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What You Need to Know About Lumbar Herniated Disc Surgery

Published November 2, 2018   | Written By Jason Garber, MD   | Reviewed By Jerry Nichols, MD

Whether you live an active life or like to take it slow, the daily wear and tear we experience affects all parts of the body, but especially the back. Despite the name, degenerative disc disease isn't a disease at all—the term refers to the normal changes of your spine that come with age. While the cause of herniated lumbar discs often stem from degenerative disc disease, something as normal as sneezing or poor posture can also cause this problem. Whether you choose conservative treatment or surgery for a lumbar herniated disc, millions continue to search online to help heal this common form of back pain.

Types of Lumbar Herniated Disc Surgeries


Depending on the patient's symptoms, most are able to treat their herniated disc without going under the knife. Some conservative treatment options include over-the-counter pain relievers, resting, and closely observing if your pain continues to progress. When your lower back pain begins to interfere with daily activities, it may be time to consider surgery as a possible solution.

Laminotomy and Discectomy


The most common and traditional way of surgically treating a herniated disc is by undergoing a laminotomy and discectomy. The laminotomy relieves the pain and pressure of the pinched nerve by removing a piece of the lamina—part of the bony structure of the spine—while a discectomy either removes the herniated portion of the disc or removes the disc completely. For these procedures, first an incision is made in the area of the herniated disc, the muscles are moved and an opening is created between two vertebrae in order for the surgeon to see the spinal column.

For the laminotomy, a small part of the vertebrae called the lamina is partially removed create more room for the next step of the procedure. In the case of a discectomy, the surgeon removes the erupted disc material in the spinal column along with any other materials that may cause compression on nerves (i.e.disc, bone, cysts, etc.). Before closing the incision, surgeons may also remove the nucleus pulposus material to prevent the disc from herniating again.

As technology continues to advance in the medial field, newer procedures like microdiscectomy and endoscopic discectomy surgeries have become popular because of the added benefits. Both procedures remove the herniated disc material, however these newer surgeries leave a much smaller incision. In addition to the smaller incision scar, patients also experience quicker recovery and less damage to the tissue surrounding the spine.

Dr. Jason Garber, spine surgeon at Center for Spine and Brain Surgery in Las Vegas, Nevada says, “Microdiscectomy is a great tool in a surgeon’s belt for a first line of defense against herniated discs. For many patients, a microdiscectomy is all that they need or it at least buys them time before hardware needs to be placed.”

Spinal Fusion


Instead of removing or replacing your herniated disc, spinal fusion alleviates your lower back pain by permanently joining two vertebrae into one bone. Eliminating the range of motion where the damaged disc is located can relieve your lower back pain and help correct recurrent herniated discs. Spinal fusion surgeries have a different purpose than artificial disc replacement procedures (more on that in the next section). You might be surprised to learn that similar steps are taken during both procedures.

First the surgeon makes a small incision normally below the belly button and the intestinal organs are gently moved to the side to reach the spinal column. After the surgeon has a clear view of the spine, the herniated disc material is removed before replacing the disc or fusing the vertebrae together. During the spine fusion process, a bone graft is added to the vertebrae that grows the two vertebral bodies into one bone.

“Not every patient is indicated for disc replacement. For some, a fusion makes more sense. That is why it is important for surgeons to be trained to offer multiple solutions for back pain. An evidence based spine surgeon will consider each of the options, present the pros and cons to their patient and decide on the best approach together,” said Dr. Garber.

Artificial Disc Replacement


Depending on which lumbar disc is herniated, you may be eligible for artificial disc replacement surgery. Adding more stability and flexibility to your spine, this surgery replaces the damaged lumbar disc with an artificial disc made of either plastic or metal. Once the artificial disc is placed in the spine, a combination of interbodies, plates, rods, and screws are added to ensure the vertebrae fuses to the artificial disc

“Lumbar total disc replacement is now considered a standard of care for DDD sufferers,” said Dr. Garber. “For my younger, more active, patients sometimes it does not make sense to do a spinal fusion. Disc replacement allows for a more anatomically accurate correction of the degenerative spine and the value of preserving motion has been widely reported in the literature.”

Compared to other lumbar surgeries, artificial disc replacement patients usually experience fast relief, less pain and fewer complications. If you think artificial disc replacement could be an option for you, learn more about the process from start to finish here.

Conclusion


When conservative treatments fail to help the pain of a herniated disc, surgery may be the next solution. While procedures like laminotomy and discectomy are the most common lumbar herniated disc surgeries, artificial disc replacement and spinal fusion can also be options depending on the symptoms and severity. Before making a decision, consider more than one opinion from a spine expert. Learn more about the advantages and disadvantages of spinal fusion and disc replacement while considering lumbar herniated disc surgery, or find more answers to your back pain questions at backernation.com

Last change: November 7, 2018

Contributors and Experts

Dr. Garber is a neurosurgeon with Western Regional Center for Brain & Spine, where he concentrates on the treatment of complex spinal disorders, as well as intracranial disorders.