Partial Lumbar Discectomy and Disc Excision
An actual surgery done by Jeff Fischgrund, M.D.
Lumbar disc herniations occur frequently in people ages 25-45. A disc herniation (or rupture) occurs when the outer portion of the disc (annulus) gets thinned or weakened and tears. A small portion of the inner part of the disc (nucleus pulposus) then ruptures or herniates through this tear and lays outside the confines of the normal disc space. If this disc herniation pushes on a spinal nerve, patients will often have pain, weakness and/or numbness going down either leg. Very large disc herniations can affect the nerves going down both legs and can occasionally even affect the nerves to the bowel and bladder.
Lumbar disc herniation can result from minimal trauma or can be due to automobile accidents or heavy lifting episodes. Most commonly, lumbar disc herniations are due to the normal degenerative process which occurs in all people as we age. Fortunately, most lumbar disc herniations can be treated without surgical intervention. Often times, a treatment regimen consisting of medications, physical therapy and activity modification can lead to decreased leg symptoms in 90% of all patients. Surgery is indicated in those patients who failed conservative treatment and continue to have significant pain radiating down one or both of the legs.
This procedure is often done through a short (1-inch) incision in the middle of the low back. Surgeons often use either a microscope or surgical loupes to assist with visualization of the anatomy. After the skin incision is complete, the muscles are moved to one side and the spinous process, lamina, and space in between the two lamina, is visible. The lamina is thinned down with cutting instruments such as a Leksell and Kerrison rongeur. After removal of a small amount of bone, the yellow ligament (ligamentum flavum) is visible and a portion must be removed to visualize the underlying nerve roots. The nerve roots are covered by a membrane called the dura. At this point in the operation, the compressed nerve root is often seen and must be moved to visualize the underlying disc herniation. The nerve root is carefully moved, which then allows the surgeon to remove the ruptured disc fragment. After removal of the fragment, the nerve usually has much more space and is no longer compressed.
This procedure usually takes from 45-minutes to 1-hour and can be done under either general or spinal anesthesia. Most patients stay in the hospital for 24-hours or less and need to decrease their activity levels for 6-weeks following the surgical procedure. Patients should avoid heavy lifting, bending, twisting and turning for these 6-weeks. Occasionally, physical therapy is needed to rehabilitate the back muscles. Most patients notice a significant decrease in their leg pain very soon after the surgical procedure. Often times, numbness in the leg or foot can persist for several months.