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Discectomy and Microdiscectomy

Discectomy is a surgical procedure performed to remove part or all of a damaged or slipped (herniated or bulging) disc in the spine, usually for treatment of nerve root entrapment (compression) or sciatica.

Also known as: discectomy can also be known as disc surgery

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Everything you need to know

Discectomy is a surgical procedure performed to remove part or all of a damaged or slipped (herniated or bulging) disc in the spine, usually for treatment of nerve root entrapment (compression) or sciatica.

The discs in the spine act as cushions or shock absorbers between the vertebrae (the bones that interlock to form your spinal column.) When a disc becomes damaged or herniates, its soft centre bulges out through its tough exterior. This can irritate or put pressure on the spinal nerves, leading to pain, numbness, weakness, or other neurological symptoms, such as tingling and pins and needles (parasthesia). Occasionaly vital nerves for bowel and bladder function can be affected.

‘Micro’discectomy is a technique that uses a microscope allowing for a smaller incision and usually faster recovery as a result.

A discectomy may be recommended if your symptoms have not been relieved by more conservative treatments such as physiotherapy or spinal injections, and your symptoms are affecting your quality-of-life.

Surgery is considered if you are healthy enough to withstand the risks and stresses of surgery and general anaesthetic. Usually with the right decision making 90% of patients are happy that they had this surgery.

A discectomy can help treat the following conditions:

  • Herniated disc: Also known as a slipped or ruptured disc. This is when the soft centre of a spinal disc bulges (herniates) out through the tougher exterior and presses on nearby nerves, causing pain, numbness, and weakness.
  • Degenerative disc disease: Over time, the elasticity of the discs reduces. This is a normal part of ageing. However, for some people, this leads to the development of degenerative wear changes in the small (fact) joints of the vertebrae rubbing together and putting pressure on the spinal nerves, which can cause back or neck pain and tingling or numbness in the arms or legs. A discectomy to remove the damaged disc can help alleviate symptoms by taking pressure off the affected nerves.
  • Sciatica: This is term used to describe a particular type of pain when the sciatic nerve is injured or under pressure. Symptoms include pain down one or both legs to below the knee, pain in the buttocks and difficulty walking. It’s often caused by a herniated disc in the lower back.

It’s important to remember that most people with disc-related issues will not need surgery. The decision to proceed with surgery is typically based on the severity and duration of symptoms, your overall health, and the extent of disc damage or risk to the nerves of the spinal cord, amongst other factors. A thorough evaluation by a medical professional is necessary to determine if a discectomy is the most appropriate course of action for you.

In most cases, your doctor will try non-surgical treatments first, such as medication, physiotherapy or spinal injections. If these don’t work and your symptoms are affecting your enjoyment of life or the risks of not operating outweigh the risks of surgery, a discectomy may be recommended.

Before surgery

Firstly, you will have an appointment with one of our spinal consultants. If you don’t already have a confirmed diagnosis, they will take a history, conduct a physical exam, and refer you for a scan to pinpoint the location and severity of your problem. This could include an X-ray or MRI (Magnetic Resonance Imaging) of your spine, and you may need to have some blood tests as well.

If you are diagnosed with a disc problem, your doctor will talk you through your options. If surgery is recommended, your doctor will walk you through the potential risks and benefits and details of the procedure.

If you decide to go ahead with surgery, we will help you prepare, but you should also try to eat healthily in the run up and stop smoking if you can.

Preparation will involve having some pre-operative tests, which will include an MRSA test.

If you take any blood thinners—for example, Warfarin, Rivaroxaban, or Aspirin, tell your doctor straight away, as you may need to stop taking these or modify your intake a week or so before surgery. Your doctor or pre assessment clinic will give you specific instructions if this is the case. You should also tell your doctor if you take nonsteroidal anti-inflammatory drugs, such as ibuprofen or Naproxen.

For at least six hours before your scheduled surgery, do not eat or drink anything except tap water – and this only up to two hours before your operation. This includes not drinking sparkling water, and milky drinks such as coffee and tea, chewing gum and hard candies. The preoperation and Admissions assessment team will advise you on this in advance of the surgery day.

Brush your teeth with toothpaste only on the morning of surgery. If you take any prescriptions medications, bring them to hospital with you. Your doctor will let you know if you can take these with a sip of water before your surgery or if you should wait until after.

On surgery day, it’s a good idea to wear loose, comfortable clothing and bring a small bag with things you might need during your stay. Items to remember include a toothbrush and toothpaste, your phone and a charger, a book, any prescription medications and a change of clothes.

