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Surgical Options for Slipped Disc

In our earlier post on Herniated Disc or 'Slipped' Disc, we looked at the structure of an inter-vertebral disc and what a herniated disc is. Here, we will discuss when surgery is indicated in people with herniated disc(s) and what are the various surgical options available.

When is surgery an option?

In general, surgery is recommended when a ruptured disc is pinching a spinal nerve root(s) and you have:

  1. leg pain which limits your normal daily activities; or

  2. weakness in your leg(s) or feet; or

  3. numbness in your extremities; or

  4. impaired bowel and/or bladder function

When is surgery NOT an option?

In general, surgery is not an option when:

  1. your back and leg pain is not caused by a ruptured disc; or

  2. you do not have leg symptoms;

  3. there is a medical reason which prevents you from having surgery;

  4. medication which reduces swelling or relieves pain would provide you with adequate relief; physical measures would improve your condition>

Surgical options

Laminectomy and disectomy

By definition, a disectomy means removal of disc, and laminectomy means removal of the lamina, which is a bone that is part of the vertebra.

A discectomy is performed under general anesthesia. In order to remove the fragment of herniated disc, your surgeon will make an incision over the center of your back. The incision is usually about 3 centimeters in length. Your surgeon then carefully dissects the muscles away from the bone of your spine. Using special instruments, your surgeon removes a small amount of bone and ligament from the back of the spine. This part of the procedure is called a laminectomy.

Once this bone and ligament is removed, your surgeon can see, and protect, the spinal nerves. Once the disc herniation is found, the herniated disc fragment is removed. Depending on the appearance and the condition of the remaining disc, more disc fragments may be removed in hopes of avoiding another fragment of disc from herniating in the future. Once the disc has been cleaned out from the area around the nerves, the incision is closed and a bandage is applied.

Microdisectomy

Newer techniques may allow your surgeon to perform a procedure called an endoscopic discectomy. In an endoscopic discectomy your surgeon uses special instruments and a camera to remove the herniated disc through very small incisions.

The endoscopic microdiscectomy is a procedure that accomplishes the same goal as a traditional open discectomy, removing the herniated disc, but uses a smaller incision. Instead of actually looking at the herniated disc fragment and removing it, your surgeon uses a small camera to find the fragment and special instruments to remove it. The procedure may not require general anesthesia, and is done through a smaller incision with less tissue dissection. Your surgeon uses x-ray and the camera to "see" where the disc herniation is, and special instruments to remove the fragment.

Endoscopic microdiscectomy is appropriate in some specific situations, but not in all. Many patients are better served with a traditional open discectomy. While the idea of a faster recovery is nice, it is more important that the surgery is properly performed. Therefore, if open discectomy is more appropriate in your situation, then the endoscopic procedure should not be done.

Chemonucleosis

Chemonucleosis involves the injection of an enzyme called chymopapain directly into the herniated disc to dissolve the protruding gelatinous substance. This can relieve the pain and other problems caused by the disc impinging on the nerve.

Before receiving chymopapain, you should discuss its use and the possibility of serious side effects, with your doctor as in very rare occasion, the use of chymopapain may cause paralysis of the legs or death. Another dangerous side effect of chymopapain injection is a severe allergic reaction called anaphylaxis. This side effect occurs in less than 1% of the patients receiving the medicine, but it occurs more often in women than in men.

Chymopapain injections are given only in a hospital, by your surgeon.

The sale and distribution of chymopapain was discontinued in the US in January 27, 2003.

