Watkins Medical Centre
Level 8, 225 Wickham Terrace,
Spring Hill QLD, 4000

All appointments
Phone: (07) 3831 7034

 

Lumbar discectomy   

 

Discectomy (sometimes also referred to as microdiscectomy) is an operation that involves removal of part of the intervertabral disc.The procedure is performed for a disc herniation. Disc herniations cause pain in the limb (sciatica if in the leg) by means of the compression and inflamation of the nerve that normally supplies the feeling to that limb.

 

 

 

The operation

The surgery is peformed under general anaesthetic. A small vertical  incision (a few centimetres) is made in the midline over the area of the herniated disc. An x-ray is used to confirm that the appropriate level is being operated on. The disc is approached via the spinal canal. This involves some manipulation of the cauda equina and the nerve root.

 

 

Complications

  1. Nerve damage
  2. Infection
  3. Failure to relieve pain
  4. Recurrent disc herniation
  5. Cerebrospinal fluid leak

Post operative course

Usually you will wake and the leg pain will have gone. It is usual that some pins and needles may be present and even that these may be worse after the surgery. These usually settle in a few days. There will be some wound pain, though for the first few hours this is usually controlled by local anaesthetic that is injected into the wound at the end of the procedure. After this wears off pain control is usually managed by a patient controlled analgesia device (PCA) There will usually be a wound drain. The PCA and the wound drain are usually removed after 24 hours. After that pain control is usually by a tablet or injection. You are then encouraged to get out of bed and to mobilize. You can be discharged when you are comfortable and independant enough to do so. This varies from patient to patient though is usually between 1 - 4 days.

 Preventing recurrent disc herniation

The most important thing to avoid in the first 4 weeks after surgery is an early recurrent disc herniation. As the fragment(s) of prolapsed disc have been removed from the tear in the disc there will be a 'hole' in the outside of the disc (the annulus). Until this hole heals with scar tissue (about 4 - 6 weeks) there is a risk of a recurrent herniation of disc material through the 'hole'. It is important that whilst healing is occuring that you avoid things that increase pressure in the disc. The most important things that increase disc pressure are:

    1. sitting without a back support
    2. driving
    3. bending and lifting

      These activities should therefore be minimized within the first 4 weeks.

      Time off work

      If you are in sedentary work, or can return to light duties initially you should be able to manage part time work in three weeks. Everyone will be different and exactly how part time you are will depend on your progress. Most people should be at full duties in a sedentary or moderate level job by six weeks. If you are in a heavy job you will need to do some gymnasium work before the heavier parts of your job are recommenced at about 8 weeks post operatively.

      Success rate

      It is difficult to accurately define the succes rate of the procedure in general. Elements that affect the success rate are the size and type of  disc prolapse. When the tear in the annulus is narrow and the height of the disc is otherwise good, success rates are 90% + . At the other end of the spectrum when there is a very broad based disc bulge with a narrowed disc space the reuslts are not as good.  In some series as low as about 65%. In these cases fusion may be considered as an alternative. The risk of recurrent disc herniation is dependant on occupation with the rate being high (about 25%) in heavy manual labourers and low (about 2-5%) in sedentary workers.

      Long term consequences

      At 10 years there is a slightly higher chance of having back pain than the general population. This chance is the same as in patients who recover from disc herniation without surgery.