Feb 18, 2018

If you have a lumbar herniated disc in your spine (sometimes called a “slipped” or “ruptured” disc), you’ve probably gotten several opinions from spine doctors regarding surgical options for your condition. Surgery may help to alleviate your pain and increase your mobility, but it’s important to know all the information about the pros and cons of surgical treatment before deciding to go this route.

About half of all patients with a herniated disc find that symptoms such as leg pain improve on their own or become much less severe in 4-6 weeks. If you have already tried conservative treatments such as physical therapy and medication with no significant results, then surgical treatment might be your best option.

Treatment for a herniated disc should be individualized specifically to each patient, depending on the duration and severity of their pain. Success rates from surgery can range from 90% or higher for leg pain.

If the pain is preventing you from doing the things you want to do in life, surgery may be recommended. For example, if your job requirements prevent you from working or cause symptoms to recur or persist. If your symptoms begin to affect other parts of your body, including bowel or bladder dysfunction or nerve damage to your legs, you should have an immediate surgical evaluation as these conditions may require urgent attention.

SURGICAL TREATMENT OPTIONS FOR THE LUMBAR HERNIATED DISC INCLUDE*:

MICRODISCECTOMY

The most common procedure, where a small portion of the bone over the nerve root and/or disc material is removed, the nerve is retracted and the disc material from under the nerve root is removed to relieve neural impingement and provide more room for the nerve to heal.

LUMBAR LAMINECTOMY

A lumbar laminectomy (also known as open decompression) is typically performed to alleviate pain caused by neural impingement that can result from lumbar spinal stenosis. This surgery is designed to remove bone over the nerve roots to give the nerve root more space and room to heal. This procedure differs from the microdiscectomy in that the main goal is to remove bone and thickened ligament and trim the facet joint. In most cases the disc is left alone.

ARTHROSCOPIC LUMBAR DISCECTOMY

A procedure that shrinks the disc without traumatizing sur-rounding tissue by removing a portion of the disc from within the disc itself, which may be impinging upon nerve roots, creating pain.

MICROENDOSCOPIC SURGERY

A lumbar micro endoscopic discectomy is a minimally invasive procedure performed through a tubular device and designed to relieve pain caused by herniated discs pressing on nerve roots.

LUMBAR SPINAL FUSION

Fusing the spine can eliminate the source of the pain (the disc) and stop the motion in between the vertebrae. It can be done from the front of the spine or the back, or from both the front and the back in certain cases. Spinal fusion can cut pain in half and success rates range from 72-91%** depending on the technique used. The Swedish Lumbar Spine Study found that patients who underwent fusion surgery did better over the long run than patients who had non-surgical treatment for chronic back pain. However, over 27% developed degeneration or breakdown of the disc next to the fusion.** On average, 6.7 years after the first fusion surgery, patients needed another operation.**

REFERENCES:

*Anderson, P.A., et al., Randomized Controlled Trials of the Treatment of Lumbar Disk herniation: 1983-2007, JAAOS 2008; 16:10:566-573. **Fritzell, P., Hagg, O., et al., Swedish Lumbar Spine Study Group, Lumbar Fusion versus nonsurgical treatment for Chronic low back Pain. A multicenter trial from the Swedish Lumbar Spine Study group. Spine 2001; 26:2521-32.