An open discectomy is the most common surgical procedure used to treat a herniated or ruptured disc. The goal of this treatment is to achieve the partial or complete surgical removal of a damaged intervertebral disc. Removing the damaged disc eliminates the source of pressure and irritation on the nerve roots, which in turn removes the cause of the symptomatic back pain and weakness. Although this type of procedure may be done either as an open surgical procedure or via a minimally invasive method, a stay in the hospital or clinic of one to three days is typically required.
This surgery is performed to relieve sciatica due to disc herniation. Most of the lumbar disc herniations occur in the posterolateral position. In about 10% of cases disc herniations occur in the foraminal position. Foraminal disc herniations cause more pain and more severe neurological deficit and are more likely to require surgical intervention. Far lateral disc herniations are a type of foraminal disc herniations.
It is technically more difficult to surgically treat foraminal disc herniations than posterolateral disc herniations. L5 S1 foraminal disc herniations require removal of about one half of the L5 S1 facet joint. Surgeon stays on the opposite side of the disc herniation and look across into the foramen from the opposite side of the leg pain in order to remove the disc herniation. Foraminal disc herniations at other levels require paralateral approach staying lateral or outside of the facet joint. This is technically more difficult approach and many spine surgeons are not familiar with this approach.
Many of lumbar disc herniations resolve on their own. Surgery is usually indicated when the sciatica persists longer than 6 weeks interfering with activities of daily living. Exceptions are severe intolerable pain, profound neurological deficit, progressive neurological deficit, and cauda equina syndrome causing bowel and bladder dysfunction.
Success rate of lumbar microdiscectomy is quite high greater than 90 %. Surgery usually takes slightly more than one hour. Patients usually stay overnight. Office or light duty return to work is possible in a week or two. Heavy manual laborers such as carpenters are not released to full duty work for about a month to 6 weeks.
The most common complication of the procedure is recurrent disc herniation and this can occur in about 10% of cases. There is poor correlation with patient's activity level in my experience. It can occur any time after the surgery from a few days or many years later.
Other complications include dural tear( about 1 to 2%), nerve root injury( about 1 out of 1000 or less), wound infection( less than 1%), bleeding( very rare). Spinal cord injury or paraplegia is extremely rare as one is operating below the termination of the spinal cord. Very rarely epidural hematoma usually due to anticoagulation of patient's blood due to blood thinners can cause progressive blood clot formation tracking up to the spinal cord level resulting in paraplegia. Therefore it is essential that patients stop all types of anticoagulation including coumadin, persantin, aspirin, mortrin, naprosyn, Vioxx, Celebrex, advil, alleve, Relafen, fish oil, and all other types of blood thinners at least one week prior to surgery.
In less than 5 % of patients persistent low back pain, so called postlaminectomy low back pain, may remain despite complete clearance of their sciatica and some of these patients may require lumbar spinal fusion due to their chronic low back pain if it does not respond to physical therapy and other types of conservative care.