Intervertebral Diskectomy

Prior to Procedure

Your doctor will likely do the following:

• Physical exam
• Ask about the pain and when it started
• Refer you to a neurosurgeon or orthopedic surgeon

Before scheduling the procedure, the surgeon may:

• Order a magnetic resonance image (MRI) of your back
• Order discography (injection of dye into various areas of the spine to determine if they are the cause of the pain)

In the days leading up to your procedure:

• Review your regular medications with your surgeon. You may be asked to stop taking some drugs, such as aspirin.
• Ask about restrictions to your activities during the postoperative period.
• Arrange to have someone drive you home.
• Arrange for help at home after returning from the hospital.

The day before and the day of your procedure:

• Do not eat or drink anything after midnight unless told otherwise by your doctor.
• Wear comfortable clothing.

Anesthesia

General or local with sedation

Description of the Procedure

There are different types of surgical procedures and techniques used for a diskectomy:

Anterior Cervical Diskectomy —The surgeon makes a cut in the skin on the left or right side of the neck. He or she will go through a muscle to reach the spine. The surgeon removes the disc material after confirming by x-ray that it is the correct disc. He or she may also remove a portion of the bone to give the nerve more space. A bone graft may be placed to fuse the vertebrae.

Posterior Cervical Diskectomy —The surgeon cuts the skin at the back of the neck and pushes the muscle aside. A small piece of bone is removed to access the disc space. The nerve is gently pushed aside and the disc material removed.

Lumbar Diskectomy —The surgeon makes a 1-1½ inch cut in the skin on the lower back. He or she will move the muscles out of the way and possibly a small part of the bone to gain access to the nerve and disc. The disc or offending disc fragments are lifted out.

There are a variety of techniques used to perform a diskectomy. Your surgeon will pick the technique that is most appropriate for your particular case. An “open” technique involves a larger skin cut so that the surgeon can directly visualize the area of operation. A “minimally invasive” technique (eg, microdiskectomy or percutaneous approach) uses a smaller skin cut and the assistance of a variety of tools to help the surgeon see the operation site and to help operate in a smaller space.

Some of the tools used are: a microscope (to aid in seeing the small area of operation), microsurgical tools (such as small drills), an endoscope (a tiny camera threaded into the operating site through a tube), and a laser (which can vaporize disc material instead of cutting it with a scalpel and removing it). Using these tools for a “minimally invasive” approach generally results in less pain, quicker recovery time, and less scarring compared to an “open” approach.

How Long Will It Take?

The time in the operating room depends on the procedure. Microdiskectomy usually takes longer than an open procedure. But recovery is faster. This procedure is not always appropriate, however.

Will It Hurt?

Anesthesia prevents pain during surgery. Ask your doctor about medications to help with the pain during your recovery.

Possible Complications

• Bleeding
• Infection
• Nerve damage
• Bladder or bowel incontinence
• Leakage of spinal fluid
• In anterior cervical cases, damage to other structures in the neck or hoarseness due to nerve injury

Average Hospital Stay

Many lumbar procedures are done as outpatient surgery. Cervical diskectomy patients may be admitted to the hospital for a short stay.

Postoperative Care

Follow your doctor’s instructions. He or she may limit bending, lifting, or twisting for six weeks. An exercise program will help stretch and strengthen your muscles and decrease the risk of future back problems.