One of the most common types of back surgery is disk removal (diskectomy), the removal of an intervertebral disk, the flexible plate that connects any two adjacent vertebrae in the spine. Intervertebral disks act as shock absorbers, protecting the brain and spinal cord from the impact produced by the body's movements.
About 150,000 Americans undergo disk removal each year in the United States. Removing the invertebral disk is performed to treat back pain that has lasted at least six weeks as a result of an abnormal disk and that has not responded to conservative treatment. Surgery is also performed if there is pressure on the lumbosacral nerve roots that causes weakness or bowel or bladder disfunction.
As a person ages, the disks between the vertebrae degenerate and dry out, and the fibers holding them in place tear. Eventually, the disk can form a blister-like bulge, compressing nerves in the spine and causing pain. This is called a "prolapsed" (or herniated) disk. If such a disk causes muscle weakness or interferes with bladder or bowel function because it is pressing on a nerve root, immediate surgery to remove the disk may be needed.
The aim of the surgery is to try to relieve all pressure on nerve roots by removing the pulpy material from the disk, or the disk itself. If it is necessary to remove material from several nearby vertebrae, the spine may become unsteady. In this case, the surgeon will perform a spinal fusion, removing all the disks between two or more vertebrae and roughening the bones so that the vertebrae heal together. Bone strips taken from the patient's leg or hip may be used to help hold the vertebrae together. Spinal fusion decreases pain but it also decreases spinal mobility.
The doctor will obtain x rays, neuroimaging studies, including computed tomography scan (CT scan) myelogram and magnetic resonance imaging (MRI), and clinical exams to determine the precise location of the affected disk.
The surgery is done under general anaesthesia, which puts the patient to sleep and affects the whole body. Operating on the patient's back, the neurosurgeon or orthopedic surgeon makes an opening into the vertebral canal, and then moves the dura and the bundle of nerves called the "cauda equina" (horse's tail) aside, which exposes the disk. If a portion of the disk has moved from between the vertebrae out into the nerve canal, it is simply removed. If the disk itself has become fragmented and partially displaced, or not fragmented but bulging extensively, the surgeon will remove the bulging or displaced part of the disk and the part that lies in the space between the vertebrae.
The patient is given an injection an hour before the surgery to dry up internal fluids and encourage drowsiness.
After the operation, the patient will awaken lying flat and face down, and must remain this way for several days, changing position only to avoid bedsores. There maybe slight pain or stiffness in the back area.
Patients should sleep on a firm mattress and avoid bending at the waist, lifting heavy weights, or sitting in one spot for a long time (such as riding in a car).
After surgery, patients can usually leave the hospital on the fourth or fifth day. They must:
- avoid sitting for more than 15-20 minutes
- use a reclined chair
- avoid bending, twisting, or lifting
- begin gentle walking (indoors or outdoors), gradually increasing
- begin stationary biking or gentle swimming after two weeks
- continue exercise for the next four weeks
- slow down if they experience more than minor pain in the back or leg
All surgery carries some risk due to heart and lung problems or the anesthesia itself, but this risk is generally extremely small. (The risk of death from general anesthesia for all types of surgery, for example, is only about 1 in 1,600.)
The most common risk of the surgery is infection, which occurs in 1-2% of cases. Rarely, the surgery can damage nerves in the lower back or major blood vessels in front of the disk. Occasionally, there may be some residual paralysis of a particular leg or bladder muscle after surgery, but this is the result of the disk problem that necessitated the surgery, not the operation itself.
While disk removals can relieve pain in 90% of cases, there are some people who do not get pain relief, depending on how long they had the condition requiring surgery and other factors.
After about five days, most patients can leave the hospital. They can resume all normal activities, including work, after four to six weeks of recuperation at home.
In properly evaluated patients, there is a very good chance that disk removal will be successful in easing pain. Even in patients over age 60, disk surgery has a "good to excellent" result for 87% of patients. Disk surgery can relieve both back and leg pain, but the greatest pain relief will occur with the leg pain.
Younson, Robert M., et al., editors. The Surgery Book: An Illustrated Guide to 73 of the Most Common Operations. New York: St. Martin's Press, 1993.
Diskectomy — The surgical removal of a portion of an intervertebral disk.
Dura — The strongest and outermost of three membranes that protect the brain, spinal cord, and nerves of the cauda equina.
Herniated disk — A blisterlike bulging or protrusion of the contents of the disk out through the fibers that normally hold them in place. It is also called a ruptured disk, slipped disk, or displaced disk.
Intervertebral disk — Cylindrical elastic-like gel pads that separate and join each pair of vertebrae in the spine.
Laminectomy — An operation in which the surgeon cuts through the covering of a vertebra to reach a herniated disk in order to remove it.
Vertebra — The bones that make up the back bone (spine).