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Overview

Discectomy: Procedure, Recovery, Cost, Risk & Complication

Discectomy refers to a surgical procedure that involves the removal of a damaged part of a herniated disk (also known as ruptured, slipped, bulging disk or disk prolapse) in the spine. A herniated disk is a condition where a portion of the soft material present in the disk pushes out from a crack in the tough exterior. The herniated disk may cause irritation or compression of the nerves located nearby, resulting in numbness, weakness and pain. These symptoms may affect the neck or the back and even radiate down to the arms and legs.

A doctor generally suggests discectomy to a patient if the symptoms have gradually worsened or the non-surgical treatments have not been effective. Though there are several ways for performing a discectomy, surgeons prefer minimally invasive discectomy, where small incisions are made and a small video camera is used for viewing purpose.

Indication

A patient may be recommended to undergo discectomy in the following circumstances:

  • If one has trouble in standing or walking due to a nerve weakness
  • When other conservative treatments such as physical therapy or medication does not bring any improvement in your condition
  • A disk fragment is lodged in the spinal canal, pressing on to a particular nerve
  • Extensive pain in the legs, arms, buttocks or chest that becomes difficult to tolerate

Pre Procedure

It is important to follow the following pre-procedure instructions before undergoing a discectomy:

  • There may be a few tests like an x-ray or EKG that you need to undergo before the surgery
  • Stop smoking a few days before the surgery. Non-smokers are found to have lesser bleeding problems compared to smokers during a surgery
  • Inform your doctor about the medications, supplements and vitamins that you take. You may have to stop taking medicines like aspirin, blood thinners and anti-inflammatory medicines for a few days before the surgery.
  • You may have to stop drinking and eating anything for a few hours prior to the surgery. Your doctor will provide you with proper instructions. Ensure that you follow them correctly. If you have to take any medicine during that time, take it with very sips of water.

During Procedure

The surgery is performed by administering the patient with general anaesthesia. It can be done by one of the following methods or a combination of both:

  • Sacral: The physician inserts an endoscopic fiber-optic scope through the help of a tiny incision into the sacrum, which is a natural opening at the base of your spine. With the help of direct visualization, the doctor examines the insides of the spinal canal and disc for identifying any ruptures, tears, bulges or other abnormalities. The damaged disc is then shrinked with the help of laser.
  • Posterior lateral: The surgeon inserts a hollow needle through the back side of the lateral spine, directly into your disc tissue. A laser is then passed from into the disc through the needle for shrinking the bulging or herniated disc. Fluoroscopy is used for watching and guiding the progress of the whole procedure.

Post Procedure

After the surgery has been successfully completed, you will be shifted to a general bed where the doctors will monitor you and look for any complications related to the surgery or anaesthesia. You can go home the same day, or you may to stay in the hospital for a few days if you had a pre-existing health condition.

You can get back to work in 4-6 weeks after the surgery. In case your profession involves lifting heavy objects or operating heavy machinery, you may have to wait for 8 weeks before you resume working. Limit activities that involve bending, lifting or stooping for 3-4 weeks after the surgery. Also, avoid sitting down for long hours during this time.

Ensure to take your medications in time. A physical therapist will be able to teach you exercise for improving the flexibility and strength of your muscles around the spine.

Risk & Complication

Discectomy is generally considered to be a safe procedure. However, as with every surgery, there may be some risks that are associated with it. These complications also depend on your age, your general health condition, and how your body reacts to the surgery and the medications. Some of the complications that may occur are:

  • Bleeding from the incision site
  • Infection at the incision site
  • Leaking of the spinal fluid
  • Build-up of fluid in the lungs, leading to pneumonia
  • Injury to the nerves or blood vessels in and around the spine while performing the surgery
  • Injury in the protective layer that surrounds the spine
  • Persistent pain even after the surgery

More Info

A discectomy reduces the symptoms of a herniated disc, but it does not cure the reason why the disc was actually herniated. To avoid injuring your spine once again, your doctor may recommend losing weight, go for low-impact exercises, and limit activities that involve repetitive or extensive twisting, bending or lifting. You can assume your normal diet, from the time you get back home. Fruits, vegetables and extra fluids must be added to avoid constipation.

Attending follow-up session with your doctor is important after undergoing a discectomy. You may also have to undergo an x-ray so that your doctor can analyse your progress.

