Discectomy for Herniated Disc in the Lower Back
A herniated disc can press against the spinal cord or the nerve roots that fan out from the spinal cord. Discectomy may relieve nerve compression and pain caused by a herniated disc.
This article will describe a lumbar discectomy, including details of open versus minimally invasive discectomy. It will also discuss how to prepare for surgery, what to expect with recovery, and more.
A lumbar discectomy is removal of a disc in the lower back, or lumbar spine. The spine has 26 vertebrae. The lumbar spine has five of them: L1–L5.
Other areas where surgeons perform discectomy include the neck and the middle part of the back. The removal of a disc in the neck area, or cervical spine, is called a cervical discectomy. The removal of a disc from the middle of the back, or thoracic spine, is called a thoracic discectomy.
Related surgical procedures
Your doctor may need to perform other procedures at the same time as the lumbar discectomy. These include:
- Foraminotomy: This procedure widens the opening, or foramina, in a vertebra where the nerve root leaves the spinal canal. Your doctor may use this procedure when the opening is too narrow, causing pressure on the spinal nerve.
- Laminectomy: This procedure removes the bony area of the vertebra, which is called the lamina. Laminectomy may be necessary to access your spinal disc.
- Spinal fusion: This procedure permanently joins together two vertebrae.
Your doctor may recommend a discectomy if other treatments have not relieved your symptoms and you are a candidate for surgery.
You may be a candidate for surgery if you have:
- a herniated disc compressing a nerve root
- pain, weakness, or numbness that continues despite conservative treatment such as physical therapy and medication
- problems walking and performing other daily tasks
- inability to control your bowels or bladder, which is a sign that multiple nerves are compressed
Ask your doctor about all your treatment options. Consider getting a second opinion before deciding on a discectomy.
Your surgeon will use one of the following approaches:
- Open discectomy: This involves a 3–4 centimeter (cm) skin incision over the affected part of your spine. The surgeon uses a microscope to dissect the area, removing muscle and other tissue to access the disc. Another name for this procedure is lumbar open microscopic discectomy, or microdiscectomy. The surgeon removes the bulging part of the disc and does not replace it with any material. Open discectomy may be part of a larger surgery in which the doctor needs to perform additional procedures, such as laminectomy.
- Minimally invasive surgery (MIS) discectomy: This involves a 1.5–2 cm incision. The surgeon places a tube into the incision. They use a retractor to expand the tube rather than cut through muscle and other tissues. They insert specialized surgical instruments through the tube. MIS involves a microscope or an endoscope, which is a camera.
Open vs. MIS lumbar discectomy
Open lumbar discectomy is more common than MIS lumbar discectomy. With the open approach, the surgeon has “the greatest ability to see and explore the surgical site,” says the North American Spine Society.
The MIS approach has some advantages over the open procedure. It generally involves a faster recovery, less pain, and a lower risk of some complications, such as infection.
A systematic review of randomized controlled trials indicates that the open approach is more effective than the MIS approach in terms of leg and low back pain relief, quality of life, and rehospitalization. However, another systematic review indicates that the MIS and open approaches have “equivalently good outcomes.”
Your surgeon will talk with you about which procedure may be best for you. Learn about the different discectomy procedures and ask your doctor why they suggest a particular type for you.
Type of anesthesia
Your surgeon will perform a discectomy using either general anesthetic or regional anesthetic, depending on the specific procedure.
Knowing what to expect can help make your road to recovery after a discectomy as smooth as possible.
You may not need a hospital stay. You will be in the recovery room after surgery until you are fully alert, breathing effectively, and your vital signs are stable. Patients usually go home on the same day. Sometimes an overnight hospital stay is necessary.
Most people can return to work in 2–4 weeks. It may be longer if your job is physical. Full recovery time is 6–8 weeks.
Your doctor will probably encourage you to walk and avoid sitting for long periods. They generally recommend limiting bending and twisting as well as lifting more than 5 pounds for 3–6 weeks. You will have physical therapy to help you recover.
You may have pain at the surgical site. You may also have some of the pain you had before surgery. Medication by mouth may be enough to manage it and get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When to contact your doctor
It is important to keep your follow-up appointments after a discectomy. Contact your doctor for questions and concerns between appointments. Call them right away or seek immediate medical care if you have:
- difficulty breathing
- change in alertness
- chest pain
- inability to urinate or have a bowel movement
- leg pain, skin discoloration, or swelling
- pain that your medication is not managing
- unexpected drainage, pus, or swelling of your incision or change in skin color around the incision
- weakness, numbness, or difficulty moving
As with all surgeries, a discectomy involves risks and possible complications.
The general risks of surgery include:
- anesthesia reaction
- bleeding or hemorrhage
- blood clot
Complications of discectomy can include:
- damage to the nerves leaving your spine
- disc fragments remaining
- injury to tissues or organs that must be displaced to access your disc
- pain that does not get better or that returns
Talk with your doctor about the potential complications of discectomy well in advance of your surgery. The surgical team can treat most of these problems.
Below are other questions that people ask about discectomy.
Is lumbar discectomy a major surgery?
Lumbar discectomy would not be defined as major surgery, according to a 2020 article. Major surgeries are those in which the patient has a medical condition in addition to the one being addressed by surgery, as well as a higher chance of death from the surgery.
What is the success rate of discectomy?
The success rate of lumbar discectomy varies. A 2021 meta-analysis found the rate of “satisfactory outcome” was approximately 80% for lumbar disc herniations, including L3–L4 herniations. A 2019 study involving 60 patients from a hospital in Guangdong province, China, found the success rate for lumbar discectomy is about 90%. The success rate of MIS versus open discectomy was comparable in both articles. The rate of herniation recurrence ranges from 1–25%, according to a 2022 review.
Lumbar discectomy is the surgical removal of part or all of a bulging disc in the low back. It is usually an open procedure under general anesthesia. The recovery time is 6–8 weeks, but you may return to some everyday activities within 2 weeks. There is a chance that disc removal does not relieve your symptoms. It is important to talk with your doctor about what to expect.