| |
|
|
|
| Lumbar Disk Surgery |
| DISK SURGERY: RELIEVING THE PAIN |
Persistent pain in your low back or leg caused by spinal disk problems can be frustrating because it limits your ability to move and do the things you enjoy. To manage your low back (lumbar) problem, you may have followed your doctor's conservative treatment plan - rest, medication, physical therapy, and exercise. But, despite your best efforts, the pain won't go away. Surgery can help relieve your pain by treating your disk problem. |
| Your Lower Back |
|
Knowing about your lumbar spine makes it easier to understand your low back problem. The bony vertebrae, which encircle and protect your spinal cord, are separated by shock-absorbing disks. The disks give your spine the flexibility to move. Nerves branching from the spinal cord pass through openings in the vertebrae to other parts of your body. Several of these nerves join at the base of the spine to form the sciatic nerve, which runs down your leg. |
Each disk has a spongy center (nucleus) surrounded by tough outer rings. Wear and tear, poor posture, and incorrect body movements can weaken the disk. |
|
|
| Disk Problems:
Pressure on the Nerve |
When a disk weakens, the outer rings may not be able to contain the material in the center of the disk. This material may bulge against or squeeze through a tear in the outer rings and press against a nerve, leading to pain in your lower back and leg. |
|
A herniated disk occurs when disk material bulges against the outer rings. The bulging disk may press against one of the nearby nerves passing through the vertebra. |
|
|
A free fragment occurs when disk material separates from and moves outside of the outer rings through a tear. The fragment may irritate a nearby nerve. |
|
|
Sciatica occurs when a damaged disk presses on one of the nerves forming the sciatic nerve. You may feel sharp, shooting pain that runs from your buttock down your leg. |
|
|
| Your Medical Evaluation |
|
A medical evaluation helps your doctor diagnose your disk problem and determine which surgery is most beneficial for you. |
|
|
| Medical History |
Your medical history helps your doctor understand your back pain and how your lifestyle may contribute to it. Your doctor will ask you where you have pain and what makes the pain better or worse. |
| Physical Examination |
Your doctor examines your spine and legs to pinpoint the source of pain. Your doctor also does simple tests for flexibility and muscle strength, and checks for pain or numbness in your legs or feet. |
| Diagnostic Tests |
| To confirm your diagnosis and locate the source of your pain, your doctor may order certain tests. |
| • |
X-rays show the bones (vertebrae) of the spine. Vertebrae that are too close together could indicate a degenerated or possibly herniated disk. |
| • |
Myelograms are special x-rays of the lumbar spine. To take a myelogram, a special dye that highlights your nerves is used. |
| • |
CT (computed tomography) and MRI (magnetic resonance imaging) are special imaging tests. They confirm which disk is damaged. |
| • |
EMGs (electromyograms) measure the electrical activity of your muscles' contractions. They can show muscle or nerve damage. |
|
|
|
|
| TYPES OF DISK SURGERY |
Your disk problem may be corrected by a diskectomy, the surgical removal of the portion of the disk that's putting pressure on a nerve, causing pain in your back or leg. Your surgeon may recommend a "classic" diskectomy, a micro-diskectomy, or a percutaneous diskectomy. The basic differences among these disk surgeries are the size of the incision, how your surgeon reaches your disk, and how much of the disk is removed. The "classic " diskectomy and micro-diskectomy require a hospital stay of a few days. Percutaneous diskectomy is usually an outpatient surgery. |
| "Classic" Diskectomy |
To remove the disk material that is causing the pain, your surgeon first makes an incision in the midline of your back (over the bump you feel when you run your hand over your lower spine). Then, to see and reach the damaged disk, your surgeon removes some or all of the lamina. Next your surgeon removes the disk material that is pressing on a nerve. |
| Reaching the Disk |
To reach the damaged disk, your surgeon forms a "window" by removing the lamina partially (laminotomy) or entirely (laminectomy). First, a thick muscle that protects the disk and nerves is moved aside, allowing the surgeon to remove the lamina and see the disk. Next, your surgeon can remove the part of the disk that is causing the pressure on the nerve. |
| Microdiskectomy |
Your surgeon may recommend a micro-diskectomy to treat your disk problem. This surgery is much like the "classic" diskectomy, except that your surgeon uses an operating microscope to magnify, highlight, and see the disk. A magnified view means that the incision, located in the midline of your back, is smaller than that of a "classic" diskectomy, with less damage to surrounding tissue. |
| Your Surgery Experience |
Before surgery, to minimize bleeding, your doctor may ask you to avoid aspirin, other anti-inflammatories, or other medications. You may be asked not to eat or drink anything for six to twelve hours before surgery. You will usually be under general anesthesia and asleep during the surgery. Afterward, you will be monitored in the recovery room until you are awake. |
| Understanding the Risks |
Your surgeon will discuss the following and any other possible risks and complications with you before surgery. In addition to the usual risks of anesthesia, other complications can occur, including infection, bleeding, injury to the nerve, and scarring. Because only a portion of the damaged disk may be removed, disk material could bulge or fragment later. |
|
|
|
|
| |
|
