Disk removal is one of the most common types of back surgery. Diskectomy (also called discectomy) is the removal of an intervertebral disk, the flexible plate that connects any two adjacent vertebrae in the spine. Intervertebral disks act as shock absorbers, protecting the brain and spinal cord from the impact produced by the body's movements.
Removing the invertebral disk is performed after completion of unsuccessful conservative treatment for back pain that has been present for at least six weeks. Surgery is also performed if there is pressure on the lumbosacral nerve roots that causes weakness, bowel dysfunction, or bladder dysfunction.
As a person ages, the disks between vertebrae degenerate and dry out, and tears form in the fibers holding them in place. Eventually, the disk can develop a blister-like bulge, compressing nerves in the spine and causing pain. This is called a "prolapsed" (or herniated) disk. If such a disk presses on a nerve root and causes muscle weakness, or problems with the bladder or bowel, immediate disk removal surgery may be needed.
The goal of the surgery is to relieve all pressure on nerve roots by removing the pulpy material from the disk, or the entire disk. If it is necessary to remove material from several nearby vertebrae, the spine may become unsteady. In this case, the surgeon will perform a spinal fusion , removing all disks between two or more vertebrae, and roughening the bones so that the vertebrae heal together. Bone strips taken from the patient's leg or hip may be used to help hold the vertebrae together. Spinal fusion decreases pain, but decreases spinal mobility.
The surgery is performed under general anesthesia. The surgeon cuts an opening into the vertebral canal, and moves the dura and the bundle of nerves called the "cauda equina" (horse's tail) aside, which exposes the disk. If a portion of the disk has moved out from between the vertebrae and into the nerve canal, it is simply removed. If the disk itself has become fragmented and partially displaced, or is not fragmented but bulges extensively, the surgeon removes the damaged part of the disk and the part that lies in the space between the vertebrae.
There are minimally invasive surgical techniques for disk removal, including microdiskectomy. In this procedure, the surgeon uses a magnifying instrument or special microscope to view the disk. Magnification makes it possible to remove a herniated disk with a smaller incision, causing less damage to nearby tissue. Video-assisted arthroscopic microdiskectomy has exhibited good results with less use of narcotics and a shortened period of disability.
The physician will obtain x rays and neuroimaging studies, including a computed tomography (CT) scan, myelogram, and magnetic resonance imaging (MRI); and clinical exams to determine the precise location of the affected disk.
An hour before surgery, the patient is given an injection to dry up internal fluids and encourage drowsiness.
After the operation, the patient is lying flat and face down when he or she awakens. This position must be maintained for several days, except for occasional positional changes to avoid bedsores . There may be slight pain or stiffness in the back area.
Patients usually leave the hospital on the fourth or fifth day after surgery. They must:
- Avoid sitting for more than 15–20 minutes.
- Use a reclined chair.
- Avoid bending at the waist, twisting, or lifting heavy objects.
- Begin gentle walking (indoors or outdoors), and gradually increase exercise . Exercise should be continued for the next four weeks.
- Begin stationary biking or gentle swimming after two weeks.
- Sleep on a firm mattress.
- Slow down if they experience more than minor pain in the back or leg.
- Refrain from sitting in one place for an extended period of time (e.g., long car ride).
Patients should be able to resume normal activities in four to six weeks.