Listed below is the step by step procedure of lumbar discectomy:
- What is Lumbar Discectomy?
- Why is Lumbar Discectomy Required?
- Pre-operative Preparation
- Day Before Surgery
- Procedure Day
- Methods/Techniques of Lumbar Discectomy
- Post Procedure
- Risks and Complications
What is Lumbar Discectomy?
A herniated vertebral disk is a very common back problem suffered by people. In this condition, the outer wall of the disk weakens with age or accident. This causes the inner core of vertebrae to pop out. The inner core that has popped out, rubs with sensitive nerves in the spine causing strong pain to the person. A lumbar discectomy, also referred to as open discectomy, is a surgery for removing part of the damaged disk. A herniated disk causes pain, weakness, numb feeling and also tingling sensations in the legs, along with sharp pain in back.
Why is Lumbar Discectomy Required?
- Herniated disk: As mentioned before, herniated disk is a very painful disorder. Doctors try to treat it with the help of therapy, medication, spinal injections. But still if the condition does not go away with the same, lumbar discectomy is recommended.
- Pressure on spinal nerves: Spinal nerves are pressurized when spinal canal is blocked because of herniated disc.
- Injuries: Discs in vertebrae can burst due to influence of any external pressure like accident, or any injury occurring during participating in any sports activity.
- Neurological physical exam
This is done to check the functioning of the nerves travelling from spine to legs.
X-rays are ordered by the doctor to help him assess condition of vertebrae present in spine. A myelogram can show whether there is pressure created by herniation on nerves or spinal cord. So a dye is injected into the spinal cord to get enhanced X-ray images. This procedure is known as myelogram.
- Magnetic resonance imaging (MRI)
Results of an MRI scan provide detailed information of nerves, ligaments and tissues surrounding the spinal region. And hence, MRI is ordered by the doctor before surgery.
- Computed tomography scan (CT Scan)
Alternatively, spinal structures can be studied with the help of images created out of CT scanning
- Nerve conduction velocity test
Nerve conduction velocity test is an indicator of nerve health and proper functioning. Sticky patches with electrodes are placed on certain pre-decided spinal nerves. An electrical impulse is passed and the time taken for it to travel to a second nerve is measured.
- Electromyography test
An electromyography test is another diagnostic test that could be ordered by the doctor before a lumbar discectomy surgery since this test reveals nerve and muscle dysfunction.
The doctor will ask you to perform generic movements so he understands the muscle strength and stability.
- Blood tests: Levels of white blood cells, hemoglobin, blood clotting factors are performed prior to surgery. These levels should be normal, and if they are not, surgery needs to be rescheduled till all these parameters attain normal levels. Blood tests can also determine if the functions of vitals body organs like liver, kidneys, thyroid gland is optimum or not.
- Physiotherapy: Lumbar discectomy will involve altering the natural structure of vertebral column. Prior to surgery, the physiotherapist will recommend some exercises to the patient which will help in strengthening the back muscles. Thus, after the surgery, patient will not have a lot of trouble in moving around and recovery time reduces considerably.
- Anesthesia: The doctor makes a thorough evaluation of the patient to assess if they have any allergy to medication. This helps in deciding which anesthetic agent can be used safeuly during surgery.
Day Before Surgery
An open discectomy or lumbar discectomy typically requires the patient a one day hospital stay before procedure. The doctor may give you instructions about what is to be eaten and what needs to be avoided on the day before surgery.
- When you arrive in the hospital, you are shifted into the pre-surgical area.
- Vital signs such as blood pressure, pulse rate and temperature are checked and noted down by a person from the medical team.
- General anesthesia is then delivered before surgery is begun with.
Methods/Techniques of Lumbar Discectomy
Open discectomy usually commences after general anesthesia is given to the patient for making them unconscious. The patient is made to lie face down or in a kneeling position. During the procedure, a one inch incision is made on the skin corresponding to the damaged part of the spine. Surgical retractors help hold the muscle and skin away after muscle tissue is removed from the lamina. The site of the vertebrae and disc needs to be clearer to the surgeon.
In some cases, the surgeon also needs to remove bone and ligaments for better visualization. This step is also to be done so that the surgeon gains access to the aimed disc without causing any harm to the nerve tissue. This process is termed as a laminotomy.
When the surgeon gets a proper view of lamina and vertebrae that are affected by herniation, he will take out the section that is bulging out from the disc wall and also any other disc fragments that may have been poking out of the disc. No artificial material is used to fix or replace on the disc tissue that is taken out. The incision is then sealed with stitches and the patient is fit to be shifted to the recovery room.
- Recovery room: You will find yourself in the recovery room after the effects of anesthesia wear off and you wake up after your operation.