The cost of discectomy would be approximately Rs. 2,25,000 – Rs. 2,75,000.

Popular Health Tips

Minimally Invasive Spine Surgery

MBBS, MS - Orthopaedics, FNB Spine surgery, Fellowship in Spine Surgery (AO Spine)
Orthopedist, Noida
Minimally Invasive Spine Surgery
Minimally Invasive Spine Surgery Traditional spinal surgeries usually require large incisions and stripping away the muscles of the spinal column just to get to a herniated disc. Now, new technology allows these complex procedures to be performed with the help of a microscope to magnify and illuminate the damaged area. Instead of stripping away the muscle, your surgeon can use a microscope to view the area through a much smaller incision and create a tunnel to the disc. This is done by splitting the muscle to pass the instrument through. Minimally invasive procedures result in less visible scars and shorter recovery times. A discectomy, or removal of the disc, can often be performed this way. However Not all patients are candidates for MIS. Whether the patient an undergo minimally invasive surgery or not is decided on the basis of clinical examination and MRI findings.
2 people found this helpful

Middle Back Pain - Probable Reasons Behind It!

Dr. Shantanu Mallick 90% (139 ratings)
FIPP ( UK ), DA, MBBS
Pain Management Specialist, Navi Mumbai
Middle Back Pain - Probable Reasons Behind It!
Middle back pain indicates a discomfort or pain in the junction of the rib cage and the spine. This area is also known as the thoracic spine. The level of pain can vary from chronic, acute to mild depending on the nature of the underlying cause. With a right diagnosis, there are plenty of treatment options available to arrest the pain and aiming at a permanent cure. Probable reasons for middle back pain? The lifting of heavy objects repeatedly or improperly can cause damage to the blood vessels and muscle tissue resulting in frequent pain in the back area. Discs are located in between the spinal vertebrae. They act as a cushion against shock and help in physical movement. An injured disc results in leaking of the liquid nucleus in its outer casting. This results in a strain in the surrounding tissues, ligaments and nerves pose a serious threat to the spine. A disc injury poses severe pain and discomfort in the middle back region. Often high impact accidents or violent falls can result in a vertebrae fracture. This kind of fracture necessarily has a co-relation with spine fracture and can result in intense middle back pain. In certain cases, a fractured vertebra can affect the spinal cord as well. Patients with osteoporosis can suffer from middle back pain too. This is a condition where the failure to regenerate old bone by the body poses a threat to the individual. People who are aged often faces middle back pain due to a condition such as the spinal stenosis- narrowing of the spinal cord. A condition known as the spondylitis that leads to inflammation of the spinal joints might lead to pain in the middle back area. Problems such as scoliosis can result in middle back pain. This happens due to the disruption of the weight distribution of the spine. Even tumors can upset the basic architecture of the spine leading to pressure on the tissues, nerves, and ligaments that result in middle back pain. Symptoms of middle back pain: Some of the typical symptoms of middle back pain include muscle spasms, sleeping problems, the stiffness of muscle in the morning, fatigue, weakness, tenderness, numbness in the back area, headache etc. Probable causes, detection, and cure: Some of the probable causes of back pain include obesity, family history, pregnancy, sedentary lifestyle etc. Over the counter medicine, heat and ice treatment, massage etc can be initially tried to get relief from the pain. If this does not fetch any result, a doctor must be immediately consulted. A Doctor first goes for a physical exam to understand the origin of the problem. He can recommend imagery tests such as MRI scan, CT scan etc. to further ensure the root cause of the problem. Once this is done, a doctor might suggest minimally invasive procedures such as fusion, discectomy, and microdiscectomy.
1 person found this helpful

Procedures That Can Help Treat Slip Disc & Sciatica!

