The goal of surgery is to prevent the herniated disc from injuring the nerves by pressing on them, therefore from causing symptoms such as pain and loss of power. The most common procedure is discectomy or partial discectomy, removing a piece of the herniated disc. Sometimes a piece of the bone at the back of the disc, named lamina, may have to be removed as well. This is called a hemi-laminotomy if bone removal is minimal, or hemi-laminectomy if bone removal is larger. If the nerve root is irritated after removal of the herniated disc tissue, a complete recovery of pain will be provided.
Recently, surgeons prefer to perform this procedure by using a microscope or endoscope, enabling a small incision that will heal rapidly.
Discectomy may be performed under local, spinal or general anesthesia. The patient is placed prone (facing the bed), and often a position is given that resembles squatting. A small cut is made on the skin located over the herniated disc, and then the muscles on the spine are pulled to the sides. The surgeon may need to remove a small amount of bone to see the compressed nerve. The herniated disc and other torn pieces are removed, without leaving any residual compression on the nerve. The bone projections (osteophytes) are also removed to ensure that the nerve will not be compressed. Bleeding is often minimal.
What Can I expect Post-Surgery?
If your primary complaint is leg pain rather than lower back pain, then you may anticipate a good result from surgery. Before the operation, your doctor will perform an examination and various tests to verify a disc hernia pressing on your nerve is causing the pain. During physical examination, a positive straight-leg-raise test, indicating sciatica, is performed. Muscle weakness, loss of sensation, and changes in reflexes may also be observed. In addition, imaging methods such as MRI (magnetic resonance imaging), CT (computerized tomography), and myelography can clearly show nerve compression. If these tests are positive, your doctor can verify nerve compression and, in that case, a 90 percent probability exists of having an obvious decrease in leg pain after surgery. You should not expect to have a complete absence of pain, however you can live quite a normal life by keeping the pain under control.
Most patients do not experience any complications after discectomy, however similar to every operation, this method carries some risks. Bleeding, infection, injury to the sheath protecting the spinal cord or nerves (dura mater), and injury to the nerves are examples. Also re-rupture of the disc after surgery and relapse of symptoms is possible. In approximately 5 percent of patients, the disc may rupture again and cause symptoms in the future.
Obtain information from your doctor about activity limitations that may be necessary after surgery. Walking around once anesthesia wears off is a good practice. Most patients are discharged within 24 hours following surgery or even the same day. You should avoid driving, sitting for a long time, lifting heavy objects and bending forward for at least four weeks after surgery. Some patients benefit from a therapy program that can be applied under a doctor's counseling. Ask your doctor for back strengthening exercises to avoid facing the same situation again.
When Would I Need Immediate Surgery?
Very rarely, a large disc hernia may impinge on the nerves controlling the bladder and the bowel, resulting in loss of bladder and bowel control. This is generally in association with numbness and tingling in the groin or genital area—requiring urgent disc hernia surgery. Call your doctor immediately if you face such a condition.