Surgery for a slipped disk

Photo of a doctor and patient in the hospital (Thomas Northcut / Digital Vision / Thinkstock)

Under certain circumstances, slipped disks can be treated with surgery. This usually involves removing spinal disk 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 disk is an emergency, for example if prolapsed disk 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 a long time. 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 disk is 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.

Surgical techniques

The aim of surgery is to remove spinal disk tissue that is trapping the nerve. The idea is to give the nerve more space so the inflammation can subside and the symptoms can go away. Different surgical techniques may be used when operating on a slipped disk:

  • Open discectomy (microdiscectomy): “Open” discectomy is the most commonly performed type of surgery for a slipped disk. The damaged part of the spinal disk is removed and the surgeon is able to see the area being operated on using a microscope. People who have this microsurgical procedure need a general anesthetic and have to stay in hospital for a few days. The risks associated with this procedure include bleeding, nerve damage and infection. A general anesthetic may lead to complications like breathing or circulation problems.
  • Endoscopic surgery: Endoscopic surgery – also called keyhole surgery – uses very small instruments so the procedure only requires one small incision. This is done to speed up recovery and prevent the formation of scars that may cause problems. In this type of operation, an endoscope is inserted through a small cut and pushed through to the spinal disk. The surgical instruments are all inserted in this way under x-ray guidance. The risks associated with this procedure include bleeding, nerve damage and inflammation.
  • Surgery on the core of the spinal disk: In these “indirect” procedures, the gel-like core of the spinal disk is removed to make the spinal disk smaller, which in turn reduces pressure on the pinched nerve. All of these procedures involve inserting an instrument into the spinal disk to reach the core. The core of the spinal disk 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 are only considered if the outer layer of the spinal disk 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. The results: If someone is a suitable candidate for surgery, it can relieve pain and other symptoms such as limited mobility over the long term. The participants’ pain improved soon after surgery, whereas their mobility only improved a few weeks later.

But there is no guarantee that surgery will make the symptoms go away – they may continue or even get worse after an operation.

Research has shown that rehabilitation immediately after slipped disk surgery (follow-up rehabilitation) can shorten the recovery time and improve mobility.

Research summaries

Other surgical procedures

In rare cases, more major 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 disk together with screws so that they remain firmly in place. The spinal disk is removed, and the empty space is filled with bone or a titanium implant.

Another option is to put in an artificial spinal disk (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 too. There hasn’t been enough high-quality research to tell what benefits they have in the treatment of slipped disks, or whether the benefits outweigh the risks.

Labels: G55, M50, M51, Muscles, bones and joints, Sciatica, Slipped disk