Dr. Neeraj Jain 80% (10 ratings)
MBBS, MD, FIMSA, FIPP
Pain Management Specialist, Delhi
Procedures That Can Help Treat Slip Disc & Sciatica!
The intervertebral discs are made-up of two concentric layers, the inner gel-like Nucleus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus loses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as degeneration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner nucleus pulposus protrudes through the fibrous layer, producing a bulge in the intervertebral disc. This condition is named as herniated disc. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems of Sciatica radiating pain from back to legs in the distribution of the nerve. Other symptoms could be a weakness, tingling or numbness in the areas corresponding to the affected nerve. Sometimes bladder compromise is also present, which is made evident for urine retention and this need to be taken care as an emergency. Excessive weight, bad postures, undue movements, improper weight lifting and other kinds of traumas may weaken the intervertebral discs. When this occurs the pulpous nucleus will bulge against the annulus, or even be squeezed through it (extruded disc). The first steps to deal with a herniated or prolapsed lumbar disc are conservative. These include rest, analgesic and anti-inflammatory medication and in some cases physical therapy. At this point, it is convenient to have some plain X-rays done, in search of some indirect evidence of the disc problem, as well as of degenerative changes on the spine. If in a few days these measures have failed, the diagnosis has to be confirmed by means of examinations that give better detail over the troubled area, as the MRI, CT which will show the disc, the space behind it and in the first case, the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles. Once the diagnosis has been confirmed, one of the best alternatives existing today is the Ozone Discolysis as the results obtained are excellent and practically has no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. In most patients left with painkillers as the only treatment, the symptoms eventually disappear, only that this could take weeks to months. Ozone speeds up these developments, see the same result in a few weeks. The problem has to be seen and approached integrally and frequently the combination of therapies has to be used, most frequently physiotherapy. Also, it has to be known that those who had a herniated disc have 10 times more chances of having another herniation than the rest of the population. If despite the ozone therapy the symptoms persist, Drill Discectomy/ Laser Discectomy are good alternatives before open surgery (Discectomy) which has to be contemplated in those true emergencies, as mentioned above, this is possibly the first choice. Once the conservative treatment fails: Early aggressive treatment plan of pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only 5% of total LBP patients would need surgery & 20% of discal rupture or herniation would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then. Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon pt`s pathology & response to treatment. Using precision diagnostic & therapeutic blocks in chronic LBP, isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed. LESI: Lumbar Epidural Steroid Injection Indicated in Acute radicular pain due to irritation or inflammation. Symptomatic herniated disc with failed conservative therapy Acute exacerbation of discogenic pain or pain of spinal stenosis Neoplastic infiltration of roots Epidural fibrosis Chronic LBP with acute radicular symptoms Epidural- lumbar injection ESI Treatment Plan Compared to interlaminar approach better results are found with a transforaminal approach where drugs (steroid+ LA/saline +/- hyalase) are injected into anterior epidural space & neural foramen area where herniated disc or offending nociceptors are located. Whereas in interlaminar approach most of drug is deposited in posterior epidural space.Drugs are injected total 6-10 ml at lumbar, 3-6 ml at cervical & 20+ ml, if caudal approach is selected. Lumbar ESI is performed close to the level of radiculopathy, often using paramedian approach to target the lateral aspect of the epidural space on involved side. Cervical epidural is performed at C7-T1 level. SNRB- Selective Nerve Root Block Fluoroscopically performed it is a good diagnostic & therapeutic procedure for radiculopathy pain if There is minimal or no radiological finding. Multilevel imaging abnormalities Equivocal neurological examination finding or discrepancy between clinical & radiological signs Postop patient with unexplainable or recurrent pain Combined canal & lateral recess stenosis. To find out the pathological dermatome for more invasive procedures, if needed Intradiscal Procedures Provocative Discography - Coupled with CT A diagnostic procedure & prognostic indicator for surgical outcome is necessary for the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines. Percutaneous Disc Decompression (PDD) After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed Ozone Discolysis: Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a daycare setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. The total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no postoperative discomfort or morbidity and low cost. Dekompressor: A mechanical percutaneous nucleosome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression. Epidural Adhenolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS) A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.
4489 people found this helpful

