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Options for Lumbar Disc Surgery

A series of cushioning, gelatinous structures called vertebral discs separate the vertebrae of the spine. These discs are slightly more delicate than we would like and are prone to both injury and the ravages of time. When conservative measures such as physical therapy, pain medication and steroid shots fail, many people turn to their neuro- or orthopedic surgeon for help.

  1. Disc Disease

    • Degenerative disc disease is seen primarily in older patients and is really a natural progression of the aging process rather than a true disease. Discs in adults older than 60 become less flexible, drier and smaller. Caused by injury or sustained injury over time, herniated or bulging discs can affect a patient at any age. When a disc herniates, its cushion-like gel material completely prolapses from its protective shell and presses on extremely sensitive nerves near the spinal cord. Currently, an MRI (magnetic resonance imaging) test is the gold standard in the diagnosis of a disc disorder. Treatment consists of non-surgical techniques such as exercise or steroid injections. However, if the pain is not responsive to conservative measures, the patient may need to undergo a surgical procedure.

    Microdisectomy

    • Often, when a disc is bulging or herniated, the pressure exerted on the surrounding nerves can cause leg pain. A procedure known as a microdiscectomy is one of the best procedures currently for treating disc-related leg pain. In this type of operation, a small segment of bone, along with damaged disc material, is removed from the adjoining nerve root through a small incision. Video allows the surgeon to visualize the area of involvement. With a success rate of 90 percent, microdiscectomy often solves the problem, but, as with any surgery, there are risks involved. Infection, cerebrospinal fluid leak (the fluid which supports and cushions the brain), nerve damage or post-operative bleeding are the most common complications associated with a microdiscectomy; however, instances of severe post-operative complications are 1 per cent.

    Lumbar Laminectomy

    • Also known as an open decompression, a lumbar laminectomy is the procedure of choice for those with spinal stenosis. Stenosis occurs when the nerves are compressed due to age-related changes such as arthritis. Disc compression is also a common feature of spinal stenosis. Unlike the microdiscectomy, more of the bone is removed in a lumbar laminectomy. The aim of this type of surgery is to expand the spinal canal, clear debris such as herniated discs and enable the nerves to function normally.

    Spinal Fusion

    • Spinal fusion is essentially the same as a lumbar laminectomy with the addition of fusing vertebral bone to grafted bone with surgical screws (instrumentation) for added stability. Grafted bone is usually harvested from the pelvis. In the case of arthritic changes in the spine, or degenerative disc disease, fusion is more common than a simple laminectomy. These patients may be required to wear a supportive brace during the healing process. One type of brace used frequently is the TLSO (thoracic lumbro-sacral orthotic brace).

    Success Rates

    • As you might imagine, the less invasive the surgery, the better the success rates. Microdiscectomy patients have a success rate of 90 to 95 percent. Of this group, up to 10 percent may develop a recurrence of disc herniation. With lumbar laminectomies, 70 to 80 percent cite improvement in back and leg pain. In about 10 percent of laminectomies, post-operative instability is the leading complication which can be corrected by a fusion surgery. Fusion success rates are 60 to 70 percent.

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