Discectomy / Microdiscectomy
A discectomy is a surgery performed to relieve nerve-root compression that is caused by a herniated disc. It can be performed as open surgery or as a minimally invasive procedure. A new type of minimally invasive procedure, known as a decompression discectomy, has proven highly successful. This procedure, also known as percutaneous discectomy, is performed using a Stryker Dekompressor® disc-removal system, which can be used effectively in discectomies performed on any spinal region: cervical, thoracic or lumbar.
Discs are the cushions between the vertebrae of the spine. Each is composed of an exterior shell of tough cartilage, and a center of softer, more gelatinous material. Through aging, normal wear-and-tear or injury, the disc may bulge between the vertebrae. If it herniates (ruptures), it can cause severe pain by putting pressure on adjacent nerves, and decompression surgery may be required.
Candidates for a Decompression Discectomy
Patients for whom decompression discectomy may be a good option are patients with ongoing back or neck pain; sciatica, which involves radicular pain (traveling down the leg); or spinal stenosis, a condition in which the spinal canal has narrowed to the point that it is pressing on the spinal cord.
Typically, patients become candidates for decompression surgery when more conservative methods have failed to resolve symptoms after a period of 6 weeks to 3 months. Before surgery is recommended, the following treatments are usually tried:
- Lifestyle changes (such as diet and exercise)
- Medications (such as analgesics and NSAIDs)
- Physical therapy
- Chiropractic treatment
- Epidural injections of corticosteroids
Certain neurological symptoms, such as extreme weakness, numbness, or bladder or bowel dysfunction, especially if they occur suddenly, may necessitate emergency surgery.
Benefits of a Decompression Discectomy
There are many advantages to having a decompression discectomy. The procedure is a relatively simple one, and provides rapid relief from pain for the great majority of patients. It is only minimally invasive, so involves little scarring or pain. In addition, its advantages include the following:
- Provides tissue for biopsy
- Does no thermal (heat) damage to the nerve root
- Controls the amount of material aspirated
- May be used in all three sections of the spine
- Allows for customization of each procedure
Carrying less risk than some other types of spinal surgery, a decompression discectomy also allows for more rapid recovery.
The Decompression Discectomy Procedure
During a decompression discectomy, the surgeon uses the Stryker Dekompressor system, in combination with fluoroscopic imaging and a pump, to remove targeted matter from herniated discs. When the matter is removed, pressure on the nerves in the area, and the pain caused by that pressure, are both relieved.
During the procedure, fluoroscopic guidance helps the surgeon to direct the Stryker Dekompressor probe to the herniated disc. Once it is turned on, the tip of the probe wears away part of the center (nucleus) of the disc. This provides more space, relieving pressure on the nerve and restoring neurological function. In the course of a decompression discectomy, the surgeon is also able to do the following:
- Remove bone spurs
- Remove fibrous tissues contributing to stenosis
- Remove parts of vertebrae (laminectomy)
- Fuse affected vertebrae (spinal fusion)
Each of the above procedures helps to relieve pain by reducing or eliminating pressure on nerve roots or by stabilizing spinal segments.
Risks of a Decompression Discectomy
This procedure is considered a safe one, but any surgical procedure involves certain risks. In this case, risks during or after the procedure include the following:
- Excessive bleeding
- Blood clots
- Adverse reactions to anesthesia or medications
- Postsurgical infection
- Respiratory difficulty
While 90 to 95 percent of discectomies are successful, there is a possibility that a disc can reherniate.
Recovery From a Decompression Discectomy
A simple decompression discectomy usually requires only half an hour to perform and, in most cases, does not require hospitalization. Although recovery times are variable, most patients can return to work within a week to 10 days. Sometimes, physical therapy is necessary to help the patient develop greater strength in the back or legs, which can prevent a reoccurrence of the problem.
A microdiscectomy is performed to relieve pressure on nerve roots caused by a herniated disc. A microscope is inserted through a tiny incision in the lower back to view the pinched nerve and then remove the portion of the disc that is applying pressure on it.