An operation performed on patients with a herniated (ruptured) disc in the lower back. Of the many patients who suffer leg pain due to this problem, only a small number will need to consider surgery as an option for treatment. At least 80% of the time the symptoms resolve regardless of the treatment.
In this surgery, the herniated part of the disc is removed which relieves leg pain. It is important to realize that the surgery is performed only for persisting leg pain. Pain in the middle of the lower back is rarely an indication for surgery of this type. Leg muscle weakness or skin numbness is a sign of nerve damage which has occurred due to the compression of the nerve. These problems will not be improved specifically by surgery to take the pressure off the nerve and after the operation in all likelihood these problems will persist for many months as the nerve regenerates very slowly.
In the operation only the small piece of disc causing compression will be removed (not the entire disc). The disc prolapse has occurred due to internal wearing within the disc and this will not be repaired by the surgery. This means that, in the future, back pain due to this disc wear may occur from time to time. This pain is not related to the discectomy operation and is rarely disabling.
How it’s done
If surgery is undertaken, it is usually performed as a minimally invasive procedure. The procedure can be performed as a day stay surgery, but most patients stay in hospital overnight. General anaesthesia is utilised and the surgery is performed through an incision of approximately 3cm.
Through gentle dissection under illumination and magnification, the interface between the nerve root and disc bulge is identified and the compressing fragment is removed. Only a small portion of disc is removed. The whole disc is not removed.
After the nerve is freed completely the operation is completed. Typically this takes about 1 hour to perform.
The likelihood of good/excellent relief of leg pain is 80-90%. Numbness is slow to recover and may persist for long periods. Weakness also may take up to 6 months to return to normal. Pins and needles usually start to improve immediately. Sensory changes and leg weakness are caused by compression of the nerve root and are signs of internal damage to the nerve itself. When the pressure is relieved from the nerve, although the pain may improve immediately, these signs of internal nerve damage may persist for a long time as the nerve fibres slowly recover over many months.
Patients who have a lumbar discectomy are typically in hospital for 1-2 nights. They are advised not to work for 4-6 weeks and recommendations on back and wound care are the same as in lumbar laminectomy.
Complications of surgery are uncommon however a full discussion of the risks and benefits of surgery will be undertaken by Assoc. Professor Richard Williams prior to the procedure.