Lumbar Discectomy

Intervertebral discs are fibrocartilagenous cushions between adjacent vertebrae in the spine. The normal intervertebral disc is composed of a semi-liquid substance (nucleus pulposus) at the centre surrounded by a fibrous ring (annulus fibrosis). A herniated disc, also known as a bulging disc, is a condition in which the inner gelatinous substance of the disc is forced out through a tear in the outer, fibrous ring (annulus fibrosus). This may compress the spinal cord or the nerves around the spinal cord. Lumbar discectomy is a surgical procedure performed to remove a herniated or ruptured disc from the lumbar (lower) region and relieve pressure on the nerve, alleviating pain.

This procedure is performed under sterile conditions in an operating room with the patient under general or spinal anaesthesia. You will lie face down. Your surgeon will make a small incision over the affected disc in the lumbar region. A small portion of bone may be removed along with the adjoining ligament to expose the herniated disc. Your surgeon visualizes the discs and the nerves through a surgical microscope. This enlarges the view of the surgical site, minimizing damage to the surrounding tissues. The spinal nerve root is then gently lifted with a special hook, to gain access to the injured disc, and the ruptured or herniated disc is removed. Any loose disc fragments are also removed. After the completion of the procedure, the surgical wound is irrigated with antibiotic solution and closed.

Following surgery, you are advised to limit activities for four weeks that involve bending and lifting, and sitting for long periods. Your recovery will involve physical therapy, where you will be taught certain exercises to improve flexibility and strength of your muscles around your spine. Depending on the level of activity, you will be able to resume work in two to six weeks.

As will all surgical procedures, lumbar discectomy may be associated with certain complications which include infection, nerve injury, spinal cord injury, ongoing pain and problems with anaesthesia.

Introduction

The lower back or lumbar region is often the site of pain due to its high mobility and weight bearing. Spongy discs present between the vertebral bones of the spine help cushion the spine during stress and movement. These intervertebral discs in the lumbar region may undergo damage due to stress, causing them to herniate or rupture, and compress adjacent spinal nerves. This can lead to lower back pain, as well as pain, weakness and numbness in the lower legs. A lumbar discectomy is a surgical procedure to treat a herniated or ruptured disc, and relieve pressure on the spinal nerves.

Procedure

To perform lumbar discectomy, your doctor makes a small incision in your lower back over the affected spinal disc. Some vertebral bone and ligament may need to be removed to expose the disc. A microscope is used to visualize the disc and the adjacent spinal nerves. The spinal nerves are protected, and the affected disc completely removed. The surgical site is then irrigated with antibiotic solution and closed.

Post-operative care

Following surgery, activities such as bending, lifting and sitting for prolonged periods should be avoided for four weeks. Your doctor will advise you about exercises to improve the strength and flexibility of the lower back. You may be able to return to work in 2-6 weeks depending on the level of activity involved.

Risks & complications

Lumbar discectomy as with any invasive surgery may be associated with certain complications, which include nerve and spinal cord injury, infection and ongoing pain.