4 Causes Behind Sciatica Pain!

Dr. Tariq Tramboo 91% (41 ratings)
Pain Management, MD - Pain Medicine & Anesthesiology
Pain Management Specialist, Srinagar
4 Causes Behind Sciatica Pain!
Sciatica pain arises from the sciatic nerve which is the single largest nerve in our body. It consists of individual nerve roots, which branching out from the lower back of the spine to the back of each leg and combining together forms the sciatic nerve. The origination of the sciatic pain lies in the lower back of the body and radiates down the buttock to the sciatic nerve. Causes of the sciatica pain Arthritis: If an individual is diagnosed with arthritis, then he or she can expect a throbbing pain or numbness down till the leg. Herniated disc: Another cause could be a herniated disc in the lower back of the body. Spondylosis: Spondylosis in the lower back would also be a reason for the development of the sciatica pain. PIVD/DISC bulge Other causes are a spinal injury, diseased degenerative disc, infection on and around the lower back. The pain would worsen, if an individual is in an occupation where he or she has to stand or sit for hours at length. The lifting of heavy things would strain the sciatic nerves as well. How to identify sciatica pain? Sciatica pain varies from infrequent to a constant throbbing down the lower back. So initially it is difficult to detect whether it is sciatic pain or not. But when the constant pain in the lower back leads right down till the toes and foot, it is really time for an individual to get in touch with a doctor. The pain can give a burning sensation almost searing making it difficult for the person to stand up or walk properly. Along with the pain, one can feel fatigued. An involvement of the spinal cord is rare in the sciatic pain but is possible. Treatment for sciatica pain Sciatica can be treated in both surgical and non-surgical way. Surgical treatment is rare as sciatica tends to respond well with non-surgical treatments. If the pain continues for over a month despite treatment, surgical treatment will be considered. The non-surgical pain treatment would include physical exercises and oral medications along with natural treatment. Medications: Painkiller medications prescribed by the doctor can be used to reduce sciatica. Medicines like aspirin, non-steroidal or oral steroids can help reduce the pain. Steroid injection: Epidural steroid injection acts faster as it is injected in the affected area, thus providing relief from the pain quickly. Exercise: Early morning exercises can be quite helpful. Percutaneous Endoscopic Discectomy: The surgical treatment of Percutaneous endoscopic disc dissectomy constitutes a large part of interventional pain physicians and it has evolved considerably in terms of surgical technique and instrumentation. Percutaneous endoscopic discectomy is a relatively new technique for removing lumbar disc herniation. It involves using an endoscope to visualize the disc removal. The discectomy is performed through a posterolateral approach using specially developed instruments. The advantage of percutaneous endoscopic discectomy is that the disc is approached posterolaterally through the triangle of Kambin without the need for bone or facet resection thus preserving spinal stability. The procedure is day care and is done under local anaesthesia.
5129 people found this helpful

Sciatica - When Do You Have To Go For Surgery?

Dr. Dhruv Chaturvedi 87% (10 ratings)
MCh - Neurosurgery, MS-General Surgery, MBBS
Neurosurgeon, Delhi
Sciatica - When Do You Have To Go For Surgery?
Sciatica pain can be mild to intense. Many with lumbar herniated disc and sciatica often wonder whether or not they require a surgery. Needless to say, it is never an easy decision. But the good news is that micro discectomy surgery has a higher rate of success when it comes to relieving sciatica pain. When compared to many other options, this one is relatively minimally invasive. It doesn t alter the structure of the spine permanently since it works by removing a small portion of the disc, which has herniated or extruded out of the disc. When your sciatica pain stems from lumbar disc herniation, a small open surgery with the help of magnification is the prevalently opted surgical approach. On the other hand, a laminectomy is done when the bone or disc pinching the nerve root is required to be removed. When should you consider undergoing surgery for sciatica? Typically, neurosurgeons recommend considering surgery for sciatica in a host of situations which include the following: Severe pain in the leg lingering for more than six weeks, which mainly affects one side of the leg or buttock Intense pain in the low back and buttock, which continues through the course of the sciatic nerve andextends to the lower leg and even foot. This pain can be described as sharp and searing rather than a dull thud. When pain has not alleviated even after non-surgical treatments that may include non-steroidal anti-inflammatory drugs (NSAIDs),oral steroids, injections, manual manipulations, and physical therapy When the patient is not able to take part in the day to day activities due to intense lower back pain and the symptoms tend to become severe during movements like sneeze and cough. When the symptoms are continuing to worsen, thereby indicating nerve damage, particularly when the progressive signs have their root in neurological issues It is important to note here that surgical intervention may only be needed when the patient experiences progressive weakness in the lower portion of the body or sudden loss of bladder or bowel movement, which may stem from cauda equina syndrome. Two surgeries, namely lumbar laminectomy and microdiscectomy are performed on the basis of the cause as well as the duration of the sciatica pain. In some cases, the symptoms are unique on the basis of the underlying causes of sciatica. For instance, trying to bend the body backward or walking a longer distance than normal may trigger unbearable symptoms. On the other hand, when the affected individual tries to bend the body forward, it can lead to symptoms stemming from the lumbar herniated disc. In case sciatica occurs after an accident, injury or trauma, or if it happens in tandem with other symptoms, then it requires an immediate medical attention. Thus, choosing to go for a surgery depends on several factors that only your doctor can assess and decide upon.
2733 people found this helpful

Popular Questions & Answers

Sir I am suffering from a back pain from 3 year I got all the test normal what should i do, please advice me I should work out in this condition or not?

