Contact — Cyril Sebastian MD

Lumbar disectomy patients may leave the same day after surgery, but usually stay overnight in the hospital. Light activity is encouraged for 6-12 weeks after the surgery. Patients may be able to return to work in 1-2 weeks.

What is minimally invasive spine surgery?

What is minimally invasive spine surgery?

Minimally invasive spine surgery is an alternative to open surgery, and is being recommended for the treatment of certain neck and back conditions due to the reduced risk of serious damage to protective spinal tissue as well as faster recovery periods and less post-operative pain. Open surgery is described as a procedure in which a long incision is made to allow the surgeon to clearly view and access the targeted region in the back. Either form of surgery, minimally invasive or open, is only recommended if certain medical criteria are met. The criteria include:

  1. Pain that has been unresponsive to different types of medication or physical therapy
  2. A specific diagnosis such as spinal stenosis (narrowing of the spinal column), a herniated disc, scoliosis (abnormal curvature of the spine), etc. 

How is a Lumbar Herniated Disc Diagnosed?

In determining whether a person has LHD, at least one of the following imaging techniques are typically used to assess the condition of the spine:

  • Magnetic resonance imaging (MRI)
  • Myelogram
  • Computed tomography (CT scan)

Are You A Candidate for Lumbar Discectomy?

A lumbar discectomy is appropriate for people who experience pain due to one or more herniated discs that does not improve despite several weeks of non-surgical treatment. A lumbar discectomy may be done much sooner for weakness, inability to urinate or incontinence, or severe pain.

What is the Recovery Time for a Lumbar Discectomy?

Lumbar discectomy patients may leave the same day after surgery, but usually stay overnight in the hospital. Light activity is encouraged for 6-12 weeks after the surgery. Patients may be able to return to work in 1-2 weeks.

What are the risks with a Lumbar Discectomy?

With any procedure there are risks.  Fortunately, the risks associated with a lumbar discectomy are minimal. Along with the standard risks associated with any surgery, risks for a lumbar discectomy include injury to nerves or blood vessels and re-herniation of disc material.

Despite the potential risks that may occur, a successful disc replacement can provide a patient with either significant or complete pain relief, an enhanced mood and quality of life, and the ability to return to regular physical activity.

What is Cervical Disc Replacement?

Cervical disc replacement, also known as cervical disc arthroplasty, is a fairly new surgical technique that is performed for the treatment of cervical degenerative disc disease or cervical disc herniation.  It is currently recommended as an alternative toanterior cervical discectomy and fusion (ACDF), which entails removing portions of cervical discs through the front (anterior) of the neck and the subsequent fusion of the adjacent vertebrae that were affected by the damaged discs in order to prevent spinal instability.

Cervical Disc Replacement vs. ACDF

Cervical disc replacement surgery involves removing the damaged disc and inserting an artificial disc between the cervical. There are different designs of artificial discs, but usually the artificial disc comprises two metal plates that move about a central core. The core may be metal or some other material.  One plate is attached to the lower vertebra and the other to the upper vertebra in the affected cervical region.

Although an ACDF is an old and well-accepted procedure, it has some drawbacks. It stops motion in the affected level, often resulting in less flexibility in the neck. Because it stops motion at one or more levels of the spine, the remaining discs do more work, which may result in another disc wearing out and requiring more surgery down the road. Also, it takes time, up to a year, for a fusion to become solid. Contrary to a fusion, which is supposed to stop all motion at the affected level, the artificial disc mimics the motion of a normal disc. There is some evidence that this results in less stress to the surrounding discs and lessens the chance of another disc wearing out. Also, since a fusion is not performed, the recovery is faster.

The artificial cervical disc was first approved for use in the USA in 2007. Artificial discs had been used in other countries for a number of years prior to that. These discs are typically used for on disc level, but there is at least one artificial disc brand that is approved for two levels. Artificial discs are indicated for herniated discs resulting in nerve compression.

What conditions does an anterior cervical discectomy and fusion (ACDF) treat?

Anterior cervical discectomy and fusion (ACDF) is a combination of two surgical procedures that are typically performed to treat cervical disc herniation or cervical degenerative disc disease.

Between most of the cervical vertebrae are intervertebral discs. The discs are the cushion of the spine. One or more of the discs can rupture, causing a piece of the disc to pop out and potentially compress a nerve. Although this may happen after trauma, it more often happens for no particular reason. A cervical disc herniation can result in neck pain. When it compresses nerve, it can cause arm numbness, pain or weakness. When it compresses the spinal cord itself, it can cause difficulty with balance or even paralysis.

Cervical degenerative disc disease is the gradual deterioration of disc tissue due to wear and tear that occurs as individuals get older. This disease causes symptoms that are similar to those which occur due to cervical disc herniation, but the hallmark of this problem is neck pain.

Cervical disc herniation and degeneration can be diagnosed with a physician’s examination and imaging studies such as an MRI. Additional tests that can be performed include a myelogram and a nerve test called an EMG.

What are the risks associated with Cervical Disc Replacement?

Risks that are associated with this treatment method are similar to the risks associated with an ACDF. Serious complications are rare, but most people have some difficulty swallowing and hoarseness temporarily. Malfunctions of the devices are rare but have been reported.  Despite these types of risks and potential side effects, most patients have reported experiencing complete or dramatic pain relief as well as enhanced mobility, mood, and quality of life, and an increased ability to engage in physical activity. In addition, the need for prescription strength or over the counter pain relievers is also greatly reduced for most patients who have undergone a cervical disc replacement.

About Anterior Cervical Discectomy and Fusion (ACDF)

One of the treatment options for cervical disc problems is an ACDF. A cervical discectomy entails removing a damaged cervical disc and thereby relieving spinal nerve or spinal cord compression. The anterior approach refers to the removal of portions of the disc through an incision in the front of the neck. Most of the approach through the incision is between the esophagus and the muscles in the front part of the neck. The procedure is often done with the aid of a surgical microscope to improve visualization and safety.The majority of the disc is removed in this process. Surrounding bone spurs are usually removed as well. This procedure can dramatically reduce pain and other symptoms.

A discectomy can effectively relieve pressure on the nerves in spinal cord, but it often causes spinal instability because one or more discs are now missing. A spinal fusion, which joins the vertebrae above and below the disc, helps solve this problem.

A fusion in its strictest sense refers only to joining two bones together by new bone growth. In usual usage, however, the fusion includes the placement of spinal instrumentation to help that bone grow.

After the discectomy is complete, the space is filled by some sort of spacer. The spacer may be the patient’s own bone from his or her hip.  This is less commonly done today due to the persistent pain that can result from the hip. More often, the spacer is a pre-formed piece of human cadaver bone, a type of plastic called PEEK (polyether-ether-ketone) or metal. The PEEK and metal spacers often are ring shaped to allow the placement of cadaver bone within it.

Once the spacer is in place a thin metal plate is attached to the spine with screws for additional stability. The plate limits the movement of the vertebrae where the surgery took place so that the bone has a better chance of growing.

What are the potential complications with ACDF?

Potential complications of an ACDF are bleeding, spinal nerve or blood vessel injuries, failure of bone to grow and infection. These complications are not common. More common problems are hoarseness and difficulty swallowing; these typically improve with time. Performing a spinal fusion results in loss of mobility of the areas fused. This may result in a decrease in neck motion, especially when more than one disc is removed. Once a disc is fused, it places the adjacent discs under more stress, potentially causing them to wear out and require more surgery. Nonetheless, the health benefits of undergoing ACDF, such as a dramatic reduction in pain as well as enhanced mobility and quality of life, often outweigh the potential risks and complications that are associated with this form of treatment.