Discectomy Surgery in Delhi, India

Discectomy is a minimally invasive procedure carried out to remove the damaged portion of a herniated disk of the spine. A herniated disk compresses the adjacent nerves, causing pain and discomfort that radiates to the arms and legs.

Physical therapy can also be beneficial for backache and neck pain. However, discectomy is indicated if the pain is not relieved with physical therapy and other conservative treatment modalities fail.

When is surgery needed?

Discectomy relieves the pressure that a herniated disk applies to the spinal nerve. A disk herniates when the soft part of the spinal cord (present within the disk) pushes out through a space in the rigid exterior.

The doctor may recommend discectomy when:

• Difficulty standing or walking because of weakness in the nerves.
• Conservative treatment fails to improve symptoms after six to twelve weeks—for example, physical therapy or steroid injections.
• Pain radiates down to the buttocks, legs, arms, or chest

Diagnosis

Before the surgery, doctors take a thorough medical history to assess any pre-existing medical conditions. Specific tests that may be advised are:

• Routine blood tests to rule out infections, haemoglobin level, blood group
• Liver and kidney function tests
• Urine tests
• X-rays
• CT scans
• MRI
• Detailed assessment of heart function for elderly patients and patients with other comorbidities

Treatment

Discectomy can be performed in five steps, and the procedure lasts for about 1 to 2 hours.

Step 1: Preparing the patient

The patient is anaesthetised, followed by cleaning and preparing the area of operation.

Step 2: Making an incision

With a fluoroscope (a special X-ray), the surgeon introduces a thin needle through the skin to the bone, and the affected vertebra and disc are located.

In an open discectomy, the skin is incised in the middle of the back over the affected vertebrae. The incision length depends on the number of discectomies that will be performed. First, a single-level incision of 1 to 2 inches is made, followed by retracting the back muscles to one side to expose the bony vertebra. Then, an X-ray is taken to verify the correct vertebra.

Next, progressively larger dilators are passed to separate the muscles and form a tunnel to the herniated disc of the vertebra.

Step 3: Making a laminotomy

Above and below the spinal nerve, a small opening of the lamina is made with a drill, and laminotomy is done. It is either at unilateral, bilateral, or multiple levels of vertebrae.

Step 4: Removing fragments of the disc

The sac of the nerve root is retracted, and the herniated disk is located. The ruptured part of the disc is removed, and the nerve root is decompressed. Bone spurs or synovial cysts, if present, are removed.

Step 5: Closing the incisions

The retractor holding the muscles is removed, and the incisions are sutured or stapled. Dressings are placed.

Who are the best candidates for surgery?

Candidates with the following conditions require discectomy:

• The neurological deficit causes weakness of muscles such as hip abductors, ankle dorsiflexors, ankle plantar flexors, cauda equina syndrome, and progressive neurological deficit despite conservative treatment
• Persistent pain is refractory to conservative care, and pain adversely affects the quality of life
• Failed conservative therapies
• The predominance of radicular rather than lumbar pain
• Disc herniations resulting in cauda equina syndrome
• Progressive or new motor deficits

Who should not consider surgery?

Contraindications of discectomy include:

• Concomitant pathologies such as infection or tumour
• Segmental instability or vertebral fractures
• Spondylolisthesis or segmental instability
• Disc fragments compressing the cord medially

How to prepare for surgery?

Consent and other forms are discussed and signed in the doctor's office to inform the surgeon about medical history (allergies, medicines/vitamins, bleeding history, ongoing medications, anaesthesia reactions, previous surgeries).

• Blood thinners should be stopped before the surgery to prevent the risk of excessive bleeding. For example, avoid taking non-steroidal anti-inflammatory medicines (ibuprofen, naproxen, etc.) and blood thinners (Coumadin, aspirin, Plavix, etc.) seven days before the scheduled surgery
• Stop using nicotine and drinking alcohol one week before and two weeks after surgery to avoid bleeding and healing problems
• Before surgery, wash the skin with Hibiclens (CHG) or Dial soap. It prevents surgical site infections

Possible complications

As with any procedure, complications can occur. Some complications associated with diskectomy are:

• Bleeding
• Infection
• Leaking spinal fluid
• Blood clots
• Allergic reaction to anaesthesia
• Short-term relief and a need for another surgery

Care After Surgery

• First 24 Hours

Recovery after a microdiscectomy procedure is generally quick. However, some precautions are required to be taken.

One may face difficulty in moving and require assistance to walk and urinate.

In some cases, patients are sent home the same day, while others may require hospitalisation for a few days.

• Two to 14 Days

After going home, one may experience the following:

• Sleepiness
• Fatigue
• Pain
• Pain medicines should be taken as advised.
• Avoid bending at the waist, lifting heavy weights, twisting back to the right or left, or driving a vehicle.
• Move regularly and slowly. Ensure constant movement to prevent stiffness that can increase discomfort.
• Patients can usually take a shower within 72 hours post-procedure.
• Avoid removing any dressing to prevent infection or hamper healing.

Microdiscectomies are safe surgeries, but the doctor should be immediately contacted if any of the following occurs:

• Loss of consciousness
• Pain that doesn’t diminish after taking medication
• Calf pain or the presence of swelling in one or both legs
• Bleeding through the bandage
• A fever of more than 101°F
• Discharge that may indicate an infection
• Weakness or tingling
• Loss of bladder control

Review

Reviewed by Dr. Arun Saroha, Senior Director, Neurosurgery, Spine Surgery.