- Oxygen mask: An oxygen mask might be left on your face to help you breathe. Feeling groggy and sleepy in this time is also natural.
- Intravenous drip: After this procedure, an intravenous drip also remains on the veins of one of the arms. This is necessary for providing medicines and fluids to the patient until he can start eating and drinking by himself.
- Vital signs: A nurse will check your vitals, that is your pulse rate and blood pressure, till you are fit enough to be shifted into the hospital room.
- Anti-nausea medicine: Sometimes you are likely to feel sick and nauseous after undergoing an operation. That is because of the general anesthetic given to you during surgery that makes you feel like vomiting. If you feel sick, a nurse should be conveyed the same. Anti-nausea medicine is given to you for relieving the symptoms.
- Pain relief medication: Pain medication will be administered to you after surgery during the hospital stay.
- Getting up and moving around: Mobility after undergoing this procedure, is encouraged as much as possible. The doctors and medical team will help you get active and start walking around in a short time after surgery. Walking is necessary for preventing complications that occur from remaining sleeping in bed post surgery. A physiotherapist will train you on important exercises that are good for you to continue doing in the period after you return to your house.
- Eating and drinking: After this procedure, generally you won't be allowed to eat anything for the next 4-6 hours. The medical team will instruct you as to what to eat and how much to eat in the time after the surgery.
- When you can leave hospital: Most patients who undergo a lumbar discectomy under general anesthesia will be able to go home in around 2 days after surgery. The stay might get longer than 2 days if you are in advanced age or have developed any major disability before surgery.
Dos and Don'ts after Lumbar Discectomy
- Driving: You are expected not to resume driving, until and unless when the doctor gives you permission to do so. Limit travelling in car or 2 wheeler or any vehicle for that matter.
- Return to work: Those in physically less enduring jobs can return to work in 2-4 weeks, whereas people in physically strenuous ones need to rest for at least 6-8 weeks before resuming their jobs.
- Physiotherapy program: In the recovery period, you need to continue implementing the physiotherapy program chalked by your physiotherapist for proper and systematic recovery. The exercises are designed keeping in mind reduction of spasms, muscle pain and goal of strengthening the muscles in back.
- Don't use stairs: Don’t climb stairs or bend at the waist for the first few weeks after surgery. Try to limit climbing or alighting stairs to just once or twice in the entire day. Do not bend at the waist, instead prefer squatting down to bend your knees and squat down to pick up items.
- Don't lift weight: Ideally, do not lift anything that is over 10 pounds in weight. That includes shopping bags, grocery bags, laundry baskets and kids.
- Smoking: Do not smoke cigarettes or use tobacco products, and limit your exercise to slow walks.
- Back braces: Back braces ensure that your spine heals properly after surgery. Make sure to use them.
Risks And Complications
- Anesthetic problems: In very rare cases, patients have problems with the anesthesia that is used. But that could be resolved through discussion with patient in advance of surgery. Also, anesthetic agents have the capability of affecting the lung function. The risks of the same need to be discussed in days before surgery with anesthesiologist and doctor.
- Nerve damage: Malpositioned surgical instruments have the capability to cause damage to the nerves surrounding the spinal region or even directly to the spinal cord. Numbness and muscle weakness are results of the damage.
- Blood clots: Also referred to as deep vein thrombosis, blood clots cause swelling in the legs because of blood vessels clotting in there.If the clots mobilize, they could enter the blood vessels supplying the lungs and block the vessels. This is a serious health condition which could have a fatal outcome.
- Recurrent disc herniation: Recurrent disc herniation is a possibility occurring among 5-10% cases of open discectomy wherein, the operated disc again undergoes injury after surgery.
- Continued pain: There are many cases, where the patient complains of continued pain even after surgery.
- Risk of injury: The other vital organs that surround the spinal area like bowels and kidneys are at risk of injury because of surgical negligence.
- Wrongly operated site: There are very small chances that the wrong disc is operated, as there are many discs present in the spinal region. However, this mistake can be corrected during surgery itself via observing the area under X-rays to confirm whether it was the right spot that was operated.
- Wrongly operated site: Dural tear is a hole that occurs in the spinal canal. This is a heightened possibility when the patient is undergoing a repeat surgery or a second surgery for some other cause, as compared to a first time surgery.
Other less serious complications of lumbar discectomy are discolored incision, excess bleeding from incision, difficulty in urinating, fatigue etc.
To conclude, lumbar discectomy is a procedure that is best for patients suffering from spinal issues and pain because of it. The surgery details need to be discussed in-depth with the doctor operating on you. Solving your queries beforehand with the doctor is very important.
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