The operation is commonly called a discectomy. However, in this situation, only the protruding disc material is removed, not the whole disc. The aim of the operation is to decompress a nerve root or roots. There are several different techniques when performing an operation for lumbar disc protrusion. Expected outcomes from all methods of treatment are very similar and the choice of operation will be decided by the surgeon, with consideration of patient’s preference and personal circumstances.
Discectomy or Microdiscectomy
This is performed through an incision in the midline of the lower back (usually a small wound up to 4cm (1½ inches) in length but sometimes it needs to be longer). First the muscles are held apart to gain access to the bony arch and roof of the spine (lamina). The surgeon is then able to enter the spinal canal by removing a membrane in between the lamina and over the nerve roots (ligamentum flavum). Often, a small portion of the inside facet joint is removed, both to enable access to the nerve root and to remove pressure on the nerve.
Magnification is used at this point to give a greater view of the structures. The nerve root is then gently moved to the side and the disc material is removed from under the nerve root. The disc is then entered, to remove any loose fragments of the disc material within it.
Spinal surgery is often not a ‘cure’, and cannot prevent further disc degeneration, but is aimed to provide benefit with a high percentage improvement and relief of leg symptoms. Sometimes however, numbness or weakness can persist, even with a technically successful operation. Good relief from leg pain following disc surgery usually occurs in approximately 85–90% of cases (up to 9 out of 10 people). This is not necessarily felt immediately but over a period of time, sometimes several weeks. Relief from back pain, however, is less reliable and should not be regarded as the main aim of the surgery. Recent evidence however demonstrates that back pain is reduced in many instances.