Surgery of a Herniated Disc

Herniated Disc Surgery

What is a Herniated Disc?

Herniated disc surgery is one of the many treatment options available to those suffering with a herniated disc. This type of surgery is usually performed by a neurosurgeon. Other treatment options include, physical therapy, chiropractic and acupuncture, to name a few. The severity of the injury and the degree of pain will usually dictate the type of treatment that is best. Fortunately, there are many treatment options for those with this condition.

A herniated disc refers to a condition affecting an intervertebral disc that separate vertebral bones, or vertebral bodies, in the spine. There are 24 vertebral bones separated by 23 intervertebral discs in the adult spine. A disc herniation occurs when the outer covering of the disc, known as the annulus fibrosis, tears. When this happens the gel-like interior of the disc, known as the nucleus pulposus, can ooze through the torn annulus fibrosis.

When this happens, the extruded nucleus pulposes can create painful pressure on adjacent nerve roots. This material can also chemically irritate nerve roots, causing pain. The severity of a patient’s symptoms depends on a number of factors, including the amount and location of the material extruded.

What Are The Symptoms Of A Herniated Disc?

The symptoms of a herniated disc can vary according to the site and size of the herniation. Traumatic injury to the spine or age-related degeneration can cause a disc to herniate. Oftentimes a combination of both can cause a disc to herniate. In fact, the chances of having a disc herniation increases as you age because of the normal degeneration of the spine associated with aging.

Some disc herniations are completely asymptomatic – or without any symptoms. In other cases, however, this condition can be extremely painful, requiring extensive medical treatment and, at times, surgery. If you do need disc surgery, your doctor may refer you to a neurosurgeon, a type of surgeon who specializes in conditions of the central and peripheral nervous systems.

Nerve root involvement associated with a herniated disc will usually result in greater discomfort. Nerve root involvement occurs when a disc compresses a nerve root. When this happens, symptoms can include sharp pain, numbness, tingling, and weakness of an extremity. These symptoms are consistent with a condition known as radiculopathy. You may be referred to a neurologist, if you are experiencing these types of symptoms.

Radiculopathy can occur at any level of the spine and impair the peripheral nervous system, causing a condition known as referred pain. When this happens, a patient experiences pain in a leg or arm, although the actual cause of the pain may be a compressed spinal nerve in the back or neck that is impairing the peripheral nervous system. Your doctor may use an EMG/NCV study to test for this condition.

How Is A Herniated Disc Diagnosed?

Magnetic Resonance Imaging or MRI is the diagnostic tool of choice for doctors who think you may have a herniated disc. An MRI examination is a painless procedure that provides your doctor with very detailed images of the inside of the body.

An MRI of your neck or back can help your doctor can determine whether you have a herniated disc, or some other condition affecting your spine. Your spinal cord, nerve roots as well as degenerative conditions can all be visualized with an MRI.

Non-Surgical Treatment For Disc Herniation

Conservative treatment, including physical therapy, can be used to manage a disc herniation that is mildly symptomatic. In addition, your doctor may recommend that you engage only in light activities for some period of time, to avoid a flare up of your condition. Your doctor may also suggest certain exercises to help decrease spinal stiffness and increase your range of motion.

Non-Steroidal Anti Inflammatory Drugs, or NSAIDs are the drugs of choice for patients with a herniated disc. These include medications like Naproxen, Ibuprofen as well as many others.

Consultations with a chiropractor, physical therapist and acupuncturist may be helpful. The treatment offered by these health care providers can be very effective in helping to promote healing. Your health care provider should carefully evaluate your condition and create a treatment plan tailored to relieve your symptoms.

An effective treatment plan may include: spinal manipulation; stretching exercises; electrical muscle stimulation; massage, and ice and heat therapy. Together, these can represent effective non-surgical modalities of treatment for disc herniation. 

Surgical Treatment of Herniated Disc

Most often, herniated discs are treated without surgery. However, if conservative treatment fails, a patient may be a candidate for herniated disc surgery. While the decision to undergo surgery should always be made after speaking with your doctor, these are some factors that suggest you may be a candidate for this type of surgery:

• chronic and progressive pain limiting normal activities;
• progressive worsening of neurological deficits;
• loss of normal bowel and bladder function;
• difficulty standing or walking; and
• limited response to medication and physiotherapy.

Common Types of Herniated Disc Surgery

Discectomy: This type of surgery involves the partial and/or full removal of the disc that causes pressure on the spinal nerves. At times a patient who undergoes a discectomy will require a spinal fusion.

A spinal fusion involves fusing two or more vertebra permanently. To do this, your surgeon will use bone harvested from other parts of your body or cadaver bone, to fuse vertebral bones. Metal screws and rods are used to stabilize the fused vertebrae. The part of your spine fused, is permanently immobilized after the surgery. This procedure requires admission to a hospital for several days.

Microdiscectomy: This is a newer, less invasive counterpart of the discectomy procedure, and is done via a smaller incision created with specialized instruments for the removal of a herniated disc. It is done with the help of an endoscope and magnification of the operative field. It usually is associated with a shorter period of recovery, and can be done on an outpatient basis in some cases. 

Disc Replacement Surgery/ Artificial Disc Surgery: This procedure involves the removal of the damaged disc, and its replacement with an artificial plastic or metallic disc. This procedure is done under general anesthesia.

Each of these procedures is associated with certain risks and benefits, depending on your medical and surgical history. It is important that you meet with your surgeon, and ask any questions you may have to ensure that you understand the which procedure is being proposed, and what you can expect based upon your own medical and surgical history.

Post-Surgical Rehabilitation

Pain is common after spinal surgery and can be managed with analgesics and other types of medication. You should expect your pain to diminish as the days pass following your surgery. Your surgeon will schedule an appointment for you to be seen soon after your surgery, to monitor your progress, check for infection, and assess your condition.

As you begin to feel better, your surgeon may recommend that you begin a course of physical therapy to help you regain muscle strength after your surgery.