Surgical Treatment for Disc Herniations
MICROSURGICAL LUMBAR DISCECTOMY
One's decision to undergo surgery is based on continued or worsening pain, altered sensation, or weakness despite conservative treatment. The patient understands that further non-operative measures are possible however, due to the severity of symptoms, the patient elects to pursue surgical treatment. The normal anatomy, as well as that of nerve compromise from a disc herniation or stenosis is illustrated in the figures below.
The disc is a cushion or shock absorber between the vertebral bodies or bones of the spine. Comprised of a strong outer wall or annulus with a softer more compressible interior, the disc allows for motion and flexibility without pain. Degeneration of this structure may lead to fissures developing in the outer wall allowing the softer interior to extrude or herniated similar to jelly out of a jelly donut. Nearby nerves are therefore at risk of compression by the disc fragments.
The goal of surgery is to remove the offending disc material and take the pressure off of the local nerve. Sometimes a small window of bone is removed from the lamina to gain entrance into the nerve canal. Except for the dislodged fragments, most of the remaining disc material will be left to function as the normal cushion. A small incision will be utilized for the microsurgical procedure and then closed with dissolvable stitches. If more than one level is compressed, the entire lamina or several may be removed to fully decompress the spinal canal.
Risks include, but are not limited to, failure to relieve symptoms, worsening of symptoms, paralysis, weakness, numbness, bowel bladder or sexual dysfunction, spinal fluid leak, meningitis, infection, scarring, recurrent disc herniation or nerve symptoms, instability, need for further surgery, anesthesia complications, vascular injury, blood clots, and death.
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