Discectomies for Herniated Disc

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Discectomies for Herniated Disc

During a discectomy, the pieces of a herniated disc that press on a nerve or on the spinal cord are surgically removed. Discectomies are done when a herniated disc is causing pain down one leg (sciatica) or arm and/or other symptoms including numbness, weakness or electrical sensations (also down one leg or arm.)

When you have a discectomy, all or part of the lamina, which is an area of bone at the back of the vertebra, also has to be removed.

 This is to enable the surgeon to reach the nerve and disc. Depending on how much bone is removed, this aspect of the procedure is called either a laminectomy (when all of the lamina is removed) or a hemilaminectomy (when only half of the lamina is removed).

When a Discectomy Is Needed:

Most of the time, conservative methods such as medications, physical therapy, or steroid injections are tried before surgery. In fact, a herniated disc often heals without surgery at all -  but it can take up to a year. Having a discectomy may greatly shorten your healing time. If your pain is intense, or the weakness/numbness is noticeable, a discectomy may be a good choice, but if your symptoms are mild or moderate, therapy may be all you need.

Either way, discuss your symptoms and options with your doctor.


Microdiscectomy is a minimally invasive procedure performed in an outpatient setting.

A very small incision is made in the skin and tiny tube-shaped implements are inserted all the way in until they reach the disc. The entire surgery takes place through the implements.

Because muscles are moved out of the way rather than cut, as they are in an open discectomy (see below,) healing time is generally faster and less painful than with an open procedure.

Open Discectomy:

Open discectomy is a traditional back surgery. It is done in a hospital setting under general anesthesia. (You probably will only need to stay in the hospital for one day.)

Open discectomy involves making an incision that is approximately 1" long.  In this type of discectomy, the muscles have to be cut to give the surgeon access to the disc.  This generally means more time for post-surgical healing is needed (when compared to microdiscectomy.)  Post-surgical healing after open procedures can be more painful, as well.

Other than the differences in healing time and difficult, the two procedures are comparable.

A small 2011 study published in the Journal of Orthopedic Surgery (from Hong Kong) found that both open discectomy and minimally invasive discectomy were equally effective in relieving symptoms.  But, the authors say, the minimally invasive surgeries required shorter hospital stays, earlier returns to work and recurrence of the original problem.  

That said, the authors caution that minimally invasive discectomy techniques are very demanding on the surgeon, and require specific training.

Choosing a Surgeon For a Discectomy:

Both orthopedic and neurosurgeons perform many kinds of back surgeries, including discectomies. Either type of doctor will be well prepared for the job. The choice of a surgeon for a discectomy really comes down to your evaluation of the individual's skill level. Don't hesitate to ask many questions before deciding who exactly will do the procedure.

Effectiveness of Discectomies:

Discectomy works about 80 to 90% of the time and usually results in rapid relief of leg pain and other symptoms. Benefits of discectomy hold steady over time - a study published in Spine journal found that most surgery patients enjoyed complete pain relief even after 10 years.

But that same study found after 1 year, 25% of both the surgery patients and the conservative care patients had needed another lumbar spine surgery. After 10 years, the majority of both groups reported long-term resolution of their pain - but this was true for more people in the surgery group (69%) than in the conservative care group (6%.)

The possibility of a recurrence of the herniation is a real one. A 2015 systematic review of studies, found that after two years, pain may recur in up to 25% of patients who underwent a one-level discectomy.  The authors say that about 6% needed reoperation was needed.

The good news is that surgery for the recurrent disc herniation is not always necessary. Again, studies show that surgery and conservative care for a subsequent herniation after a discectomy get about equal results in terms of pain relief.

Risks and Complications of Discectomies:

Along with the potential for reherniation (discussed above,) discectomy risks include infection, bleeding, injury to the dura mater (covering around the spinal cord) or injury to nearby nerves, arteries or veins. If you notice redness or discharge from your incision, pain or weakness down your arm or leg, you become feverish, have problems urinating or are bleeding, call your doctor immediately.

After Your Discectomy:

You may have post-operative pain at the incision site immediately following the surgery. Pain from your herniated disc may linger for a while, too.

It's a good idea to start walking as soon as you are able. This will likely help speed recovery, prevent scar tissue and mobilize your spine. Within a couple of weeks, you should be able to ride a bike or swim. Most people get back to work in 2-8 weeks, depending on how physical their job is. Physical therapy can help you return to your regular activities quickly. If your doctor doesn't refer you to a P.T. you might consider asking her about it.

Many patients, especially with a first discectomy, make a full recovery.


Garg, B., Nagraja, U., Jayaswal, A. Microendoscopic versus open discectomy for lumbar disc herniation: a prospective randomised study. J Orthop Surg (Hong Kong). April 2011. Accessed Feb 2016.http://www.ncbi.nlm.nih.gov/pubmed/21519072

Dewing et al. The outcomes of lumbar microdiscectomy in a young, active population: correlation by herniation type and level. Spine (Phila Pa 1976). Jan 2008.

Atlas et al. Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the maine lumbar spine study. Spine (Phila Pa 1976). Apr 2005.http://www.ncbi.nlm.nih.gov/pubmed/15834338

NASS. Open Discectomy. NASS. Burr Ridge, IL. Accessed: Feb 11 10.

Legrand et al. Spine Section of the French Society for Rheumatology. Sciatica from disk herniation: Medical treatment or surgery? Joint Bone Spine. Dec 2007.

Parker S., Mendenhall S., Godil S., Sivasubramanian P., Cahill K., Ziewacz J., McGirt M. Incidence of Low Back Pain After Lumbar Discectomy for Herniated Disc and Its Effect on Patient-reported Outcomes. Clin Orthop Relat Res. June 2015. Accessed Feb 2016.http://www.ncbi.nlm.nih.gov/pubmed/25694267

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