| How is an open discectomy performed? | | | | neurologic deficits (such as significant weakness) are |
| An open discectomy is performed under general | | | | at higher risk of incomplete recovery. |
| anesthesia. The procedure takes about an hour or so, | | | | Other risks of surgery include spinal fluid leaks, |
| depending on the extent of the disc herniation, the | | | | bleeding, and infection. All of these can usually be |
| size of the patient, and other factors. A discectomy | | | | treated, but may require a longer hospitalization or |
| is done with the patient lying face down, and the | | | | additional surgerypercutaneous arthroscopic laser |
| back pointing upwards. | | | | discectomy |
| In order to remove the fragment of herniated disc, | | | | A percutaneous arthroscopic laser discectomy is done |
| your surgeon will make an incision over the center of | | | | when the patient's history, physical examination and |
| your back. The incision is usually about 3 centimeters | | | | imaging (such as CT scan or MRI) indicates herniated |
| in length. Your surgeon then carefully dissects the | | | | or bulging disc and the material inside the disc has not |
| muscles away from the bone of your spine. Then | | | | ruptured into the spinal canal. There also may be |
| using special instruments, your surgeon removes a | | | | signs of serious nerve damage in the leg, severe |
| small amount of bone and ligament from the back of | | | | weakness, loss of coordination and/or loss of feeling. |
| the spine. This part of the procedure is called a | | | | Anyone with any significant bony anomalies or |
| laminotomy. | | | | foraminal stenosis would not be a candidate for a |
| Once this bone and ligament is removed, your | | | | percutaneous arthroscopic laser discectomy, but |
| surgeon can see, and protect, the spinal nerves. | | | | would benefit from a Foraminotomy procedure. |
| Once the disc herniation is found, the herniated disc | | | | When a traditional percutaneous arthroscopic laser |
| fragment is removed. Depending on the appearance | | | | discectomy is performed, the surgeon uses X-ray |
| and the condition of the remaining disc, more disc | | | | monitoring and fiber optics resulting in pictures |
| fragments may be removed in hopes of avoiding | | | | displayed on a monitor similar to a TV screen, |
| another fragment of disc from herniating. Once the | | | | therefore allowing the surgeon to see what is |
| disc has been cleaned out from the area around the | | | | compressing the nerve during the procedure and |
| nerves, the incision is closed and a bandage is applied. | | | | remove it with laser, ensuring a much higher rate of |
| What is the recovery from a discectomy? | | | | success. A percutaneous arthroscopic laser |
| Patients often awaken from surgery with complete | | | | discectomy can be performed without the need for |
| resolution of their leg pain; however, it is not unusual | | | | general anesthesia in an outpatient surgical setting. |
| for these symptoms to take several weeks to | | | | After a local anesthetic is administered, a small incision |
| slowly dissipate. Pain around the incision is common, | | | | is made and a round Depuy tube is put into the |
| but usually well controlled with oral pain medications. | | | | incision This tube allows the surgeon to perform |
| Patients often spend one night in the hospital, but are | | | | percutaneous arthroscopic laser discectomies with |
| usually then discharged the following day. A lumbar | | | | minimal damage to the surrounding muscles. The |
| corset brace may help with some symptoms of pain, | | | | muscles are pushed out of the way and are not torn |
| but is not necessary in all cases. | | | | or cut. |
| Gentle activities are encouraged after surgery, such | | | | The laser, camera, suction, irrigation and other surgical |
| as sitting upright and walking. Patient must avoid | | | | instruments are inserted through this working tube. |
| lifting heavy objects, and should try not to bend or | | | | Once everything is in place, the surgeon utilizes a |
| twist the back excessively. Patients should avoid | | | | laser to vaporize the disc material, therefore |
| strenuous activity or exercise until cleared by their | | | | diminishing the pressure on the spinal cord and/or the |
| doctor. | | | | spinal nerve. Many patients feel immediate relief |
| What are the potential complications of discectomy? | | | | during the percutaneous arthroscopic laser |
| The most common problem of a discectomy is that | | | | discectomy as the pressure is minimized. When the |
| there is a chance that another fragment of disc will | | | | procedure is complete, the tube is slowly removed, |
| herniate and cause similar symptoms down the road. | | | | allowing the muscles to move back into place. |
| This is a so-called recurrent disc herniation, and the | | | | A percutaneous arthroscopic laser discectomy is a |
| risk of this occurring is about 10-15%. | | | | relatively short procedure, only taking ½ hour |
| Most patients find relief of much, if not all, of their | | | | to 45 minutes to perform with a quick recovery |
| symptoms from a discectomy. However, the success | | | | ensured afterwards. After 1-2 hours of monitoring, |
| of the procedure is about 85-90%, meaning that | | | | the patient (with a companion) is free to go. Patients |
| 10% of patients who undergo a discectomy will still | | | | are generally encouraged to take a long walk the |
| have persistent symptoms. Patients who have | | | | afternoon or evening of their percutaneous |
| symptoms for long periods of time, or severe | | | | arthroscopic laser discectomy procedure. |