Discectomy is a surgical procedure performed by experienced neurosurgeons to remove the herniated disc material from the lower (lumbar) back (spine). This is done to remove the herniated disc material from the lumbar spine, which is pressing against the nerve root or the spinal cord.
Compression of the nerve root or the spinal cord results in extreme pain in the lower back, which may radiate down the leg. This can terribly affect the movement of individuals and reduce their quality of life.
There are two types of discectomy surgeries – open discectomy and microdiscectomy. The latter was introduced into the clinical practice in the 1970s and slowly took over the traditional approach of treatment for herniated lumbar disc.
Both these approaches intend to obtain the same result, that is, to relieve the pressure of the compressed nerve root. The main objective is to relieve the pain, numbness, weakness, and the loss of motion that the patient is experiencing. However, the approach to remove the herniated disc material is different.
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This article talks about the difference in the approach used in open discectomy and microdiscectomy. Additionally, it examines whether it is more beneficial to undergo open surgery to minimally invasive and whether there is any difference in the outcomes.
Open Discectomy versus Microdiscectomy: Difference in Approach
In open discectomy, the surgeon makes a single, large cut to expose the herniated disc. Different surgical tools are then used to remove the herniated disc material to remove the pressure off the nerve root. Lastly, the incision is closed with the help of sutures.
In the case of microdiscectomy, on the other hand, the surgeon makes use of a microscope to have an enlarged view of the herniated disc. This is why only a small incision is required by the surgeon to insert the miniature tools and remove the herniated disc material.
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Which One Is Better?
There is no answer when it comes to the question that which approach is better than the other. It largely depends on the choice and the comfort of the surgeon and the condition of the patient.
Disc herniation may take place at several levels. Therefore, a surgeon may decide to conduct an open surgery if it is at multiple places. If only a single disc is affected, microdiscectomy could be a better approach. However, that does not mean that minimally invasive discectomy surgery cannot be conducted if the herniation is at several levels.
Over the last two decades, several researchers have conducted studies to analyze the difference in the outcomes associated with open discectomy and microdiscectomy. However, no research has proven significant different so far.
People who undergo open discectomy or microdiscectomy show similar improvements after one year of the surgery. Even though there may be no significant difference in the outcomes, there are a few clear-cut benefits that microdiscectomy has over open surgery. Some of these benefits include the following:
- Microdiscectomy is considered to be more accurate because the surgeons can actually see the enlarged internal images on the computer screen.
- The surgery time is less as compared to open discectomy.
- There is a less risk of infection as the incision size is extremely small in comparison to open discectomy.
- Less number of days in the hospital.
- Reduced risk of post-surgical complications.
- Quick recovery and return to normal routine.
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Is Surgery Mandatory For Lumbar Disc Herniation?
No, surgery is not always the only option for the treatment of herniated lumbar disc. Lumbar disc herniation can cause functional disability and terrible sciatic pain. However, a surgery is only advised when there is no other option left. It is also done when the patient has had persistent radicular pain even after two to six months.
Generally, a doctor advises a surgery in the following cases:
- When there is a persistent pain, numbness, and weakness, which is affecting the quality of life.
- When the pain does not get better even after several weeks of nonsurgical treatment such as physical therapy.
- The tests and physical examination conducted by the doctor show that there is a loss of motion, weakness, or abnormality that can definitely get better with a surgery.
Even though the patient can take their own time to decide whether or not to undergo a surgery after it has been suggested, it is sometimes conducted as an emergency procedure. A doctor conducts open discectomy or microdiscectomy as an emergency procedure when the patient experiences cauda equina syndrome. This syndrome is characterized by the following symptoms:
- Loss of bladder control
- New weakness or tingling sensation in both or just a single leg
- Numbness or tingling sensation in the buttocks or genitals
Advantages of Discectomy Over Nonsurgical Treatment
Nonsurgical treatment may take months to provide some bit of relief in the case of extensive lumbar disc herniation. In such cases, a discectomy can offer quick and long-term relief while tremendously improving the quality of life of the patient.
Some of the major problems associated with lumbar disc herniation such as weakness, numbness, loss of motion, and tingling sensation are almost immediately taken care of by the discectomy surgery.
Additionally, the surgical procedure allows for quick return to the normal day-to-day routine. The patients are advised an early surgical intervention when pain is incapacitating. It is also done when the patient is restricted to the bed with the strong administration of pain-relieving medications.
Prolonged pain due to nerve compression may bring undesirable lifestyle changes in the life of the patient. Additionally, he or she may lose the motivation to return to work or daily routine if they continue to suffer from pain for long. In such cases, a surgery is conducted for better outcomes.
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