Surgery for
Herniated Disc Problems
Surgery for Disc Problems
To determine who would benefit from surgery in case of herniated disc, the following criteria are usually considered. He individual must have:
1. Have a disc pressing on a nerve root, as shown by an MRI or CT scan.
2. Have consistent pain despite conservative treatments.
3. Severe pain radiating into the buttock or leg (sciatica) that does not
decrease even after 4-6 weeks of conservative treatment.
4. Neurological warning signs like loss of ankle reflex or the loss of
bladder control.
There are several options for relieving pressure on a compressed nerve root.
a. Discectormy
Discectomy involves removing the protruding disc that is pulling pressure on the nerve root. Either a portion of the disc or all of it is removed. This operation has a high rate of success in providing pain relief. In discectomy, a small incision is made over the offending disc and the disc material that is pressing on the nerve is removed.
b. Microdiscectomy
It is like discectomy but requires a smaller incision. It has the benefit of shorter hospital stay.
c. Percutaneous disc removal
This procedure involves removing the problem disc fragment through an endoscope. A small tube is inserted through a tiny opening in the skin of the back. Using a specially designed surgical instrument at the end of the tube, the surgeon cuts away parts of the disc. This procedure does not disturb muscles and ligaments which are important for the stability of the spine. Recovery is faster and less painful. It does not require general anaesthesia.
d. Laser Disc Decompression
This involves an approach similar to percutaneous disc removal. The laser energy is introduced through a needle to destroy a small amount of nucleus
pulposus, thereby reducing the pressure on the nerve. It can be done in an outpatient setting, and it is performed under local
anaesthesia.
e. Chemonucleolysis
Chemonucleolysis is an alternative to surgical removal of the disc. An enzyme,
chymopapain, which is prepared from the papaya plant, is injected into the disc space to reduce th size of herniated discs. The resulting decrease in the size of the disc releases pressure on the nerve root. The injected disc tends to redevelop itself with normal tissue. Because of serious side-effects, this procedure is rarely used.
f. Intradiscal Electrothermal Therapy (IDET)
It is a technique for desensitizing the disc and increasing its structural integrity. The procedure involves placement of a heating element within the disc, which heats the annulus. This procedure reduces discal pain and allows for increased activity in approximately two-thirds of properly screened patients. This compares favourably to fusion surgery. In addition, if IDET does not yield significant improvement, discectomy and fusion can still be performed without altering the success rate.
