Lumbar Discectomy
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Key Takeaway
- A lumbar discectomy is a surgical procedure to treat a herniated disc, where the inner part of the disc leaks out and affects your spine.
- The soft, gel-like centre of a herniated disc can put pressure on nearby nerves and cause various complications.
- A lumbar discectomy has multiple surgical options, including minimally invasive procedures, which can treat specific kinds of disc herniation cases.
- Recovery outcomes are usually positive if you listen to your doctor’s advice, restrict your movements in the early weeks post-surgery, and attend rehabilitation sessions regularly.
What is Lumbar Discectomy?
A lumbar discectomy is a surgical procedure that removes part or all of an intervertebral disc in the lower back (lumbar spine). It is commonly performed to treat herniated discs, where the soft centre of the disc (nucleus) pushes through the outer ring (annulus). Timely treatment may help prevent severe complications that could affect your overall well-being.
While lumbar discectomies are typically performed as open surgeries, minimally invasive techniques such as microscopic and endoscopic procedures have also become popular alternatives.
Why is Lumbar Discectomy Performed?
Like the rest of your spine, your lower back is made up of several bones called vertebrae that provide stability to the upper body and protect the spinal cord. Between each vertebra are intervertebral discs that act as shock absorbers for the spine. An injury to your lower back can potentially damage the annulus, allowing the nucleus to leak out. Age-related degeneration can also weaken the discs, causing them to dry out and allowing the nucleus to bulge outward.
When the nucleus leaks, it can potentially press on nearby nerve roots extending from the spinal cord or even impinge on the spinal cord itself. The nucleus’s material may also cause nerve inflammation, leading to symptoms such as pain, numbness, tingling, or muscle weakness in various parts of the body.
In most cases, a lumbar discectomy is recommended only if nonsurgical treatment has not relieved the symptoms of a herniated disc. If you continue to experience significant muscle weakness, loss of mobility, or even a loss of bladder control, your back pain doctor or surgeon may recommend a lumbar discectomy as a possible treatment option. This decision also depends on your overall health status and lifestyle considerations.
There are several options to consider for your lumbar discectomy.
- Open surgery: Involves a surgeon making a large incision over the lower back to access the spine. Surrounding muscles and tissues are pushed aside to perform the necessary surgical procedures. This method is used for treating multiple herniated discs or more complex cases.
- Microdiscectomy: Also known as microdecompression surgery, microdiscectomy is a minimally invasive procedure that involves making small incisions on the back. A microscope with an attached light is used to examine the area, helping the surgeon to perform the procedure. It is often used to treat a single herniated disc.
- Endoscopic discectomy: A minimally invasive procedure that uses an endoscope to access and visualise the lumbar spine. The endoscope includes a camera and light that transmits a live feed to a monitor, guiding the surgeon during the procedure.
Essential Considerations for Lumbar Discectomy
Before undergoing a lumbar discectomy, your doctor will need to inform you of what you can expect before, during, and after the procedure.
Recovery Outcomes for Lumbar Discectomy
Depending on the surgical approach used for your lumbar discectomy, recovery can range anywhere from a few weeks to several months. Open surgeries may involve a longer recovery period compared to endoscopic discectomies or microdiscectomies, as they require a larger surgical incision and are sometimes used for more complex conditions. Your doctor will outline a recovery plan based on the procedure performed, and your progress will be monitored during and after surgery.Â
You may need to attend follow-up appointments so your doctor can evaluate your recovery and recommend any necessary adjustments. These may include changes to your prescriptions, updates to your rehabilitation plan, and other criteria that may arise based on your recovery process.
Risk Factors of Lumbar Discectomy
Like any medical procedure, a lumbar discectomy carries potential risks. It is important to understand these potential risk factors and ask your doctor any questions you may have about the procedure. Some risk factors include:
- Nerve damage
- Tissue damage, particularly to the dura, which protects the spinal cord
- Bleeding
- Possible infection
- Blood clots
- Recurrent disc herniation
- Damage to the spinal cord
Preparations for Lumbar Discectomy
During the initial consultation, the doctor will review your medical history and may conduct additional diagnostic tests to assess your suitability for the procedure. Further questions may also be asked to better understand your condition and help develop a treatment plan that is tailored to your needs.
The medical team will also explain the recommended treatment and provide general guidelines to help you prepare for surgery. You are encouraged to discuss your condition, possible risk factors, and how you can prepare for treatment with your doctor.Â
Before Lumbar Discectomy
The consultation session provides time for you to learn what to expect from the lumbar discectomy and how to prepare for it. Here are a few essential pointers to keep in mind before your procedure.
- Current health: Some medical conditions may increase the risk of complications after surgery. A comprehensive health screening helps your doctor plan your surgery. If you are currently on any medications, especially blood thinners, you may be advised to switch to other alternatives or stop taking them temporarily.
- Illness: If you feel unwell on the day of your surgery, inform your doctor immediately. If necessary, the procedure may be rescheduled to ensure your well-being.
