What is a lumbar discectomy?
A discectomy is a surgical procedure in which a damaged disc is “cut out.” The disc is removed by creating access through the bone that makes up the back of a vertebra. This part of the vertebrae is called the lamina. Discectomies may be performed as “open” surgery through a large incision or as a minimally-invasive procedure using various special instruments.
The surgeon makes this determination based on the patient’s anatomical structure and needs. In some cases, a lumbar discectomy is combined with spinal fusion. This technique joins the vertebrae that had been separated by the disc that has been removed. The purpose of the fusion is to maximize the structural integrity of the spine.
WHAT CAN CAUSE LUMBAR SPINE PAIN?
People who are injured in a fall, a motor vehicle accident and even those who have had no known trauma can develop problems in the lower back. Individuals that mistakenly lift excessively or with the wrong body mechanics can also acutely injure themselves. Athletes in some sports will have a significant incidence of injuring the lumbar spine.
WHAT ARE THE SYMPTOMS OF LUMBAR SPINE PAIN?
Lower back pain is nearly a universal condition, as over 80 percent of people will suffer from lower back pain at some point in their lives. Lower back pain often starts as acute pain in reaction to an injury, such as lifting a heavy object the wrong way.
This pain can become chronic if the initial acute pain is not managed. While pain is the obvious symptom, the types and areas described will be helpful for Dr. Watson in diagnosing the exact cause/origin.
There are typical symptoms, which may be a combination of the following varying types of pain:
- Dull, aching pain: This kind of pain usually remains localized in the low back. It isn’t sharp or burning. It may include muscle spasms and mobility may be limited.
- Radiating pain: Also called sciatica, this pain moves down the thighs and into the low legs and feet, usually on one side only. It is caused when the sciatic nerve is irritated.
- Pain that worsens with sitting: After sitting, this kind of pain can make it difficult to simply rise and stand up. Sitting puts pressure on the discs, which makes the pain worse. Walking can alleviate the symptoms, only to have them return after sitting.
- Pain that lessens with changing positions: This pain will show itself in certain positions but will feel better in others. If you have compression and spinal stenosis, walking will be painful, but leaning on something could make the pain subside.
- Pain that is worse when first waking but lessens: Low back pain is the worst in the morning for many people. It decreases after the person gets up and moves about. This is because the long periods of rest, decreased blood flow during sleep, and the positions or pillows/mattress involved with sleep.
LOWER BACK PAIN PATIENT TESTIMONIAL
WHEN IS A LUMBAR DISCECTOMY PROCEDURE NECESSARY?
If you are experiencing any of the symptoms, a lumbar discectomy could be right for you.
Weakness that happens acutely is a very significant issue that should be investigated quickly. Loss of control of bowels or bladder, as well as loss of use/control of the lower extremities, signify an emergency.
WHO IS A CANDIDATE FOR A LUMBAR DISCECTOMY?
By the time a disc is herniated, the presence of pain and other symptoms in the same region of the spine typically denote asymptomatic disc or discs. That person is frequently a candidate for the lumbar discectomy procedure at the levels of the herniated discs. Dr. Watson will assess your symptoms in his Tampa office before proposing the best treatment plan for lower back pain relief.
HOW IS LUMBAR PAIN DIAGNOSED?
At Innovative Spine Care, any diagnosis from Dr. Watson starts with the patient’s medical history. From there, he’ll ask you about your current symptoms, your activity level, your sleep habits, your posture, and any recent injuries you may have had. This could even have been a past injury that you didn’t associate with your current pain. This history and your answers to these questions can be the most important tool in his diagnosis.
Next is a physical exam. This will include:
- Palpation: Dr. Watson will feel the lower back for areas of tenderness, joint abnormalities, muscle spasms, or areas that are abnormally tight.
- Neurologic exam: A motor exam will check movement of your hips, knees, and feet. He’ll have you flex your toes, ankles, and lower legs. He may test sensory responses to touch, a pin prick, or other stimuli to the lower trunk, buttocks, and legs.
- Range of motion: You’ll be asked to bend or twist in certain positions, and Dr. Watson will look to see which positions create or worsen pain.
- Reflexes: Your leg reflexes will be checked. If they are weakened or you have decreased muscle strength, you could have nerve root compression.
- Leg raise: When lying on your back, you’ll be asked to raise one leg as high as possible, keeping it as straight as you can. If this creates low back pain, a herniated disc can be the cause.
Imaging tests may be necessary if the patient’s pain is severe, hasn’t resolved or lessened within 2-3 months, or is not responding to conservative treatments. Dr. Watson could have a clear idea of what is causing your pain, but not exactly where the problem is originating. Imaging tests can give him this piece of the puzzle.
These imaging tests could include:
- X-rays show abnormalities in the spine, such as fractures, arthritis, bone spurs, or tumors.
- Computer tomography (CT) scans provide a cross-section of the spine. X-rays are used to create a 3D image of the spine, allowing viewing from different angles. Dye may be injected around nerve roots to highlight spinal structures.
- Magnetic resonance imaging (MRI) provides a detailed image without the radiation of x-rays. MRIs are effective for detecting abnormalities with soft tissues.
- Injection studies can be used to confirm the sources of pain. Local anesthetic or steroid medications are injected into specific areas to calm the pain, verifying the point of origin.
WHAT CAUSES LUMBAR NERVE COMPRESSION?
The typical cause of nerve compression is either a disc herniation that narrows the neural foramen or exit point for a segmental nerve from the spinal canal. That compression can also occur because of the presence of bony prominences in the neural foramen typically growing off of the back of the vertebral bodies.