Once you have arrived and are settled in your room, a nurse will help prepare you for surgery by monitoring vital signs (blood pressure, temperature heart rate and Oxygen levels in your blood using a probe on your finger,  and running through your medical history, medications and emergency contacts.

Your doctor will see you before the procedure and run you through the procedure once again –  and if you have not already done so in clinic, will ask you to sign a consent form for surgery.

During surgery

Firstly, you’ll have an intravenous (IV) line inserted  into a vein. This is usually done in your arm or the back of your hand. Through this, your surgical team can quickly give you medications and fluids. The surgical team will also place heart and oxygen monitors on you to help them keep you stay safe throughout surgery.

After some final safety checks, surgery can start.

Firstly you’ll be given general anaesthesia. The injection can sting as it goes in to your arm –  this is normal and only short lasting. This means you will be asleep throughout the procedure.

For this surgery, you will normally be lying face-down on a curved mattress, so the surgeon can easily access your spine. An XRay machine is used to ensure that the correct disc level is treated. The surgeon will then make an incision that will run vertically along your back of your spine. The size and location of the incision will depend on how many discs are being treated and the complexity of the operation.

Next, the surgeon will move aside the muscles to expose the area of the spine that needs treating. They will then  expose the disc and will remove enough disc tissue and sometimes small amounts of adjacent bone to remove pressure on the nerves. Most of the disc will be left behind to keep working as a shock absorber. Surgery will last about 60 to 90 minutes.

To finish, the surgeon will inject local anaesthetic into the wound edges for post operation pain relief, and close the incision using stitches or staples. You will then be taken to our recovery area, where specialist staff will monitor you and your vital signs as you wake up from anaesthesia. A dressing will be placed on the wound.

After surgery

Once we’re happy you’re doing well, we will take you to your private room where you can start your recovery. We’ll encourage you to start moving the day after your operation, so one of our physiotherapists will guide you through some exercises and an occupational therapist will take you through an assessment as well. Depending on your specific situation, your stay in hospital could range from one night to a few days.

Stitches

Deep stitches beneath the skin will dissolve and don’t need to be removed. Non-dissolvable stitches or staples will need to be removed about 10 days after your operation. Before you leave hospital, you’ll be given instructions and / or an appointment to have them removed. You will also have an appointment arranged for a postoperative check with your surgeon.

Your stitches will be covered by a simple adhesive dressing, like a large plaster. Be careful not to get this wet when you wash. After having your stitches removed, you won’t need a dressing and will be able to bathe and shower as normal.

For the first few weeks after your procedure, we may ask you to attend regular physical therapy. We have an excellent therapies department based on-site in our hospital. This will help you achieve an optimal recovery, so all being well you can get back to enjoying life quickly. You may find that you feel generally sore and tired for a few weeks after surgery, and this can take up to six weeks to pass.

When you get home, it’s important to take things easy at first, and gradually increase your level of activity each day. Some help at home is usually needed for at least the first week after surgery. You might like to have prepared meals in your freezer for example.

Make sure you stick to the exercise programme recommended by your physiotherapist and try not to sit or stand in the same position for more than 15-20 minutes at a time, as this will make you feel stiff and sore.

For a faster recovery, it’s important to follow the advice of your surgeon. This includes:

  • Keeping an eye on your incision for infection.
  • Being kind to yourself post-surgery: it takes time for your body to return to its usual state.
  • Being consistent with your physiotherapy exercises

As a guide, you are likely to need around 6 weeks off work but if you have a physically demanding job, you may need to take 8-12 weeks off. Aim for a staged recovery back to work and consider starting part time first and incorporating more working from home days.

If you need a ‘fitness to work’ certificate (previously called a Sick Note) for your work place, ask for one from the nurses on the ward before you go home.

How to pay for your treatment

If you’re… paying for yourself

Did you know you don’t need private medical insurance to come to St John & St Elizabeth Hospital? As a self-pay patient, you can access safe, outstanding quality health care at times to suit you.

For scans and tests, as well as to see most consultants, you’ll still need to be referred by a medical professional like your GP, but as a self-pay patient, the process is more straightforward. You won’t need authorisation from an insurance provider, and you’ll have greater choice of consultant and appointment times.

If you’re… insured

St John & St Elizabeth Hospital is approved by all major medical insurance companies. If you have a personal private health insurance policy, or your company provide it for you, you can use it to pay for your care from your initial consultation through to treatment, surgery and aftercare such as physiotherapy. Not all private health insurance plans cover the same things. It’s very important to check exactly what you are covered for with your insurance provider.