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A discectomy is an orthopaedic surgery which takes a herniated disc and removes it from the spinal canal. In a disc herniation, a fragment of disc pushes out from between two vertebral bodies and ends up in the spinal canal, causing pain and possible nerve damage. Most people feel pain that is like an electric shock, and this is associated with numbness and tingling in the area affected by the damaged nerve. In severe cases, there can be weakness of the affected area.
The surgical management of a herniated disc involves removing the fragment of the spinal disc that is pressing on the nerve. This is what they call a discectomy. Most discectomies are done as open procedures. The surgeon makes a little incision in the back and is able to look directly at the herniated disc. It is an easy procedure then to remove that section of disc so that the pressure is relieved off the nerve or nerves.
The discectomy is done under general anaesthesia and takes about an hour to do, depending on how much disc is involved and how big the patient is. The patient is lying face down during the procedure so the back is exposed. The incision is about 3 cm long and is enough so the surgeon can see the disc once the muscles are dissected away from the bone. The doctor first does a laminotomy, which removes a section of bone so the disc is more visible. The herniated disc is found and is removed. This takes the pressure off the nerves and the patient’s symptoms are improved. After this, the incision is closed and a dressing is applied.
There are risks to having discectomy surgery. One risk is that another segment of disc will be missed and will herniate, having related symptoms to the initial nerve symptoms. This is called a recurrent disc herniation and happens about 10-15 percent of the time.
Most of the time, the patients get relief after having their discectomy. The success of the discectomy, however, is only about 85-90 percent so that ten percent of patients will have residual symptoms. Some will have severe neurological deficits after the procedure—sometimes being permanent symptoms.
Other risks of surgery to remove a herniated disc include having a spinal fluid leak, an infection from the surgical site, and surgical bleeding. Most of these complications are treatable but would involve further surgery or a prolonged hospitalization.
There are newer surgery techniques available that allow the surgeon to do a microdiscectomy and an endoscopic discectomy. The microdiscectomy procedure is minimally invasive surgery on the disc that makes use of tinier instruments and smaller incisions. In the endoscopic surgical technique, the surgeon uses a lighted camera inserted through a small incision at the site of the herniated disc. Small instruments are used to trim away the herniated disc. The surgeon will be unable to see the disc with the naked eye so there is some risk of damage to nerves at the time of surgery.
In the endoscopic surgery, the surgeon can ideally perform the same surgery as the open procedure with the exception that everything is seen through the endoscope; special instruments are used to remove the damaged portion of the disc. General anaesthesia may or may not be used and there is more than one incision, each of which is smaller than with an open incision. X-tray is used along with the camera to visualize the disc and surrounding structures.
Not all patients are appropriate patients for the endoscopic microdiscectomy or regular microdiscectomy; patients are encouraged to talk to the surgeon in order to decide if the smaller procedures are safe and effective.
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