Causes, effects, and when surgery is right
Between each of the bones in your spine (the vertebrae) is a disc. These discs act as shock absorbers and help cushion your bones. A herniated disc is one that extends beyond the capsule containing it and pushes into the spinal canal. You can have a herniated disc anywhere along your spine, even in your neck, but it’s most likely to occur in the lower back (lumbar vertebrae).
You might develop a herniated disc from lifting something the wrong way or from suddenly twisting your spine. Other causes include being overweight and experiencing degeneration due to disease or aging.
A herniated disc doesn’t always cause pain or discomfort, but if it pushes against a nerve in your lower back, you may have pain in the back or legs (sciatica). If a herniated disc occurs in your neck, you may have pain in your neck, shoulders, and arms. Besides pain, a herniated disc can lead to numbness, tingling, and weakness.
Surgery involving the spine is typically not recommended until you’ve tried all other options. These may include:
- nonsteroidal anti-inflammatories
- pain relievers
- exercise or physical therapy
- steroid injections
If these are ineffective and you have persistent pain that is interfering with your quality of life, there are several surgical options.
When considering surgery, make sure you see a qualified spine (orthopedic or neurosurgical) surgeon, and get a second opinion. Before recommending one surgical procedure over another, your surgeon will likely order imaging tests, which may include:
- X-ray: An X-ray produces clear pictures of your vertebrae and joints.
- Computed tomography (CT/CAT scan): These scans provide more detailed images of the spinal canal and surrounding structures.
- Magnetic resonance imaging (MRI): An MRI produces 3-D images of the spinal cord and nerve roots, as well as the discs themselves.
- Electromyography or nerve conduction studies (EMG/NCS): These measure electrical impulses along nerves and muscles.
These tests will help your surgeon determine the best type of surgery for you. Other important factors in the decision include the location of your herniated disc, your age, and your overall health.
After gathering all the information they can, your surgeon may recommend one of these surgeries. In some cases, a person may require a combination of surgeries.
In a laminotomy, a surgeon makes an opening in the vertebral arch (lamina) to relieve pressure on your nerve roots. This procedure is performed through a small incision, sometimes with the aid of a microscope. If necessary, the lamina can be removed. This is called a laminectomy.
Discectomy is the most common surgery used for herniated disc in the lumbar region. In this procedure, the portion of the disc that is causing the pressure on your nerve root is removed. In some cases, the entire disc is removed.
The surgeon will access the disc through an incision in your back (or neck). When possible, your surgeon will use a smaller incision and special instruments to achieve the same results. This newer, less invasive procedure is called microdiscectomy. In some cases, these procedures can be performed on an outpatient basis.
Artificial disc surgery
For artificial disc surgery, you’ll be under a general anesthesia. This surgery is usually used for a single disc when the problem is in the lower back. It’s not a good option if you have arthritis or osteoporosis or when more than one disc shows degeneration.
For this procedure, the surgeon enters through an incision in your abdomen. The damaged disc is replaced with an artificial disc made from plastic and metal. You may need to stay in the hospital for a few days.
General anesthesia is required for spinal fusion. In this procedure, two or more vertebrae are permanently fused together. This may be accomplished with bone grafts from another part of your body or from a donor. It may also involve metal or plastic screws and rods designed to provide additional support. This will permanently immobilize that portion of your spine.
Spinal fusion usually requires a hospital stay of several days.
All surgeries have some risk, including infection, bleeding, and nerve damage. If the disc isn’t removed, it can rupture again. If you suffer from degenerative disc disease, you may develop problems with other discs.
Following spinal fusion surgery, a certain amount of stiffness is to be expected. This may be permanent.
After your surgery, you’ll be given specific discharge instructions regarding when to resume normal activity and when to begin exercising. In some cases, physical therapy may be necessary. It is very important to follow your doctor’s recommendations.
Most people recover well after disc surgery, but each case is unique. Your individual outlook depends on:
- the details of your surgery
- any complications you may have encountered
- your general state of health
To help prevent future problems with your back, try to maintain a healthy weight. Always use proper lifting techniques. Strong abdominal and back muscles help support your spine, so be sure to exercise them regularly. Your doctor or physical therapist can recommend exercises designed for that purpose.