A lumbar discectomy is a surgical procedure to remove a herniated (slipped) disc from the spinal canal. Surgery involves removing the fragment of spinal disc that is causing the pressure on the nerve.
What is a Herniated Disc?
Discs are round cushions that sit between the vertebrae (bones of the spine). They act like shock absorbers, enabling you to bend and move without your bones rubbing together. When a disc herniation (rupture) occurs, a fragment of the normal spinal disc is dislodged that may then press against the spinal cord or the nerves that surround the spinal cord. This can lead to pain, numbness, electric shock pain and weakness in your back, arms and legs. These symptoms are characteristic of a herniated disc.
Causes of a Herniated Disc
Certain movements can cause a slipped disc such as twisting or turning to pick up a large or heavy object. This action places a great amount of strain on the lower back, resulting in a slipped disc. You are more susceptible to a herniated disc if you have a physically demanding job.
Obesity also puts individuals at an increased risk of a herniated disc as extra pressure is put on the discs to support the additional weight. A sedentary lifestyle can result in weakened muscles that will also put you at a greater risk of a herniated disc.
Age plays a factor in increasing your risk of experiencing a herniated disc. As we age, our discs begin to lose some of their protective water content that leads them to slip more easily out of place. This is more common in men than women.
Symptoms of a Herniated Disc
A herniated disc can occur in any part of the spine, from the neck to the lumbar spine (lower back), although the lumbar spine is the most common area for it to occur. Symptoms of a herniated disc include:
- Pain that worsens when walking or standing
- Pain when walking short distances
- Pain and numbness, usually on one side of the body
- Trouble controlling the bladder or bowels
- Pain that worsens at night with certain movements
- Unexplained muscle weakness
- Tingling, aching or a burning sensation in the affected area
- Pain that extends to the arms and legs
Diagnosing a Herniated Disc
Your doctor will take a detailed medical history that will involve discussing when you first felt symptoms, what activities cause your pain and if any particular activity aggravates it.
They will also carry out a physical examination to identify the source of your pain. This involves checking your nerve function and muscle strength, and whether you feel pain when moving or touching the affected area. A physical examination is often enough to diagnose a herniated disc, although further testing may be required as this can help your doctor view bones and muscles in your spine and identify damaged areas. You may be referred for imaging such as:
Once your doctor has all the necessary information, a clear diagnosis can be made with a recommended treatment plan.
Treatment for a Herniated Disc
Treatment for a herniated disc varies depending on the severity of your condition, the level of discomfort you are experiencing and the extent to how far the disc has slipped out of place.
If your symptoms are not severe, relief from a slipped disc can be managed through physical therapy. This involves stretching and strengthening the back and surrounding muscles. When performed regularly, exercise can help reduce your pain to a manageable level.
Whilst the thought of exercise can be off-putting when you are experiencing pain from a herniated disc, it is important to continue with an exercise programme as otherwise this will lead to joint stiffness and weakened muscles. Recommended low impact activities include walking and swimming.
Over the counter medication such as ibuprofen can help, along with avoiding heavy lifting and painful positions.
If you are still experiencing pain, your doctor may prescribe stronger medications. These include:
- Narcotic pain relief
- Muscle relaxers to relieve muscle spasms
- Nerve pain medication
If your pain has not improved after 6 weeks, your doctor will discuss the option of surgery with you.
A lumbar discectomy is usually performed under a general anaesthetic so you will be asleep throughout the procedure and will not feel any pain. It can however be carried out under a local anaesthetic so you will be awake during the procedure but the area around the affected disc will be numb and you will not feel any pain.
The surgeon uses a special type of X-ray to ensure the correct location, and then makes a small incision in your back, at the level of the affected disc; this is usually about 3cm in length. The muscles are then carefully dissected away from the bone of the spine and using special instruments, a small amount of bone and ligament is removed from the back of the spine. This part of the procedure is called a Laminotomy.
Once the bone and ligament has been removed, the spinal nerves are protected. The herniated disc fragment is removed once clearly identified. More disc material may be removed to avoid another fragment of the disc from herniating in the future; the surgeon makes this decision depending on the appearance and condition of the remaining disc. Once the disc has been cleaned out from the area around the nerves, the incision is closed and a small dressing applied.
The procedure takes approximately 1 hour, depending on the extent of the herniation and any other medical factors relating to the patient.
Surgery can be carried out as a day case procedure, or you may be required to stay in overnight, depending on the extent of your condition.
Lumbar discectomy is often very effective and immediate improvements can occur for many patients; however, symptoms can persist for several weeks and slowly improve.
Physiotherapy can help speed your recovery, and you will be given a set of exercises to perform that can be carried out at home once you leave hospital. Regular walking will also help you regain movement in your spine.
You are likely to feel a degree of pain in the weeks following your surgery, but over the counter painkillers can help alleviate this. Speak to your doctor for their opinion.
It is important that you avoid certain activities during your first few weeks of recovery. These include:
- Sitting for long periods of time, particularly slouching
- Excessive bending, twisting or stretching
- Lifting heavy objects
- Strenuous exercise and activities
Your doctor will advise when you can return to work. If your job is office based and requires a large degree of sitting, you should be able to return in 2-4 weeks after your surgery. If your job is more strenuous and involves heavy lifting, you may need to wait between 6-8 weeks before you can return.
Your doctor will let you know when you can start to drive again and return to normal activities.
Risks and Complications
Lumbar discectomy is generally considered a safe procedure, but as with all surgery, there are some risks involved. These include:
- Damage to the nerves or blood vessels
- Leakage of the spinal cord fluid
- Bleeding and blood clots
- Future fragmentation of the disc (the need for further surgery)
- Reaction to the anaesthetic
Risks will vary depending on your age and general health. Your doctor will discuss the risks that most apply to you before your surgery.
There is a chance that surgery will not improve your symptoms, or the pain may get worse. Success from lumber discectomy is between 85-90%, meaning 10-15% of patients will still experience symptoms and may need to undergo a further operation. This is known as a Discectomy Revision.
At One Healthcare we can book you in to see a specialist Orthopaedic surgeon, usually within 48 hours, for an initial consultation. Lumbar Discectomy is available at One Ashford Hospital in Kent and One Hatfield Hospital in Hertfordshire.
You can use your private medical insurance or pay for your Lumbar Discectomy treatment. We offer competitive, fixed price packages as well as the ability to spread your cost with the option of 0% finance. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at either the One Ashford Hospital or One Hatfield Hospital.
Why One Healthcare
- Modern purpose-built hospital opened in March 2016 (Ashford) December 2017 (Hatfield)
- Fast access to diagnostics including MRI, Xray and Ultrasound
- Private, spacious, en-suite rooms
- Specialist Physiotherapy and nursing teams
- Little or no waiting time
- ‘Ultra clean air’ theatres
- Freshly prepared food
- Calm, dignified experience