Dr. Nazima 85% (1398 ratings)
MD PHYSICIAN
General Physician, Delhi
For back pain you can take tablet diclofenac whenever pain increases. 1) Try lying on your side. Place a pillow between your knees to keep your spine in a neutral position and relieve strain on your back. If you need to sleep on your back, slide a pillow under your knees. Be sure to sleep on a comfortably firm mattress. 2) maintain posture-Sit upright, with your shoulders relaxed and your body supported against the back of your chair. Try putting a pillow or a rolled towel between your lower back and your seat. Keep your feet flat on the floor. 3) Physical therapists can teach you how to sit, stand, and move in a way that keeps your spine in proper alignment and alleviates strain on your back. They also can teach you specialized exercises that strengthen the core muscles that support your back. A strong core is one of the best ways to prevent more back pain in the future. In severe conditions surgery is required If a bulging disc is putting pressure on a nerve, your surgeon might recommend a discectomy to remove some disc material. Or a laminectomy might be recommended to decompress an area where there is pressure on the nerves or spinal cord. Spinal fusion may be done to help stabilize the spine.
2 people found this helpful

Slipped disc L4-L5 Dr. Suggest me epidural treatment, can you tell me best alternative way to heal my disc as like before. I had took PT but It works only for some days but after some days pain comes back

Dr. T.Shiva Prasad Tummarakoti 92% (911 ratings)
MBBS ,MD
Pain Management Specialist, Hyderabad
Root block is better if severe, do endoscopic discectomy under local anesthesia for permanent relief Hyderabad.
1 person found this helpful

I am suffering from pack pain called sciatica. Wht will be the treatment available for this? And also having diabetes. Please suggest best treatment available.

Dr. Virendra Rastogi 88% (122 ratings)
MBBS, MD (Anaesthesiology)
Pain Management Specialist, Varanasi
You may be having disc prolapse L5/S1. I need to look your MRI Spine lumbo sacral region and the investigation like TLC, DLC, CRP, to know if the disc is protruded, extruded with or without foraminal compression. Maybe the slip disc is compressing your nerve resulting numbness. Medicine may be of some help. Non operative treatment include TFSI, Disc Fix and Percutaneous Endoscopic Lumbar discectomy (PLED) are now available. PLED is one the latest alternative to surgery which is performed percutaneous through a small hole in skin less than 1/2 inch, no blood loss, using local anaesthesia and you will be ambulatory on next day ,need hospitalization for max. 3 days.

I'm Harmeet Singh Chhabra Male 21 years old sir Im having pain in back since 3 months actually I use to do exercise normal exercise at my home using gym dumbles and suddenly I realize pain and from the side of bone till foot it pains badly please advise me regarding this problem. Thank you.

Dr. Virendra Rastogi 88% (122 ratings)
MBBS, MD (Anaesthesiology)
Pain Management Specialist, Varanasi
You may be having disc prolapse L4/5or L5/S1. I need to look your MRI Spine lumbosacral region and investigation like TLC, DLC, CRP, to know if the disc is protruded, extruded with or without foramin compression. Maybe the slip disc is compressing your nerve resulting numbness. Medicine may be of some help. Non operative treatment include TFSI, Disc Fix and Percutaneous Endoscopic Lumbar discectomy (PLED) are now available. PLED is one the latest alternative to surgery which is performed percutaneous through a small hole in skin less than 1/2 inch, no blood loss, using local anaesthesia and you will be ambulatory on next day ,need hospitalization for max. 3 days.

I am yogesh 25 years old, I have disc bulge in L4 L5 I had taken physio therapy as well but no benefit Doctor suggested me epidural but I don't have believe in it, please suggest me good way

Dr. Chandrakant Lawale 85% (22 ratings)
Bachelor Of Physiotherapist
Physiotherapist, Mumbai
There are various modes of treatment for this condition but exercise s in proper direction will definitely help you out. Electrotherapy like Heating modalities, I.F.T, TENS would not resolve your problems completely. I have treated such patient with better results ONLY with d help of exercises.
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