What is lumbar discectomy?

Discectomy is surgery to remove lumbar (low back) herniated disc material that is pressing on a nerve root.

It's often done as microdiscectomy, which uses a special microscope to view the disc and nerves. This larger view allows the surgeon to use a smaller cut (incision). And this causes less damage to surrounding tissue.

Before the disc material is removed, a small piece of bone (the lamina) from the affected vertebra may be removed. This is called a laminotomy or laminectomy. It allows the surgeon to better see the herniated disc.

You may be asleep or have medicine to relax you during surgery. And the area will be numbed if you're awake. It's often numbed even if you are asleep. You might go home the same day you have surgery. Or you might need to stay in the hospital or surgery center overnight.

Incision care

• If you have strips of tape on the cut (incision) the doctor made, leave the tape on for a week or until it falls off.
• Wash the area daily with warm, soapy water, and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
• Keep the area clean and dry.

Medicines

• Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions about taking any new medicines.
• Be safe with medicines. Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Drink plenty of fluids (unless your doctor tells you not to).
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Avoid lifting anything that would make you strain. This may include heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, a vacuum cleaner, or a child.
• Try to change your position about every 30 minutes while you sit or stand. This will help decrease your back pain while you heal.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay.
• Ask your doctor when you can drive again.
• Avoid riding in a car for more than 30 minutes at a time for 2 to 4 weeks after surgery. If you must ride in a car for a longer distance, stop often to walk and stretch your legs.
• Your time off from work depends on how quickly you feel better and on the type of work you do. If you work in an office, you likely can go back to work sooner than if you have a job where you are very active. Talk with your doctor about your work needs.
• You may have sex as soon as you feel able, but avoid positions that put stress on your back or cause pain.

Exercise

• Do back exercises as instructed by your doctor.
• Your doctor may recommend that you work with a physical therapist to improve the strength and flexibility of your back.

Other instructions

• To reduce stiffness and help sore muscles, use a warm water bottle, a heating pad set on low, or a warm cloth on your back. Do not put heat right over the incision. Do not go to sleep with a heating pad on your skin.

Surgery for a lumbar (low back) herniated disc works well for many people, but not for everyone. For some people, it can get rid of all or most of their symptoms.

In a study of people who had sciatica caused by a herniated disc, the chances of having no symptoms or almost no symptoms 3 months to 2 years later was a little higher with surgery than with nonsurgical treatment. But, overall, most people felt better with or without surgery.

In a study of people who had 6 to 12 weeks of severe sciatica related to a herniated disc, one group was assigned to have surgery soon (the surgery group). The other group (the nonsurgical group) was assigned to try nonsurgical treatments for 6 months, followed by surgery if their symptoms didn't improve. Both groups were asked about their recovery 2 months after surgery or the start of nonsurgical treatment. People in the surgery group felt better (closer to complete recovery) than people in the nonsurgical group. But after 1 year, both treatment groups rated their recovery about the same.

If you don't choose surgery now, you can change your mind later if your symptoms haven't gotten better or have gotten worse even with other treatments. Surgery seems to work just as well if it's done within 6 months after symptoms start.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to shower or bathe with a special soap the night before and the morning of your surgery. The soap contains chlorhexidine. It reduces the amount of bacteria on your skin that could cause an infection after surgery.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

As with any surgery, there are some risks.

• Surgery doesn't always work. Or it may not work any better than other treatment.
• There is a slight risk of damaging the spine or nerves.
• There is some risk of infection.
• There are risks with anesthesia.

Microdiscectomy is surgery to remove part or all of a bulging or damaged (herniated) disc in the spine. A herniated disc in the low back (from the first lumbar vertebra to the sacrum) is called a lumbar herniated disc. It if irritates or presses on the spinal nerves, it can cause pain and numbness in the buttock and leg.

Most people can get better on their own. But for some people, surgery may help the pain and numbness. It may also improve movement.

You will probably be able to go home the same day as your surgery, or the next day.

After surgery, you may have less leg pain and numbness. And you may be able to move your leg better. Some people feel better very soon after surgery. But if you had leg pain or numbness for a long time before surgery, it may take longer to feel better.

Your back will probably feel stiff and sore. You may find it uncomfortable to sit or stand in one position for very long. This usually gets better after several weeks. But your back could be a little stiff for up to 6 months. You will have a small scar on your back, but it may fade with time.

Many people are able to go back to work and their daily routine as soon as the pain improves. If you work in an office, you may go back to work in a week or two. If your job requires physical labor (such as lifting or twisting), you may be able to go back to work in 4 to 8 weeks.

Walking and doing back exercises can help you get better faster. Your doctor may recommend that you work with a physical therapist to make the muscles around your spine stronger and more flexible. You will need to learn how to lift, twist, and bend in ways that keep your back safe.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled.
• If your doctor has told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. You may be asleep or have medicine to relax you. And the area will be numbed if you're awake. It's often numbed even if you are asleep.
• The surgery will take about 1 to 2 hours.

You may be asleep or have medicine to relax you. And the area will be numbed if you're awake. It's often numbed even if you are asleep. You will not feel pain during the surgery.

The doctor will make a 1- to 2-inch cut (incision) in the skin over the spine. The doctor will put surgical tools through the incision and will use a special microscope (scope) to view the area.

The doctor may first remove a small amount of bone and other tissue from the spine. This helps the doctor see the area around the disc. Then the doctor removes the bulging disc material. Next, the doctor closes the incision with stitches.

Surgery is done to decrease pain and allow you to regain normal movement and function.

You and your doctor may consider surgery if:

• You have very bad leg pain, numbness, or weakness that keeps you from being able to do your daily activities.
• Your leg symptoms do not get better after at least 6 weeks of nonsurgical treatment.
• Results of a physical exam show that you have weakness, loss of motion, or abnormal feeling that is likely to get better after surgery.

Surgery is an emergency if you have cauda equina syndrome. Signs include:

• New loss of bowel or bladder control.
• New weakness in the legs (usually both legs).
• New numbness or tingling in the buttocks, genital area, or legs (usually both legs).