Discectomy

If you are interested in finding out about discectomy surgery, the reasons for discectomy and the benefits of discectomy, the following information will help you.

If you are considering surgery to treat a slipped disc (discectomy) or have an operation planned, it is important to know all you can about it. This includes:

• why you need a discectomy operation

• what it will be like

• how it will affect you

• what risks are involved

• any alternatives.

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things when carrying out discectomy surgery, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your choices of slipped disc treatment with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

You have a slipped intervertebral disc in your backbone (spine or spinal column). Other names for a slipped disc are a herniated disc or a prolapsed disc. The disc presses on the nerves in the spine. It may cause leg pain (sciatica), numbness or bladder problems.

What is an intervertebral disc?

The vertebrae are the bones that make up the spine. The front of each bone is solid and is called the body. This is where the disc fits. There is an disc between each vertebra. These intervertebral discs act like shock absorbers to let the spine bend and twist. Each disc can be considered as having two parts rather like a soft centred sweet. The tough outer rim is bound to the vertebra above and below. The middle of the disc is soft and it is this part that moves out of place (herniates or prolapses).

Behind the body of each vertebra is an arch of bone called the lamina. The arches form a channel called the vertebral canal. The spinal cord runs down the vertebral canal from the brain, protected by the bony arches. Spinal nerves run out from the spinal cord through gaps between the arches. They run to different levels in the trunk, arms and legs. The lowest spinal nerves run to the buttocks and bladder. The spinal cord only runs part way down the spine. It stops at the level of the lowest ribs. Below this, spinal nerves run down the vertebral canal to the correct gaps between the arches. These nerves, packed in the canal, look like the tail of a horse (cauda equina in Latin). The spinal nerves and cord carry feeling impulses from the body up to the brain and impulses from the brain down to the muscles.

What has gone wrong?

The central part of one or more of your intervertebral discs has slipped or herniated through the outer rim. This causes some back pain.

If the slipped disc tissue presses on the spinal nerves in the gaps between the bony arches, you will get a feeling of pain in your leg, called sciatica. You may also feel weakness in your leg muscles. If the slipped disc tissue presses on the nerves of the cauda equina, which run through the vertebral canal, this can cause buttock numbness and bladder problems with difficulty in controlling urine.

The aims

The aim is to remove the soft part of the disc that is out of place, so that the pressure on the nerves is relieved and the condition does not come back.

The benefits

The operation should stop the pain in your leg. If you have some weakness in your leg this should improve.

Are there any alternatives?

If you do not have any muscle weakness, you can wait and see if your pain settles with time. Only the minority of patients with sciatica need an operation, even if they are shown to have a herniated disc on a scan.

Some patients find that an injection of anti-inflammatory steroid around the nerves in the back relieves their pain; this is called an epidural injection.

Physiotherapy or osteopathy can help reduce back pain but cannot help reduce sciatica.

What if you do nothing?  

If you only have pain, but no muscle weakness, your pain may settle if you wait long enough.

If you have weakness of your leg and you do not have an operation, the muscles may remain weak permanently.

Who should have it done?

You should have the operation if you have ALL of the following:

• Your leg pain is worse than your back pain
• You have had leg pain for several months that is not getting better
• Your leg pain is interfering with your life
• You have had a special scan (MRI scan) that shows that you have a disc pressing on the nerve

You should have an early operation if you have weakness in some of your leg muscles or numbness in your leg that is getting worse. If you have buttock numbness, leg weakness and a bladder problem (cauda equina syndrome) you need an operation urgently.

Who should not have it done?

The aim of the operation is to cure your leg pain. Your back pain may remain unchanged after the operation. If your back pain is more of a problem than your leg pain, you should not have the operation.

Author: Mr Boyd Goldie MBBS FRCS BSC DHMSA. Consultant in orthopaedics & trauma.

© Dumas Ltd 2006

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