Lumbar Discectomy

About Lumbar Discectomy

Lumbar discectomy removes the portion of a herniated intervertebral disc that is pressing on a spinal nerve root in the lower back, causing radiating leg pain known as sciatica, numbness or weakness. It is one of the most common spine operations. Many disc herniations improve without surgery, and the operation is usually considered when leg pain persists or when there is significant or progressive nerve deficit; cauda equina syndrome, compression of multiple nerve roots affecting bladder and bowel control, is treated as a surgical emergency. Microdiscectomy, the standard technique, uses an operating microscope or magnifying loupes through a small incision in the midline of the back. The muscles are moved aside, a small window of bone and ligament is removed in a laminotomy, the nerve root is gently retracted, and the herniated fragment is removed. William Mixter and Joseph Barr linked disc herniation to sciatica and described its surgical treatment in 1934, and the microsurgical technique was popularized in the 1970s. Endoscopic discectomy is a less invasive option at some centers. Most patients experience substantial improvement in leg pain, while back pain responds less predictably. Recurrent herniation at the same level is a recognized complication, along with tears of the dural lining, infection and nerve injury. Randomized trials have shown that surgery gives faster relief than continued nonsurgical care, although differences tend to narrow over longer follow up.