Discectomy Surgery

There are several categories of discectomy procedures, which are based on the location of the affected disk(s):

 

• Lumbar Discectomy: This refers to discectomy surgeries performed on the lower back, usually leveraging a posterior (back) approach to accessing the vertebrae.
• Cervical Discectomy: This refers to discectomy procedures in the neck region. These are often characterized by anterior (front) access under the chin.
• Thoracic Discectomy: This describes discectomy surgeries performed on the mid-back. While less common than lumbar or cervical procedures, thoracic discectomies may be recommended for severe mid-back pain relief. They often utilize lateral access from the side of the body.

 

Types of Discectomy

Discectomy surgery can relieve pressure on nerves, disks and the spinal cord caused by a herniated disk or other conditions. Houston Methodist surgeons use the most advanced surgical techniques available to help reduce pain, prevent permanent injury to the spine and restore function, whenever possible.

Our spine surgeons have the expertise needed to successfully perform delicate discectomy procedures such as:

Microdiscectomy

Microdiscectomy is a minimally invasive spine surgery (MISS) that accesses the affected disk through a small incision in the back. A microscope guides the surgeon to locate the disk and remove all portions that are compressing the spinal nerve. This approach is most common for lumbar discectomies. While microdiscectomy is performed under general anesthesia, it is considered an outpatient procedure, with patients typically returning home on the same day.

Anterior Cervical Discectomy and Fusion (ACDF)

Anterior cervical discectomy and fusion (ACDF)  is a combination surgical procedure that incorporates both discectomy and spinal fusion to alleviate neck and arm pain. During ACDF, any disk material pressing on the nerves is carefully removed before the remaining vertebrae are fused together for greater stability. While this procedure only requires a small incision in the neck, patients can expect a short (1-2 day) hospital stay and a longer recovery period.

Endoscopic Discectomy

This minimally invasive surgery is performed by inserting a small camera through the incision to gain a clear picture of the affected disk and remove only the necessary amount of disk material. This procedure ensures minimal scarring and a quick recovery. It is typically performed under local anesthesia and patients can return home on the same day.

Microendoscopic Discectomy

Microendoscopic discectomy is similar to endoscopic discectomy in that it utilizes a small camera to see and operate on the affected disk. However, microendoscopic procedures use a tube/retractor system, typically have a slightly larger incision area, and are generally considered to be more invasive.

Open Discectomy

Open discectomy is a more traditional and more invasive approach to this type of spine surgery. In an open discectomy, the patient is placed under general anesthesia, and an incision (typically greater than 1 inch) is made in the back. In some cases, part of the vertebra may be removed to better access the disk (a procedure known as laminotomy). 

How Does a Discectomy Work?

Discectomy works by removing diseased or compromised portions of the disk material between the vertebrae. Removing this material helps alleviate compression of the nerves in and around the spinal column. This is an effective method for relieving neck and back pain, especially pain that radiates into the arms or legs.

To perform a discectomy, spine surgeons use highly specialized equipment to visualize the impacted area and remove only the necessary sections of disk material. This reduces muscle damage to the surrounding area, lessens the likelihood of scarring and promotes a quicker recovery.

In severe cases, the entire disk may need to be removed. In instances such as this, the surgeon may also perform a spinal fusion to connect two vertebrae together for improved stability.

Discectomy Success Rates

Discectomy surgery is known to have a high success rate, particularly in the case of microdiscectomy, which has been shown to have a success rate of up to 90%. Patients report that this type of surgery is highly effective at relieving radiating back and leg pain, but that it doesn’t appear to help as much with chronic low back pain. A majority of the time, discectomy procedures are successful the first time. Rarely, they may require a follow-up procedure.

What Conditions Does a Discectomy Treat?

Discectomy is suggested to treat several conditions that cause different types of back and neck pain. These conditions include:

Herniated Disk

Disk herniation occurs when the center of a vertebral disk pushes out through a crack in the exterior disk casing. Bulging disks are very similar, but do not break through the exterior. Both conditions cause shooting or radiating pain through the legs or arms, along with tingling, weakness and numbness as a result of nerve compression.

Degenerative Disk Disease

Degenerative disk disease (DDD) is an age-related spinal condition in which the disk material between vertebrae breaks down and loses its ability to provide cushioning and shock absorption. This causes pain that worsens with certain types of movement, like bending or twisting. DDD can sometimes be managed with nonsurgical treatment like physical therapy, but in severe cases, discectomy may be recommended.

Cauda Equina Syndrome

Cauda equina syndrome is a rare but serious condition in which the nerve roots at the base of the spine are severely compressed, resulting in extreme pain, saddle anesthesia (numbness in the groin and buttocks), weakness and incontinence. Severe herniation of a large lumbar disk is the most likely cause of this condition, and emergency discectomy may be recommended.

Radiculopathy

Commonly known as a “pinched nerve,” radiculopathy refers to the radicular (radiating) pain caused by nerve root compression. Radiculopathy may be caused by a herniated disk, spinal stenosis or bone spurs. Like other disk and spine conditions, radiculopathy is characterized by pain that spreads through the legs or arms, muscle weakness and pins-and-needles sensations in the hands and feet.

Sciatica

Sciatica is not a standalone condition, but rather a collection of symptoms, characterized by one-sided pain that shoots down the back, buttocks and thigh. Sciatica may be a result of many other spinal conditions, including disk herniation, spondylolisthesis, spinal stenosis or piriformis syndrome.

Who Qualifies for Discectomy Surgery?

Patients who qualify for discectomy surgery are generally those who have one of the spine conditions listed above, and for whom more conservative treatments have not been effective. Most spine specialists begin with a cautious treatment plan that may include physical therapy, epidural injections or medications. Surgical approaches usually aren’t considered until these efforts have been exhausted, and the patient has seen no improvement after 6-12 weeks.
The physician may recommend MRI or CT imaging to confirm the presence of a herniated disk or related condition that would benefit from discectomy surgery. Before scheduling the procedure, the physician may suggest further examination to ensure the patient is a good candidate for surgery.

Preparing for a Discectomy

To prepare for discectomy or microdiscectomy surgery, patients will need to consult with their surgical team. Recommended prep may include:

• Stopping blood thinners and other specific medications a week or two prior to surgery
• Fasting after midnight before the surgery
• Arranging for a driver to transport the patient to and from the surgery center
• Quitting or avoiding smoking beforehand
• Showering with antiseptic soap
• Completing pre-surgical testing, like X-rays or bloodwork
• Wearing loose, comfortable clothing the day of the surgery
• Preparing the home so it’s conducive to recovery

Recovering From a Discectomy

Recovery from discectomy surgery depends on the type of discectomy performed, but generally takes 4-6 weeks. Many patients will notice pain relief within days, but other symptoms, like numbness and tingling, may take significantly longer to resolve.

Many patients will go home with activity restrictions, including limits on bending, twisting and lifting for several weeks. While some patients can return to work in as little as a week, others with more physical jobs may need to wait six weeks or more.

Immediately after surgery, patients may notice some pain and tenderness around the incision site. They will need to keep the incision dry and clean as it heals, and contact their physician if they notice any redness, fever or swelling.

Across Houston, our patients have access to our expert neck, back and spine specialists so that you can get the best possible care personalized for your needs — without traveling far from home. Explore our footprint of locations in the Greater Houston area and suburbs below.