Herniated Disc Surgery

What is Herniated Disc surgery?

Herniated disc surgery is performed for persistent pain, weakness or numbness. The pain or weakness must correspond to the nerve that is being pinched or compressed by the disc herniation and that is why a good history and examination is necessary to correlate these findings. Sometimes the disc can be herniated to the side opposite of your symptoms. This happens occasionally and I usually perform surgery on the side of the pain as long as the symptoms match the level of the disc herniation.

I just want to mention a few aspects of herniated disc surgery to keep in mind when considering it. The incision should be as small as possible to remove the problem. Soft tissues should be disturbed as little as possible (muscles, tendons, ligaments, blood vessels, and nerves) to prevent scarring that occurs in proportion to the size of the incision.

I would not consider a fusion for a herniated disc unless it had reherniated many times.

The next consideration is the location of the disc herniation. The location can mean two different things. It can refer to which part of the spine the herniation has occurred in (cervical, thoracic, or lumbar) or where the disc herniation has occurred (central canal or foraminal canal). This makes quite a difference since the anatomy is so different at the different parts of the spine (cervical, thoracic, lumbar).

For example, a laminotomy is routinely performed to remove a lumbar disc fragment in the central canal, but a laminotomy is never used to remove a cervical disc fragment in the central canal because the spinal cord would not tolerate the pressure of retraction that would likely lead to paralysis.

A cervical discectomy can be performed through the front of the neck once the trachea and esophagus has been pushed aside, but a lumbar discectomy is not performed through the abdomen because the intestines cannot be safely pushed aside, not to mention the great vessels in front of the spine. The thoracic spine has its own set of challenges.

Minimally Invasive Spine Surgery Approach


The next thing to consider is the surgical approach (endoscopic, open, "minimally invasive") and whether it includes a fusion as part of the operation. I said earlier that the goal of surgery should be to remove the offending disc herniation with as little disturbance to surrounding tissues as possible, particularly the nerve roots or spinal cord. There is sufficient technique and instrumentation around to avoid a fusion most of the time, even with a cervical disc herniation.

The term "minimally invasive" is one of the most misused terms when used in conjunction with spine surgery, and understandably so. This term "minimally invasive" is more of philosophy than a technique, but certain techniques are more "minimally invasive", like endoscopic spinal surgery. However, the procedure (fusion versus discectomy) must be kept in mind as well. The philosophy is one that embraces the least disturbance of tissues that surround a problem, such as a herniated disc.

The herniated disc may be the problem, but many tissues that are completely normal such as muscles, tendons, blood vessels and nerves surround it. The more "minimally invasive" the procedure, the less disturbance to these surrounding normal tissues, which results in smaller scars, less blood loss, less pain, and less injury to surrounding muscles. So minimally invasive implies "minimal collateral damage" when trying to achieve a certain objective such as removing a herniated disc.

I often advocate the endoscopic transforaminal approach with an endoscope because it is directed at the problem (herniated disc) with the least disturbance to surrounding tissues, through the smallest possible incision. This approach requires a lot of practice with the endoscope and an enhanced three-dimensional capability of the surgeon. There is an endoscope that can be used for cervical disc herniations too.

If this sounds like it might be right for you, contact my office to schedule your complimentary MRI consultation.  I will personally review your MRI results and call you to discuss all options available to you to stop the pain and get back to an active life.