There may also be compression by a facet complex that overgrows because of an injury or degenerative process. Nerve compression can only be determined by evidence seen on an MRI scan as similar symptoms can occur with the inflammatory process involved with a herniated disc.
WHEN IS LOWER BACK SURGERY NECESSARY?
This procedure is an option as are the other discectomy procedures. Most patients have several alternatives and the discectomy is just one. It is helpful for relieving much of the pain and other symptoms in the low back and legs.
The procedure is not needed unless the patient has symptoms severe enough for that individual to desire some sort of significant intervention including surgery to relieve the symptoms. In that circumstance, the lumbar DND is a good option for many who would prefer not to undergo a more invasive discectomy and/or fusion.
HOW IS A LUMBAR DISCECTOMY PERFORMED?
The patient may have a breathing tube inserted into the trachea or windpipe if considered necessary for safety during the procedure. This is accomplished after the patient goes to sleep.
A Thulium laser is then used to treat the posterior annulus of each symptomatic herniated disc and potentially some bulging discs. The procedure places sufficient energy into the annulus to turn off the nociceptors or pain nerves, char the annulus and sometimes shrink the bulge or herniation as well as seal the blood vessels extending into the annulus. These vessels bring compounds to the disc that cause further inflammation and pain in the area. This procedure is what relieves much of the low back and even leg pain as well as weakness, tingling and numbness in the legs. Lumbar facets that are symptomatic can be treated at the end of this portion of the procedure.
Completion of the procedure commences by injection of antibiotics into the disc(s), removal of the needles from the disc(s) and then placing a sterile dressing over the needle insertion sites.
ARE YOU AWAKE DURING A LUMBAR DISCECTOMY?
After being comfortably positioned on the operating table in the face-down position, the patient is given oxygen, connected to appropriate monitors and administered intravenous sedation to induce sleep.
HOW LONG DOES A LUMBAR DISCECTOMY PROCEDURE TAKE?
The Lumbar Discectomy and Neural Decompression Procedures are performed in a surgery center and typically is accomplished over the course of 75 minutes to 2 1/2 hours depending on the anatomy of the patient, the complexity of the pathology and how many discs are problematic.
WHAT HAPPENS AFTER MY LUMBAR DISCECTOMY SURGERY?
After the procedure is completed, the patient is awakened and moved to the recovery room until discharge. The average time in the recovery room is about 1 hour.
"I must write this review to say that after undergoing Dr. Watson's special procedure on My lower back, I am pain-free for more than 14 months so far... Dr. Watson first examined me, I was most impressed with how He was able to explain the nature of My injury in a way easy for Me to understand, and how He always ask if He can pray for Me each time I visit."
What is recovery like after a lumbar discectomy?
The traditional discectomy procedure is performed in a hospital. Patients may remain in the hospital for a few days, during which medical staff will help them move and begin to walk. In general, it can take from 1 to 4 weeks to recover from the surgical discectomy procedure. A patient’s general health, lifestyle, and underlying disc problem that had required care all contribute to how quickly they recover from their procedure.
However, statistics show that most patients can return to work within 4 weeks of their discectomy surgery. Those with more strenuous occupations may need to take 8 to 12 weeks off before they can resume heavy lifting or other physically-demanding activities.
Results of a Lumbar Discectomy
Studies have shown that 80 to 90% of patients who undergo a lumbar discectomy achieve good results. The initial pain that is treated may not go away immediately and may not go away completely.
The best results have been associated with patients who choose surgery to relieve moderate to severe pain in the leg caused by sciatica related to the damaged disc.
How soon after a lumbar discectomy will I be able to drive?
Patients who undergo a lumbar discectomy can usually drive when they feel up to it. This may not occur until the patient is no longer taking narcotic pain medications and has been followed-up by their surgeon. The follow-up visit is usually scheduled 2 to 3 weeks after the discectomy.
Will my results be permanent?
While studies suggest that patients can regain a significant degree of comfort through discectomy surgery, it is unclear whether surgery eliminates the need for additional treatment later on. It is estimated that 5 to 15% of patients who have discectomy treatment experience a recurrent disc herniation at some point. This could be on the same side or the opposite side of the spinal column.
How to care for your back after surgery
After a discectomy procedure, patients are encouraged to practice good posture and proper body mechanics when exercising. Proper lifting techniques are also necessary to reduce stress on the spine. Exercise or physical therapy can assist patients with learning how to move their body in healthier, protective ways.
How to sleep after back surgery
People who have back surgery are often told that they can sleep however is comfortable. Ideally, patients will sleep on their backs or sides. Stomach sleeping is stressful on the spine. If you are a stomach-sleeper, your doctor may suggest placing a soft pillow under your stomach to relieve the disc spaces.
When sleeping on the back, patients can elevate their upper torso, shoulders, and head with supportive pillows. A pillow or roll can also be placed under the knees. Side-sleeping may be most comfortable with a pillow between the knees.
How should I sit after lower back surgery?
Sitting puts pressure on the spine. After a discectomy, it may be advisable to avoid sitting in very soft chairs that place the hips below the knees. A doctor may recommend sitting in a normal dining chair or other firmer seat that maintains about a 90-degree angle at the hips and knees.
It can also help to sit in chairs with arm supports that make it easier to stand up from the seated position.
What are the risks of lumbar discectomy?
At Innovative Spine Care these procedures do not involve lengthy incisions, removing the herniated disc, removing pieces of bone (such as the lamina), or fusion. Because of this, despite being spinal surgery, these are very low risk treatments. There is the possibility of damage to the spinal discs beyond the pain receptors, but this is rare.
These methods, which evolved from Dr. Watson’s original focus as an anesthesiologist and then an interventional pain management expert, are effective for dealing with the pain caused by a herniated or bulging disc.