Surgery for a slipped disc
Under certain circumstances, slipped discs in the lumbar spine region can be treated with surgery. This usually involves removing spinal disc tissue to relieve the pressure on irritated nerves. Surgery can often provide long-term relief from symptoms, but is associated with certain risks.
Surgery is always performed if the slipped disc is an emergency: for example, if prolapsed disc tissue is affecting nerves so severely that the bladder or bowel no longer function properly, or certain muscles have become very weak. But this only happens rarely.
Far more commonly, surgery is performed because other treatments haven’t provided enough relief from severe pain despite being used for more than six weeks. The question of whether to go through with surgery is often difficult to answer, though. For surgery to be considered, imaging techniques and the symptoms must clearly show that a slipped disc is in fact responsible for the pain. Before deciding to go ahead with the procedure, it’s important to carefully weigh the pros and cons together with your doctor. Your individual circumstances will also play a role in the decision because they can influence the success of the treatment.
The aim of surgery is to remove spinal disc tissue that is pushing on the nerve. The idea is to give the nerve more space so the inflammation can go down and the symptoms can go away. Various surgical techniques can be used when operating on a slipped disc:
- Open discectomy (microdiscectomy): “Open” discectomy is the most commonly performed type of surgery for a slipped disc. The damaged part of the spinal disc is removed and the surgeon is able to see the area being operated on using a microscope. People who have this microsurgical procedure are given a general anesthetic and have to stay in hospital for a few days. The risks associated with this procedure include bleeding, nerve damage and infections. A general anesthetic may lead to complications like breathing or circulation problems.
- Endoscopic surgery: Endoscopic surgery – also called minimally invasive or keyhole surgery – uses very small instruments so only one small cut is needed. This is done to speed up recovery and prevent the formation of scars that may cause problems. In these procedures, an endoscope (a long, thin tube that has a light and camera at one end) is inserted through a small cut and pushed through to the spinal disc. The surgical instruments are all inserted through this cut under x-ray guidance. The risks associated with this procedure include bleeding, nerve damage and inflammation.
- Surgery on the nucleus (inner core) of the spinal disc: In these “indirect” procedures, the gel-like core of the spinal disc is removed to make the spinal disc smaller, which in turn reduces pressure on the pinched nerve. All of these procedures involve inserting an instrument into the spinal disc to reach the core. The core of the spinal disc can be removed using suction. This is called percutaneous nucleotomy. Another option is to vaporize the core using laser beams (laser discectomy). This can cause side effects, such as heat-related tissue damage. These operations can only be done if the outer layer of the spinal disc is still intact.
Surgery can help, but there is no guarantee that symptoms will disappear
The different surgical procedures described here have been looked at in a number of studies, and some have been compared with one another. Most of the studies involved surgery on people who had pain for weeks despite receiving other treatment. One of the larger studies mostly included people with severe sciatica (sciatic nerve pain). The outcome: If someone is a suitable candidate for surgery, it can relieve pain and other symptoms such as limited mobility over the long term. The pain in the participants who had surgery went away quickly after the procedure. But it took a few weeks before there was an improvement in mobility. There is no guarantee that surgery will relieve all of the symptoms.
Research has shown that rehabilitation immediately after slipped disc surgery (follow-up rehabilitation) can shorten the recovery time and improve mobility.
Other surgical procedures
Sometimes more extensive surgery is performed – especially if the vertebrae are also damaged by wear and tear and the spine is no longer stable.
In a procedure called spinal fusion, the surgeon joins the vertebrae above and below the slipped disc together with screws so that they remain firmly in place. The spinal disc is removed, and the resulting gap between the vertebrae is filled with bone or a titanium implant.
Another option is to put in an artificial spinal disc (implant) that can be used without having to fuse the vertebrae together. The aim of this procedure is to relieve the pain and also avoid the kind of restricted movement that people experience after spinal fusion surgery.
Both procedures can have considerable side effects. These procedures haven't been shown to have more advantages than disadvantages.
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