Disc Surgery

What is Disc Surgery?

There are a few different operations that alter the shape of the intervertebral disc (‘discectomy’) or replace it altogether.

These are generally only recommend for those with slipped discs in the lower back (lumbar spine) that have occurred recently or suddenly and have not improved with non-surgical forms of treatment, like physiotherapy.

Alternatively, disc operations may be performed semi-urgently if your doctor is concerned about your symptoms becoming worse or causing significant disability.

Discectomy involves accessing the spine then removing sections of the disc that are pressing on nerves.

Disc operations can be very successful at relieving the symptoms of disc herniation, including pain and ‘nerve symptoms’ like tingling and weakness in the legs. However, disc operations should not be used to treat general back pain.

Who is this operation for? 

Discectomy and disc replacement are only really appropriate when: 

  • You have a slipped disc, usually one that has slipped suddenly or recently or keeps on slipping. 
  • You have back pain with nerve symptoms that seems to be related to your disc. 

Other causes of nerve symptoms and chronic slipped disc can usually be better treated with spine fusion rather than discectomy.

Surgery will only be considered when other methods of treatment, in particular physiotherapy, has failed to significantly reduce symptoms. Alternatively, your surgeon may believe this operation is necessary to prevent further injury to your nerves and long-term disability. If this is the case, you may have surgery without first trying physiotherapy. 

Who can’t have this operation? 

This operation may not be appropriate if you:

  • Have back pain without nerve symptoms
  • Have serious other diseases affecting your heart, lungs or blood
  • Are at increased risk of developing severe infection

Complications

The risks and complications of a Disc Surgery include:

  • ‘Failure’ to improve symptoms or the recurrence of symptoms in the future. 
  • infection
  • Bleeding and bruising in and around the spine. 
  • Formation of blood clots in the leg (DVT) or clots in the lung. 
  • Dural tear (a tear in the lining around the spinal cord) leading to headaches. 
  • Incision symptoms – bleeding, failure to heal, infection

There are a number of potential complications that can arise in any surgery – for more information on these risks, please see Complications of Surgery.

Before the operation

Preadmission Clinic | Preparing for Surgery

Before your operation, you will be seen at the Preadmission clinic to make sure you are fit for the operation and all the necessary tests are performed in preparation for the operation.

During the visit, you will be seen by a

  • doctor
  • nurse
  • anaesthetist (if necessary)

You may need to undergo a specialised anaesthetic assessment. 

Tests

Your surgeon will get a series of tests on your spine before considering surgery. These may include: 

Additional tests that may be ordered for you include:

  • blood tests
  • Xray of your Chest
  • Urine Test
  • ECG

Preparing Your Skin

Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for a program to improve your skin before surgery.

Tip

Carry a list of your medications with you including the name, dosage and how often you take it.

Medications

Our doctors will advise you which medications you should stop or can continue taking before surgery. Please make sure you tell your doctors if you are taking: 

  • Any medications that thin your blood, including warfarin and aspirin.

About the Operation

When you reach the operating theatre, you will be met by your surgeon, anaesthetist and theatre nurse. 

While this operation can be performed under general anaesthetic(while you are asleep), some surgeons may prefer to perform the operation while you are awake, with other forms of anaesthetic used to numb the region they are operating on (spinal anaesthesia). If this is the case, you might have: 

  • Sedative drugs that make you drowsy, relaxed and ‘forgetful’. These drugs keep you awake and conscious but reduce your experience. 
  • An epidural injection to numb the spine (see spinal anaesthesia). 
  • A series of injections around the spine. Your surgeon or anaethetist will first sterilise the skin and inject a small amount of local anaesthetic into the skin to make the large needles less painful. 

As the form of anaesthetic used will vary between surgeons, you need to clarify which will be used in your operation. 

Once your spine has been numbed, your surgeon can make a cut over the area of the slipped disc. The muscles and ligaments are then carefully pushed away to reveal the disc and vertebrae. From here your surgeon can remove or trim areas of the disc that are compressing the nerves. Your surgeon may also decide to: 

  • Trim ligaments around the spine that are compressing nerves. 
  • Trim or remove sections of bone that are either compressing nerves or need to be removed in order to replace the disc. 

If you are having a disc replacement, your surgeon may need to make a wider cut. He or she will also need to place either a metal or plastic prosthetic disc between the vertebra to cushion and space the spine. 

Once the operation is complete, your surgeon will carefully stitch and replace the muscles and ligaments around the spine before stitching the skin closed.

After the Operation

When you leave theatre you will taken to the recovery room. From here, nurses and doctors will monitor you to check you are well and not developing symptoms in your nerves or a fever. 

If you are coping well and able to move independently without pain or headache, you should be able to go home that night. Often, your surgeon may ask that you remain in hospital overnight just to be careful.

Recovery and Rehabilitation 

Coming soon…

F.A.Q.s | Frequently Asked Questions

What are the alternative treatments to having Disc Surgery?

Doctors and surgeons will usually recommend you try non-surgical treatments like physiotherapy for at least six weeks before considering surgery. 

Other procedures and surgery used to treat slipped discs include: 

References

Briggs, T., Miles, J., Aston, W., (Eds), ‘Operative Orthopaedics: The Stanmore Guide’, Hodder Arnold, UK, 2010, pp 37-40. 

Carragee, E. J., ‘The role of surgery in low back pain’, Current Orthopaedics, Vol. 21, 2007, pp. 9–16.