Things to Know about Herniated Disc Surgery
Does it seem that nothing works to treat your herniated disc and pinched nerve? Sometimes medications and exercise aren’t enough to remedy a slipped or bulging disc – what doctors refer to as a herniated disc. If this is the case for you, the doctor may recommend surgery. Keep reading to learn more about surgical treatment options for a herniated disc causing pinched nerves.
What is a Herniated Disc?
Rubber-like discs add a cushion between the bones, or vertebrae of the spine, enabling motion throughout the spine. When discs herniate or bulge out into the spinal canal, they can pinch nerves causing pain. Sometimes this pain can become intense, and even debilitating. When the disc is located in the back, the pain can travel down into the buttocks, hip and leg. When the herniated disc is in the neck, the pain can travel down the shoulders and arms. Learn more about herniated discs (video).
Herniated Disc Causes and Symptoms
There are many factors that affect spinal discs, including age, genetics, trauma, and activity. Certain activities such as heavy lifting can cause discs to degenerate quicker and eventually herniate. Herniated disc can sometimes be asymptomatic, however if they put pressure on a nerve, they often cause severe radiating pain. If the disc is in the lower back, it can result in back and leg pain. If it is located in the neck, it can lead to pain in the neck, arms, and shoulders.
What is a Pinched Nerve?
In every level of your spine, nerves exit out of the spinal canal and run into your arms and legs. These nerves control your strength and sensation to your entire body. When these nerves become compressed, or pinched, they can lead to symptoms of pain, weakness, numbness, and tingling in the arms or legs, known as radiculopathy. The most common cause of nerve compression is a herniated or bulging disc, that pushes on the nerves as they leave the spinal canal. A common nerve that is frequently pinched in the back is the Sciatic nerve. When this nerve is pinched by a disc herniation, it will cause pain, numbness, and weakness shooting down the leg into the foot, known as ‘sciatica.’
Is Surgery Right for You?
Only your doctor can determine if herniated disc surgery in Atlanta is the right course of action for you. Most herniated discs do not require surgery and typically improve with time. Surgery is therefore a last resort treatment after other options like oral steroids, anti-inflammatories, physical therapy, and even corticosteroid injections may have proven ineffective. Before recommending surgery, the spine surgeon will order tests including an X-ray and MRI to determine the location and severity of the herniated disc. Based on these images, the surgeon may recommend surgery as the next course of action to relieve the pressure the disc is putting on the nerve.
Types of Surgery for the Back and Legs
Based on the size and location of the disc herniation, your surgeon may recommend surgery if non-operative treatments are not providing relief. In the back, this surgery will be a decompression surgery, known as a laminectomy, where a piece of bone known as the lamina is removed. When a piece of herniated disc is also removed at the same time, this is called a discectomy. Newer techniques and instruments allow for surgeons to perform these surgeries from smaller incisions, many times through a small tube using a microscope, known as a Microdiscectomy. The benefits of the micro surgery are smaller incisions, less soft tissue dissection, less bleeding, and overall less post operative pain. Ask your doctor if a microsurgery is right for you.
- Laminectomy and discectomy: During this procedure, the surgeon will make an incision in the vertebral arch (known as the lamina) to alleviate the pressure on the nerve roots. Removal of the lamina is known as a laminectomy. The surgeon also removes the part of the disc that is putting pressure on the nerve root to relieve the pain. The traditional open approach requires a larger incision, resulting in greater back muscle damage, and a generally more painful and slow recovery.
- Microdiscectomy: Sometimes called microdecompression or microdiskectomy, microdiscectomy is a newer and less invasive surgical procedure used to treat a herniated lumbar disc. Microdiscectomy achieves the same objective as discectomy, to remove the portion of a disc that is putting pressure on your nerve and causing pain. However, the use of special instruments and visualization tools used by the orthopedic spine surgeon trained to perform microdiscectomy allows them to make very small incisions, reducing injury to back muscles, and typically resulting in faster, less painful recovery than traditional discectomy. Learn more about Minimally-Invasive Lumbar Microdecompression in this informative video.
Types of Surgery for the Neck and Arms
In the neck, traditional approaches called for a fusion procedure to treat disc herniations causing pinched nerves. Fusion procedures remove the entire disc pushing on nerves, and place a piece of bone or a cage in the disc space instead. Fusions cause a loss of range of motion in the neck and put more stress on other levels in the neck. Newer techniques however have allowed surgeons to instead replace the disc with a mobile prosthesis, maintaining full range of motion in the neck. Other benefits of a disc replacement are less soft tissue dissection, less bleeding, and no need to wear a collar after surgery. Ask your doctor if a disc replacement is right for you.
- Spinal Fusion Surgery: With spinal fusion surgery, the bulging or herniated disc is removed and two or more vertebrae are fused permanently so that they heal together into a single, solid bone. The procedure may require bone grafts and the use of metal cages, plates and screws. Spinal fusion immobilizes that section of the spine permanently.
- Artificial Disc Replacement Surgery: With the newer technique of a disc replacement surgery, the herniated or bulging disc pushing on the nerves is completely removed, and a prosthesis is placed in the disc place. The disc replacement maintains all neck range of motion and puts less stress on other levels in the neck.
Post-Surgery Risks and Expectations
As with all types of surgery, there are risks that come with herniated disc surgery. These include bleeding, infection, and nerve damage. When a disc is not completely removed, there is a chance that it can bulge out again. There is always a risk that other discs at other levels can also degenerate and herniate causing nerve compression.
Following surgery, your doctor will provide you with specific instructions about when you can begin exercising and resuming your normal activities. Be sure to follow the doctor’s recommendations closely and ask questions about any part of it that you don’t understand. For most, the recovery outlook after surgery is generally positive.
If you have a herniated disc or pinched nerve and believe you need surgery, contact us at Piedmont Orthopedics | OrthoAtlanta to schedule an appointment today.