Lumbar Discectomy

Lumbar discectomy is a surgical procedure that involves the removal of the protruding portion of the intervertebral disc in the lumbar spine, responsible for back pain. The procedure is usually employed to relieve the pressure over the spinal nerve roots due to herniated or ruptured disc in the lumbar region.

The intervertebral disc is composed an outer fibrous ring known as the annulus fibrosus and gelly-like core called the nucleus pulposus. The intervertebral disc is present between two adjoining vertebrae and act as shock absorber.

Procedure

The basic steps involved in the lumbar discectomy are as follows:

• The patient is administered general anesthesia
• The patient is placed face down over a specially designed frame that reduces the pressure and relaxes the abdomen region
• The positioning of the patient, in the frame, reduces blood loss and also provides more working space for the procedure
• A small incision is made over the skin of the lumbar region and soft tissues and muscles are retracted to approach the spine
• X-rays images are used to identify the affected intervertebral disc
• The small portion of the lamina bone, covering the spinal canal is removed, by using a cutting tool
• A portion of ligamentum flavum  is also cut to expose the spinal nerves within the spinal canal
• A hole is then made in the outer layer of the disc and the disc material, inducing pressure over the nerve, is removed
• The neural foramen is enlarged to relieve any compression over the nerve root
• In some cases, a specially designed foam pad or a patch of fat is placed over the nerve root to prevent the growth of scar tissue onto the spinal nerve
• Finally the incision is closed and sutured

Post operative care

Patients are usually discharged on the same day of the surgery and can resume driving within 1-2 weeks of the surgery. General post-operative instructions for a patient after a lumbar discectomy include:

• Keep the incision clean and dry
• Move the back with care and caution
• Patient can get back to work after 3-4 weeks
• Avoid heavy work or any active sport for at least 2-3 months
• Physical therapy is recommended after 2-3 weeks of the surgery

Risks and complications

There are always some complications associated with any major surgery. Some of the complications associated with lumbar discectomy include infection, spinal nerve injury, persistent pain, instability of the spinal fragments, and thrombophlebitis.