- Fasting: You may be required to avoid food and drink for 6 hours before surgery. However, plain water is allowed to help you stay hydrated.
- Health evaluations: If you have upcoming dental or urinary procedures, rescheduling them may help to reduce the risk of infection or other complications.
- Post-surgery support: Once you are discharged, it is helpful to have someone assist you with daily tasks or accompany you when needed.
- Lifestyle changes: Avoiding smoking, reducing alcohol intake, engaging in regular physical activity, and attending follow-up appointments may support your recovery and overall health.
During Lumbar Discectomy
You will first be sedated or placed under general anaesthesia before the procedure begins. The procedure may vary depending on the type of lumbar discectomy your surgeon will perform.
Open Surgery
Once sedated, the surgeon will make an incision several centimetres long along the lower back. They will assess the extent of the herniation to determine the approach to the surgical procedure. To reach the herniated disc, the surgeon may perform a procedure called laminotomy, which involves removing small portions of spinal bone and ligament.
Once they determine the appropriate treatment for your herniated disc(s), the surgeon will carefully remove the herniated disc fragment. Finally, the incisions will be closed with stitches.
Endoscopic Surgery
Once the sedation takes effect, the surgeon will make either a single 1 cm incision or two 7 mm incisions. A guide wire is inserted and directed toward the herniated disc using fluoroscopy (a special X-ray). The endoscope is then threaded over the guide wire to provide a clear view of the lumbar spine, and the attached camera transmits a live feed to a monitor in the operating room. Other surgical instruments will be inserted through the endoscope to perform the surgery. In some cases, surrounding tissue, muscles, or structures may need to be gently moved aside to reach the affected area.
Once the extent of disc herniation is confirmed, the surgeon will repair the damage and perform additional treatments where needed. This may include removing small portions of spinal bone and ligament to reach the herniated disc or to resolve impingements and other related issues. After the procedure, the surgeon will close the incisions with stitches.
Microdiscectomy
After you are sedated, the surgeon will make a few small incisions on your lower back. The surgeon may need to move muscles and tissues aside to access the lumbar spine before positioning a surgical microscope with a light to visualise the area. Surgical tools will be used to carefully remove the herniated disc portion, relieving pressure on your nerves. A small amount of spinal bone and ligament may also be removed if required. Once complete, the surgeon closes the incisions with stitches.
After the entire procedure, the medical team will take you to the recovery room for observation before you can return to the ward.
After Lumbar Discectomy
You may be monitored for a period to ensure your recovery proceeds smoothly. However, early discharge may be considered depending on your condition. You should be mindful of the surgical area and minimise movements to support a smooth recovery. For example, avoid bending as it can strain the incision site and increase the risk of complications, including recurrent disc herniation. You will also be taught how to care for the surgical wound and keep it clean to minimise the risk of infection.
Pain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), may be prescribed to provide pain relief. Ensure that you take them at the recommended dosage to avoid complications.
Ensure that you also follow your doctor’s postoperative care instructions to ensure a smooth recovery with minimal complications.
- Limit movements around your lower back to prevent complications. This restriction may last a few weeks until your doctor clears you for physical therapy.
- Attend physical therapy sessions to gradually restore your lower back’s mobility and flexibility to normal levels. Your physiotherapist will recommend various active and passive exercises to facilitate your recovery.
- Wear a back brace to help support your posture and minimise complications.
- Avoid prolonged sitting. Break up long periods of inactivity with short walks and gentle stretches.
- Exercise regularly at home to promote your recovery and prevent gradual muscle degradation. Avoid overexerting yourself to reduce the risk of lower back strain.
- If you experience any sudden side effects from your medications, stop taking them and notify your doctor immediately.
- Have someone to assist you with daily activities during your recovery.
- Maintain a balanced diet and avoid smoking or alcohol, as these can hinder recovery.
- Keep a healthy weight to reduce pressure and weight on your lumbar spine.
Frequently Asked Questions
With proper rehabilitation and care, recovery from a lumbar discectomy can take between four weeks and several months.
A lumbar discectomy typically takes between one to two hours, although more complex cases may require additional time.
It may take several weeks of consistent physical therapy to restore your lower back’s mobility and flexibility. Your physiotherapist will provide you with ample support to facilitate your recovery, teaching you various passive and active exercises to help with your rehabilitation.
Our Orthopaedic Doctor and Surgeon for Lumbar Discectomy
Dr. Razmi
FAMS (Ortho) | M Med (Gen Surg) (SG) | FRCSEd (Gen Surg) | MBBS (SG)
Dr. Razmi, a practicing orthopaedic and spine consultant at Mount Elizabeth Novena Hospital.
Dr Razmi routinely performs discectomy (minimally invasive surgery), decompression surgery, spinal fusion, motion preservation surgery including dynamic stabilization and dynamic fusion technologies and lumbar and cervical disc replacements. He is the first surgeon in Singapore to perform stand-alone anterior approached spine fusion using the Synfix implant.
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