Minimally Invasive Lumbar Discectomy
What is a lumbar discectomy?
Lumbar discectomy is a type of surgery to fix a disc in the lower back. This surgery uses smaller incisions than an open lumbar discectomy.
Your backbone, or spinal column, is made up of a chain of bones called the vertebrae. Your spinal cord runs through the spinal column. The bones help protect the cord from injury. Discs sit between each vertebra to provide cushioning and support. Large nerves called nerve roots lead from the spinal cord through small holes in the bones called foramen. These nerve roots send and receive signals to and from the body. The signals are sent to and from your brain through the spinal cord.
Sometimes, the outer wall of one of these discs may dry out and weaken with age or injury. When this happens, the soft, inner part of the disc bulges out. This is called a herniated or bulging disc. This bulging disc can press on the spinal cord and cause symptoms such as pain, tingling, or weakness in a nearby part of the body.
During a minimally invasive lumbar discectomy, an orthopedic surgeon takes out part of the damaged disc. This helps relieve the pressure on the spinal cord. Your surgeon can use different methods to do this. With one method, your surgeon inserts a small tube through the skin on your back, between the vertebrae and into the space with the herniated disc. He or she then inserts tiny tools through the tube to remove a part of the disc. Or a laser may be used to remove part of the disc. Unlike an open lumbar discectomy, the surgeon makes only a very small skin incision and does not remove any bone or muscle.
Why might I need a lumbar discectomy?
You may need this surgery if you have a herniated disc in your lower back that is causing symptoms. The symptoms may include weakness, pain, or tingling in the back area and in one of your legs.
Lumbar discectomy can’t be used to treat all cases of back pain. And not everyone with a herniated disc needs a lumbar discectomy. Your doctor might advise the surgery if you’ve tried other treatments but still have severe symptoms. Other treatments to try first include physical therapy and anti-inflammatory medications.
Talk with your doctor about the risks and benefits of minimally invasive surgery versus open surgery. Minimally invasive surgery may lead to less pain and faster recovery. But not all surgery centers can use this method.
What are the risks of a lumbar discectomy?
Every surgery has risks. Risks for this surgery include:
- Excess bleeding
- Blood clots
- Injury to nearby nerves
- Reaction to anesthetic agents
- Only temporary relief and need for another surgery
Your risks may vary depending on your age and your general health. Talk with your doctor about the risks that most apply to you.
How do I get ready for a lumbar discectomy?
Ask your doctor how you should plan to prepare for your procedure. Ask whether you should stop taking any medications ahead of time, like blood thinners. Do not eat or drink after midnight the night before your procedure.
Your doctor may order other imaging tests of your spine, like an MRI.
What happens during a lumbar discectomy?
There are several options for the surgery. Your surgeon can help explain the details of your procedure. It may take about 1 hour. Here is an example of what you might expect:
- You will receive a local anesthetic so that you won’t feel any pain or discomfort during the procedure. And you will still be awake. Or you may have general anesthesia and sleep through the procedure.
- A healthcare provider will carefully watch your vital signs during the procedure. This includes things like your heart rate and blood pressure.
- Your surgeon will make a small incision on your back, at the level of the affected disc.
- During the procedure, your surgeon will use a special type of X-ray to make sure of the correct location.
- Your surgeon will first insert a wire into the intervertebral space. Your surgeon will push a slightly larger tube over this wire, then a second, larger tube over that one. He or she may even push a third tube over the second one. This will gently push apart the tissue down to the vertebra. Eventually, your surgeon will remove all but the largest tube.
- Your surgeon will put special small tools through this tube, including a camera and a light.
- Your doctor will remove the herniated portion of the disc using small tools, performing any other needed repairs.
- The tools and tube are removed.
- A small bandage is placed to close your wound.
What happens after a lumbar discectomy?
The surgery is usually an outpatient procedure, which means you can go home the same day. You will probably need to stay for a couple of hours after the procedure. Make sure you have someone who can drive you home.
Your doctor will give you instructions about how you can use your back. You might need to limit lifting or bending. Your doctor might have you wear a back brace for a limited time after the procedure. Most people can go back to work within a week or so. You may need physical therapy after surgery to help strengthen your back.
You may see some fluid draining from your small incision. This is normal. Tell your doctor right away if there is a large amount of drainage from the incision site. Also call your doctor if you develop a fever or if you have a lot of pain in the area.
Sometimes, the procedure causes slightly more pain for a while, but you can take pain medications to relieve the pain. Usually this goes away quickly. Your pain should become less than it was before your surgery.
Make sure to follow all your doctor’s instructions and keep your follow-up appointments.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- The risks and benefits of the test or procedure
- When and where you are to have the test or procedure and who will do it
- When and how will you get the results
- How much will you have to pay for the test or procedure