Is surgery right for you?
Apart from being an author and public speaker, I’m also an orthopedic surgeon (board certified) with a vested interest in endoscopic spine technique. My name is Dr. Tony Mork. Since 1998, my private practice has been dedicated to treating spinal conditions endoscopically. There, I have successfully performed more than 8,000 procedures, nearly all using the laser for spine problems.
Your doctor may consider surgery for a herniated disc if weakness, numbness, or persistent pain is present. A detailed examination and history should be taken in order to match your symptoms directly to the pinched or compressed nerve caused by the disc. Sometimes, but not always, the herniated disc is located on the opposite side of the body where the symptoms are found. I have seen both types of cases, and will typically operate on the side where the pain is provided the disc herniation matches the level of the symptoms.
Herniated disc surgery is not something you want to consider lightly. There are a few important aspects patients should be made aware of when considering this type of treatment. The first consideration is the size of your incision. The opening should be no larger than is necessary to address the problem. The disturbance of blood vessels, nerves, muscles, and other soft tissues should be minimized to reduce the amount of scarring that will form in direct proportion to your incision size. In my practice, I never consider spinal fusions for treating herniated discs (except in cases where re-herniation is persistent).
The location of your disc herniation is also something you’ll want to think about. Your surgeon can use the location to describe two entirely different things. For example, the location may refer to the area of your spine where the herniation has taken place (neck, lower back, or mid/upper back). Alternatively, the location can also refer to the location of the disc herniation itself (foraminal or central canal). This is incredibly important because the anatomy of the neck, lower back, and mid/upper back is quite unique. An example of this is the Laminotomy. This procedure removes disc fragments from the lower back (located in the central canal). This procedure could never be used to remove disc fragments from the neck (located in the central canal) because the resulting pressure on the spinal cord would most definitely lead to full or partial paralysis. After pushing aside the esophagus and trachea, your surgeon can perform a discectomy through the front of the neck, however this procedure should never be performed through the stomach to reach the spine because there are too many blood vessels and the intestines can’t be pushed aside safely. The middle and upper regions of the spine have many challenges similar to those seen in problems of the neck and lower back.
Your surgeon’s approach, and whether spinal fusion is on the table is another important consideration for you. You may recall from earlier when I said the surgical opening should be no larger than is necessary to address the problem, and that the disturbance of blood vessels, nerves, muscles, and other soft tissues should be minimized to reduce the amount of scarring that will form in direct proportion to your incision size. The medical field has both adequate techniques and instruments to treat disc herniation without resorting to spinal fusion 99% of the time.
Perhaps one of the most misused terms you will encounter while researching spine surgery is the phrase “minimally invasive“. While this term more appropriately refers to a philosophy, it has also come to describe different techniques and procedures. Some techniques, like endoscopic spine surgery, are more minimally invasive than others. The same is true of procedures. For example, a discectomy is more minimally invasive than a spinal fusion. You are already familiar with the philosophy underlying such distinctions. A minimally invasive technique or procedure follows the basic guidelines that: a surgical opening should be no larger than is necessary to address the problem, and that the disturbance of blood vessels, nerves, muscles, and other soft tissues should be minimized to reduce the amount of scarring that will form in direct proportion to your incision size. Really, it is an extension of the “do no harm” principle that every practicing medical physician promises to abide by.
When treating spine problems caused by a herniated disc, the approach I advocate in my own practice is transforaminal with an endoscope. I choose this approach because it is the most minimally invasive and direct. Using the endoscope allows me to address the problem, while keeping the incision size as small as possible. Not every surgeon you encounter is capable of operating with this approach. It requires considerable experience with the endoscope and advanced skills in 3D imaging. A different type of endoscope is used for disc herniations in the neck.
If you’re still not sure about whether this approach is right for you, you can contact my office and setup a complimentary MRI consult with me. After I take a look at your MRI results, I’ll give you a call and we can discuss what your options are to get back to living your life without pain.