Strictly speaking, discectomy means complete removal of the disc. However, only in anterior lumbar fusion surgery or disc replacement surgery is such a removal performed. In general, the term discectomy refers to the selective removal of part of a disc, usually that part that has protruded or herniated into the spinal canal and which is generating symptoms by compression of a nerve root.
In the cervical region this will result in arm pain (brachalgia).
In the lumbar region, it will typically result in pain radiating into the buttock and down the leg (sciatica).
Modern imaging, such as CT and MRI, allow visualisation of structures within the spine, and confirmation of the presence and extent of a disc herniation.
If conservative management such as pain relief, activity modification, anti-inflammatory medication and physiotherapy fails to settle the symptoms, or there is significant neurological deficit or risk, then removal of the compressive disc material may be recommended.
At surgery, a small incision is made in the midline of the lower back, and the muscle elevated from the back of the spine at that point, to allow a small ‘window’ opening to be made into the spinal canal to allow visualisation of the compressed nerve.
Once identified, the offending herniated disc material is gently removed from around the nerve, as well as any other loose fragments that can be identified in the back of the disc.
Recovery from surgery is usually rapid – most patients can walk immediately, and discharge home in one to two days.
There is an incidence of recurrent disc protrusion of between five and ten percent over the patient’s lifetime. This is the same whether the disc protrusion is managed conservatively or surgically, and is associated with the underlying state of the disc.