. The confusion over these two surgeries largely comes from a time when it was not unusual for both operations to be performed together. It may still be necessary to do this if the spine becomes unstable after a discectomy is done. This is more likely to be the case if the entire disc is removed.
Avoiding a Fusion when Having a Discectomy
Fusions have a long history of being fairly reliable, and techniques and technologies involved with the procedure have improved. Still, there is an understandable concern some patients have about the limited motion that results from a fusion. It is also a more invasive surgery. This is one of the reasons it is increasingly common to only remove protruding material when a herniated disc is the reason for disc surgery. By leaving as much of the disc in place as possible, it is not as likely a fusion will be necessary. Inserting an artificial disc in place of a fully removed disc is another way to maintain motion and avoid fusion surgery.
Determining What Is Right for You
With a lumbar herniated disc, it is more common today for a discectomy to be recommended than a fusion if nonsurgical treatments are not effective. Part of the reason is because a discectomy is less invasive and preserves full spinal motion. This largely depends on factors that typically include:
• The nature of the damage to the disc
• Where the problem disc is located
• Whether or not spinal stability can be maintained
• The size and location of the herniation
• Your general lifestyle (e.g., level of activity, goals with surgery, etc.)
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 the risk of reherniation, 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 at 844-288-7474.
For full benefit/risk information, please visit: https://www.barricaid.com/instructions.