Your spine flexible structure comprised of vertebrae also called the vertebral
column. Your spine divided into four parts – cervical spine, thoracic spine, lumbar
spine, and sacral spine. The spine located in the lower back where the lumbar disc problems occur. The disc is the spongy material cushioned in between the vertebrae, which provides a smooth movement to your spine. The disc sac is filled with gel liquid, and they act as shock absorbers in the spine.
A ruptured or herniated disc is the leading disc problem for which the patients often consult a spine doctor. A herniated disc can happen anywhere along your spine, even in the cervical spine (neck), but mostly it occurs in your lower back, also called lumbar vertebrae and is termed as a lumbar herniated disc.
Before considering surgery, orthopaedic spine surgeons perform some diagnosis test to confirm whether you are an ideal candidate for surgery or not. Which operation suits you as there are various surgical options to treat a herniated disc.
Different Types Of Back Surgery For Herniated Disc
Once the diagnosis is made, and when all the conservative options are exhausted, then the surgeon will suggest surgical excision of the disc fragment. Various methods can accomplish this disc fragment excision along with the loose fragment removal, which lies in the disc space. However, the choice of procedure based upon the location of the spinal problem is and how bad it is.
Classical Laminotomy/laminectomy
This procedure is not done as a routine nowadays.
Laminectomy/laminotomy is the surgical procedure to relieve pressure on the spinal cord or the spinal nerve roots by removing a part of the lamina in the spine. The lamina is a layer of bone that protects the back of the spinal canal and it makes up your spine. There might be various causes of a herniated disc that narrows the opening of the spinal canal, and the nerve roots may become squeezed. Laminotomy is a procedure that removes part of the lamina or removes the whole lamina on selected vertebrae. It provides the surgeon with a better view of the herniated disc.
The procedure can also remove thickened ligament tissue and reduces the pressure on the nerve roots, which help to relieve back pain, leg or arm pain and sciatica. The laminotomy can be done at the same time during diskectomy or can perform as a separate surgery.
Fenestration and Laminotomy
Surgically removing the damaged disc offers a simple and efficient solution to manage severe back pain, sciatic pain etc. Fenestration has been established as a reasonably safe procedure with satisfying results in most of the patients. The technique of fenestration being used extensively over the years as it has certain advantages over the traditional laminectomy technique.
The technique of fenestration is known for its less time consuming, less blood loss and few or no postoperative complications. It is a minimally invasive surgical procedure that helps to remove the damaged disc and provide relief from pain.
The studies on fenestration conclude that the technique is a simple and reliable method to treat lumbar disc prolapse. Nearly 76% of cases with lumbar disc prolapse operated by fenestration method had complete relief from pain. The technique does not compromise over the stability of the spine compared to laminectomy surgery.
Microlumbar discectomy
A herniated disc presses the nerve resulting pain, numbness, or weakness may occur in the leg often referred to as sciatica. If back surgery is required in such cases, minimally invasive micro lumbar discectomy might be a good option.
The soft tissue is removed using a microscope, and then the bone is exposed. Microscopic lumbar discectomy surgery improved surgical lighting and vision, made the herniated lumbar disc surgery more precise and accurate. Some other surgical instruments are used in microscopic discectomy procedure to remove bone spurs and the lamina through the side of the approach. There are two approaches in microscopic discectomy.
- Midline approach (hook –blade retraction)
- Approach through tubular retractors
As an alternative to the endoscope procedure, modified tubular retractors are included in the microscope. The potential benefits include less muscle damage, better cosmesis and decreased pain & operative time. The recovery is also faster after surgery.
Endoscopic Surgery
Endoscopic spine surgery is a minimally invasive procedure in which a tube-like device with a camera head, a light, and a passage sending thin surgical instruments to pass through. The surgical instruments are used to remove soft tissue to gain access to the spinal canal. Then nerve is isolated from the site of the damaged disc by a nerve retractor. The surgeon, with help from other surgical instruments, removes the herniated disc portion. The nerve is restored to the normal position, thus helps to relieve pain. There are two types of endoscopic techniques.
- Youngs technique
- Arthroscopic techniques (uniplanar biportal)
Recovery After Herniated Disc Surgery
Surgery for a herniated disk is often beneficial, and it works better to provide pain relief than other treatments. You can experience the improvement in the symptoms like pain and numbness just in a few weeks after surgery.
Physiotherapy can help you to recover faster. You can visit the rehab centre, or can do exercises on your own at home as suggested by a therapist. Walking can also help you to regain mobility in your spine.
For the first few weeks after surgery, you should not:
- Lift heavy objects
- Sit for a long time
- Bend or stretch your back too much
- You should not drive.
Your doctor will let you know when you can go back to work, or do other usual works. Probably you can go back to work within 2 to 4 weeks. You may lift heavy objects at your job within 6 to 8 weeks. However, recovery varies from person to person based on various factors.