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Theressa Lim
Theressa Lim
I had an excellent sports massage by Wan Ling, which was very different from the usual massage I've tried elsewhere. Wan Ling skillfully and systematically loosened every muscle in my upper back and neck over the course of an hour. If anyone is seeking relief from tense muscles, I would highly recommend making an appointment with Wan Ling.
Rebecca Lim
Rebecca Lim
Came to see Xue Ting with a broken shoulder for the last 6 weeks and was impressed with her attentiveness and ability to make me feel me feel comforted in my condition . Very dedicated and good therapist indeed .
Janet Koh
Janet Koh
They adopt a scientific and personal approach. The therapists put in a lot of effort to diagnose the issue before attending to it. Overall, I would strongly recommend their professionalism and methods.
Varun Sharma
Varun Sharma
Really good sports massage! Booking process was efficient too :)
Charmaine Miranda
Charmaine Miranda
Friendly and really professional service! I immediately felt welcomed the moment I stepped into the clinic! The physio offered me great advice beyond what I had asked, which allowed me to have a deeper understanding as to why I had my issue in the first place. With this kind of service, I would honestly recommend this physio if you are serious about getting better.
Jimmy Allen Poh
Jimmy Allen Poh
Thoughtful and sincere service. Highly recommended!
Benedict Koh
Benedict Koh
My mum received her first Apos treatment. We intend to continue until her hip muscles become strong. We believe in the treatment as we saw how amazing it was. The idea was simple. Really love that she can be herself again, for long term. The hip and knee cap operations offers 15yrs. Hence we reject the cost and short-life. My wish is that the treatment cost can be lowered and more are aware of this treatment. God bless and thank you team.
Victoria Soh
Victoria Soh
Look for Soo, he is a great physiotherapist . Always communicating and always asking for my feedback. I’m on the right path to recovery all thanks to Soo. Two thumbs up.
Daniel Wang
Daniel Wang
Xue Ting has been working on my troublesome QL, hip girdle - basically the whole left lower kinetic chain! She has been patient, strong and cerebral in her approach to my 48 year old compensatory mechanisms. Her strong massage will finish with an assessment of muscle imbalance and poor activation with finally a retraining back to healthy movement.I’m impressed! Thanks Core Concepts!
Brett McLaren
Brett McLaren
I went from barely understanding physical therapy for injuries, to highly recommending Core Concepts to friends and family for their aches and pains. Ken was knowledgeable, patient and explained symptoms and consequences in a simple, relatable manner. I hope more people will come to understand how physio is a much better alternative to short-term painkillers.
Manda Misso
Manda Misso
Ken is really amazing!
Terry Tan
Terry Tan
The physiotherapist here explained the problem very well and provided me with exercises that helped improved my condition.
Ferdinand Mar
Ferdinand Mar
I have been experiencing great pain on my shoulder coupled with occasional numbness on my arm. Thanks to Ken Liew, I felt so much relieved after my first session. He was very patient and knowledgeable and had definitely made my 1st visit to a physiotherapy clinic a very memorable one. Thank you so much Ken
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Bee Choo Gian
I have been experiencing knee pains lately especially walking up and down the stairs. The pain was so bad that I was very concern. I chanced upon CoreConcept on FB and book an appointment with them at Camden Medical Centre. My therapist was Ken Liew, he is very professional and knowledgeable. He did a thorough job to assess my condition. To my surprise I felt immediate relieved on my knee after the first session with him! Amazing! Looking forward to my next session. 😊
Sandy Toh CH
Sandy Toh CH
Hi I am Sally and I am in my late sixties. I have endured a year of thigh(joint) pains and thought that it must be due to old age. Visited Core Concepts at Novena and after only 2 sessions, my condition improved so much that I was able to climb stairs easily again. THANKS to my Physiotherapist Samuel Ong who is extremely polite, professional and knowledgeable.
Shino Tutu
Shino Tutu
I have had several sports related injuries and Core Concepts has saved me and put me "back to new" each times! The therapists are excellent - knowledgeable and professional, and the receptionists (Carol, Adiqah and Rin) are always friendly and helpful. They even give me oreo cookies for my children! :)
Paola Venturini Hubert
Paola Venturini Hubert
Highly recommended for sports massage
Simon Ray
Simon Ray
