Diskectomy is a surgical treatment for low back pain related to failing or damaged spinal disks. The surgeon removes part of the disk to relieve pressure on nearby nerves, and reduce low back pain and shooting pain down the legs (sciatica).
You should consider diskectomy only after first trying conservative measures like waiting for the disk to heal on its own, pain medications, back exercises, and physical therapy.
What is a slipped disk?
Spinal disks have a tough outer wall with softer, gelatinous material inside. Disks serve as cushions and shock absorbers between the bones of your spine (vertebrae). As disks age, they may start to bulge outward like an underinflated car tire. Sometimes the wall of the disk tears, allowing the soft gelatinous material inside to protrude outward.
A “slipped” or “ruptured” disk can put pressure on bundles of nerves, called nerve roots, that exit on either side of each vertebra. This causes pain in the lower back as well as shooting pain (sciatica) down the back of one or both legs.
Symptoms of sciatica include:
- low back pain
- sharp pain or electric “jolts” down the back of the leg
- tingling in the foot
- weakness in the leg
Diskectomy can help relieve sciatica and pain because during the procedure, a portion of the damaged or failing disk is removed, which takes pressure off the nerves. Diskectomy is the most common spinal surgery in the United States.
When to consider diskectomy
You may want to talk to your doctor about surgery if you’ve tried conservative treatments but are still experiencing pain. Despite conservative care, low back pain and sciatica can persist for months and become chronic. You may have trouble walking or standing, carrying out normal day-to-day activities, or going to work.
In a review of studies, researchers only identified one study that found evidence that early diskectomy may provide better short-term relief than prolonged conservative treatments. The same researchers found no difference in outcomes after one to two years. More research is needed to better understand who may benefit from diskectomy.
Following are some conservative methods your doctor may recommend before surgery:
- Wait. For a new case of disk-related back pain, most people improve within several weeks.
- Use over-the-counter pain relievers.
- Apply a heating pad or cold packs to ease your discomfort. Learn more about when to treat pain with heat versus cold therapy.
- Try physical therapy.
- Enroll in a comprehensive back rehabilitation program, available at many spine centers.
- Try complementary and alternative treatments, such as spinal manipulation (chiropractic), massage, acupuncture, and mindfulness-based stress reduction.
How diskectomy works
Most diskectomies take about an hour and require general anesthesia, which means you’ll be unconscious. During the surgery, you’ll lie face down on an operating table. There are different types of diskectomies a surgeon can perform.
Standard or “open” diskectomy
During this type of surgery, the surgeon makes an incision to provide a clear view of the disk. They then use surgical instruments to trim away part of the disk.
Open diskectomy often includes a procedure called laminectomy to remove part of the outer arch (lamina) of the vertebra. This can help relieve pressure on the nerves.
This is a less invasive version of open diskectomy and is the technique preferred by most surgeons. During microdiskectomy, your surgeon makes a small incision in your back and inserts tools to observe the disk by video. The surgeon also removes a small portion of the lamina to make it possible to see the disk. This is called hemilaminectomy.
After observing the disk, your surgeon then trims away part of the disk, as they would with a standard diskectomy. The difference is that with microdiskectomy, they are able to operate using a smaller incision.
In percutaneous or “through the skin” diskectomy, the surgeon makes a small incision. They then use a special X-ray imaging device, called a fluoroscope, to guide a slender tube through the incision and into the body of the herniated disk. The surgeon then inserts special tools through the tube to remove disk material to take pressure off nearby nerves.
Different techniques are used to perform percutaneous diskectomies. They include removing disk material using a laser instead of surgical tools, injecting a chemical that dissolves disk material, or treating the inside of the disk with heat or radio waves to shrink it.
Recovery from this surgery
After waking up from the anesthesia, you’ll spend an hour or two in the recovery room. Many people are able to go home the same day. You’ll need someone to drive you home.
Before you go home, make sure to get instructions on how to keep the surgical incision clean. You’ll take antibiotics as a precaution against infection. The wound will be sore for several days, and fluid may seep from it.
If you notice any signs of infection in the incision, contact your surgeon and get immediate medical care. The “red flag” signs of infection are:
- a feeling of warmth around the incision
The period it takes for you to return to your normal activities, including work, ranges from two to six weeks. During this time, your surgeon will suggest you avoid lifting weight, bending, or sitting for prolonged periods of time. These activities put stress on the spine.
Exercise can help to prevent recurrences of low back pain and disk problems. If you’re overweight, losing weight may help, too. Consult your doctor or physical therapist before starting an exercise program for back pain.
Risks of diskectomy
Diskectomy is generally safe, but as with any surgery, there’s a risk of complications. These include:
- excess bleeding or blood clots
- leaking spinal fluid
- injury to blood vessels or spinal nerves
- injury to the protective layer surrounding the spine
How effective is diskectomy?
Clinical trials show that diskectomy reduces pain and disability in the short term, compared with not having surgery. But it doesn’t guarantee that symptoms won’t return in the future.
Studies haven’t conclusively shown that microdiskectomy is more effective or safer than open diskectomy, or vice versa. Potentially, microdiskectomy could reduce complications and shorten recovery time because it requires a smaller incision.
Diskectomy is a common procedure for people with chronic back pain caused by aging or injured spinal disks. Experts recommend first trying nonsurgical treatments before surgery. Your doctor may suggest surgery sooner if you have symptoms of nerve damage like numbness, burning, or “pins and needles” sensations, and hypersensitivity to touch. Exercise to strengthen muscles and support the spine can help prevent future flare-ups of a painful disk. Here are strengthening exercises for the back that you may want to try.
Artificial disks may someday offer an alternative to diskectomy. The implants were approved by the U.S. Food and Drug Administration as an alternative to spinal fusion. Spinal fusion is a procedure where a failing disk is removed entirely, and then two vertebrae are fused together with bone grafts or metal hardware.
Studies haven’t directly compared artificial disks to diskectomy. At the same time, disk replacement has risks, like paralysis or major bleeding if the implant fails. Diskectomy remains the best surgery for chronic disk-related back pain that doesn’t improve after conservative treatments.