Sarah Lewis, PharmD
What is a discectomy?
Discectomy is the surgical removal of part or all of a spinal disc. A discectomy treats degenerated, herniated (prolapsed, bulging or slipped), or ruptured spinal discs. Spinal discs are located between each vertebra of your spine and act as cushions to protect your spine. A herniated disc can press against the spinal cord or the nerves that fan out from the spinal cord. It can relieve nerve compression and pain caused by a herniated disc.
Discectomy is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having a discectomy.
Types of discectomy
The types of discectomy procedures include:
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Cervical discectomy is the removal of a disc in the neck area (cervical spine).
Lumbar discectomy is the removal of a disc in the lower back (lumbar spine).
Sacral discectomy is the removal of a disc in the back between your pelvic, or hipbones (sacral spine).
Thoracic discectomy is the removal of a disc in the middle part of the back (thoracic spine).
Other surgical procedures that may be performed
Your doctor may perform other procedures in addition to a discectomy to treat certain conditions. These include:
Foraminotomy is the widening of the opening where the nerve roots leave the spinal canal. Your doctor may use this procedure when the opening (foramina) is narrowed causing pressure on the spinal nerves.
Laminectomy is the removal of a bony area called the lamina. The lamina is the back part of each vertebra of the spine. A laminectomy can relieve pressure in your spinal canal or on your spinal nerves. This may be necessary to access your spinal disc.
Spinal fusion is the permanent joining together of two vertebrae. This procedure permanently stops movement between the two vertebrae.
Why is a discectomy performed?
Your doctor may recommend a discectomy to treat certain diseases and conditions of the spine. Your doctor may only consider a discectomy for you if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all your treatment options and consider getting a second opinion before deciding on a discectomy.
Your doctor may recommend a discectomy for degenerated, herniated or ruptured discs if you have:
Back or leg pain or weakness or numbness that does not get better with other treatments in six weeks or more. Other treatments include anti-inflammatory medications, rest, and physical therapy.
Problems with walking and performing other daily tasks
Inability to control your bowels or bladder
Who performs a discectomy?
The following specialists perform discectomy:
Orthopedic surgeons specialize in the medical and surgical treatment of diseases and conditions of the muscles and bones, including the spine.
Neurosurgeons specialize in the surgical treatment of diseases and conditions of the nervous system, including the spine.
How is a discectomy performed?
Your discectomy will be performed in a hospital or surgery center. Your surgeon will use one of the following approaches:
Open surgery involves making a two-to-four inch incision down the middle of the affected part of your spine. An open surgery incision allows your doctor to see and access the surgical area directly. This is the most common type of surgery for ruptured or herniated discs of the lumbar spine. Your surgeon may perform an open surgery if you need other surgical treatment on your spine in addition to a discectomy. Other treatments include laminectomy, foraminotomy, and spinal fusion.
Microdiscectomy is a minimally invasive surgery. It involves inserting special instruments through a small incision, usually less than one inch, along the side of the affected area of your spine. Microdiscectomy may be an option if you do not need other surgical treatments.
Microdiscectomy generally has generally involves a faster recovery, less pain, a lower risk of some complications, such as infection, than open surgery. Surgical tools are threaded around body structures instead of cutting through them as in open surgery.
Anterior discectomy is the removal of a spinal disc through an incision in the front part of your body. For cervical discectomy, the approach is through the neck. For lumbar and sacral discectomy, the approach is through the abdomen or belly. For thoracic discectomy, the incision is in the chest.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different discectomy procedures and ask why your doctor will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform a discectomy using either general anesthesia or regional anesthesia, depending on the specific procedure.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your discectomy
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other body functions. This occurs throughout your surgery and recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of a discectomy?
As with all surgeries, a discectomy involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding or hemorrhage (heavy bleeding), which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of discectomy
Complications of discectomy include:
Damage to the nerves leaving your spine, which could result in permanent pain or weakness
Disc fragments may remain, particularly with microdiscectomy. This requires more surgery to remove them.
Injury to tissues or organs that must be displaced to access your disc.
Pain that does not get better or that returns
Reducing your risk of complications
You can reduce the risk of some complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Informing your doctor or radiologist if you are nursing or if there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my discectomy?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a discectomy by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before a discectomy and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Why do I need a discectomy? Are there any other options for treating my condition?
What type of discectomy procedure will I need?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
How should I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my discectomy?
Knowing what to expect can help make your road to recovery after a discectomy as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are fully alert, breathing effectively, and your vital signs are stable. Patients usually go home on the same day. Sometimes a hospital stay of one to two days is required.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Your doctor will probably encourage you to walk and avoid sitting for long periods. You will also have physical therapy to help you recover.
Full recovery time takes six to eight weeks. It might take longer for you to return to full activities if you have a job that requires heavy lifting or operating heavy machinery that vibrates, such as a jackhammer.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor and care team will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after a discectomy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
Weakness, numbness or difficulty moving a part of your body
How might discectomy affect my everyday life?
Discectomy may cure your condition or significantly reduce your symptoms so you can lead an active, normal life. Discectomy may effectively treat pain and allow you to move better. Recurrence of back or neck pain is common. You will need to learn strategies to prevent future back pain and other problems. This includes:
Appropriate exercise programs
Good posture habits
Keeping a healthy body weight
Proper lifting techniques
Use of an ergonomic work area
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