Extremely friendly staff and therapists! Folks Novena Square are just simply smiley and happy. Coming here towards the end of the work day always brings up my mood. Therapist and coach are fabulous. My condition improve so much that I can even start to train up some of my predominately unrealized problems. Highly recommended!
Von Ling Wei Hao
Von Ling Wei Hao
I go to Novena and Cheryl is my therapist. She was upfront from the get go about my neck condition. I liked her honesty and said we'll give it a try. I was better after 4 weekly sessions and continued to go to her every 2 weeks. With her help I am in a better condition, had to put in effort on the exercises she taught me as well.
Tania Chevrez
Tania Chevrez
Li Hoong is a very dedicated sports massage therapist and functional trainer. Her ultimate goal is the client's holistic well-being. Highly recommend.
Pei Yee Wong
Pei Yee Wong
i have tried different physiotherapy sessions with almost 10 physiotherapists in india and in Singapore, my back pain was treated well by CHERYLL, with God's grace , i was pain free only after Cheryll attended to me. Thank you Cheryll and core concepts for the great experience.
Madiha Sadiq
Madiha Sadiq
I am working with Yiren on my knee after my ACL/MCL reconstruction and recovery has been good! He does a thorough job to assess my progress each session and challenges me to push myself to get to various milestones. He's extremely friendly and helpful despite my many questions. Thanks!
Yingling Huang
Yingling Huang
After many different physio and massage sessions in different places, my experience with the core concepts team has been the best. I started seeing them for sports massage, and now for my knee rehab. The level of care and attention makes me want to do more for myself. Isn't this most important when one tend to slack off with the prescribed exercises?
YitKoon Gan
YitKoon Gan
Very friendly and professional physiotherapist as well as receptionists within the clinic. Dr. Issac Wong is easy to approach and came up with alternative ways for me to strengthen my weak thigh muscles and it really helped in reducing my knee pain! Thanks :)
Sam Costanza
Sam Costanza
The best physiotherapist ever. Cheryl is really good. Doesn't shortchange me of time and make sure I feel better before she lets me go. The front desk staff are great too. Very accomodating and friendly. Thank you Carol and Farrah. Only thing if they can give instructions to how to go to their place will be great. Usually only unit number but do give some details like mrt exits and directions to lift and such will be excellent. Coz I almost got lost in 2 different places. Overall still love core concept because of Cheryl! Thank you Cheryl!!
Jeanette Goh
Jeanette Goh
Found out about Core Concepts last year through social media and made an appointment as i was experiencing some neck and shoulder discomfort after a traffic accident. My therapist was evidently experienced and was able to pinpoint the cause of my aches. The one thing i loved about my experience at Core Concepts is that they are not like typical physiotherapists who simply prescribe take home exercises, instead my therapist was extremely hands on, helping me to massage my neck at the right spots to relief the stiffness - best massage ever! Would highly recommend Core Concepts!!
Claire Chia
Claire Chia
Easily the best physio clinic I've been to.
Natarajan Baradwaj
Natarajan Baradwaj
The only physio clinic i trust! A unique approach to treating pains, you simply have to try it out for yourself. Have recommended many friends and family and core concepts has not disappointed. Thumbs up!!!
Claire Chia
Claire Chia
From the reception to the therapist, they are friendly and nice. I was taught on a 2 steps stretching to strengthen my leg muscles that I can do it myself daily and It did help :) Will recommend to anyone who wish to have therapy sessions.
Jaz
Jaz
Knowledgeable and brilliant!
Brenda Chong
Brenda Chong
-emails with advertisement and birthday wishes came, but they didn't think that their customer (with 4/10 sessions remaining in his package) would have expected a reminder of ANY kind if his package was already expiring. I asked the clerk from my last visit how many sessions I had remaining, and she told me 4, with no update on the expiry at all. -assumed I wanted a physiotherapy (PT) appointment when my past SMS have always been for sports massage (SM); whenever I asked for "available slots", they would give me the slots for SM. yet they suddenly gave me the list of available slots for PT ytd. I'm also to blame for not verifying and reading their long SMS carefully.-their masseuse is very good though, skilful and respectful. They ask important questions to understand their client before starting on the SM. I'd still return even though the administrative process is lacking.
Beale Liu JieXiong
Beale Liu JieXiong
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