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:
leg pain which limits your normal daily activities; or
weakness in your leg(s) or feet; or
numbness in your extremities; or
impaired bowel and/or bladder function
When is surgery NOT an option?
In general, surgery is not an option when:
your back and leg pain is not caused by a ruptured disc; or
you do not have leg symptoms;
there is a medical reason which prevents you from having surgery;
medication which reduces swelling or relieves pain would provide you with adequate relief; physical measures would improve your condition>
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.
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 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.