A discectomy (also called open discectomy, if done through a 1/2 inch or larger skin opening) is the surgical removal of abnormal disc material that presses on a

nerve root A nerve root (Latin: ''radix nervi'') is the initial segment of a nerve leaving the central nervous system. Nerve roots can be classified as: *Cranial nerve roots: the initial or proximal segment of one of the twelve pairs of cranial nerves leaving ...

or the

spinal cord The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column (backbone). The backbone encloses the central canal of the spi ...

. The procedure involves removing a portion of an

intervertebral disc An intervertebral disc (or intervertebral fibrocartilage) lies between adjacent vertebrae in the vertebral column. Each disc forms a fibrocartilaginous joint (a symphysis), to allow slight movement of the vertebrae, to act as a ligament to hold t ...

, which causes pain, weakness or numbness by stressing the spinal cord or radiating nerves. The traditional open discectomy, or Love's technique, was published by Ross and Love in 1971. Advances have produced visualization improvements to traditional discectomy procedures (e.g. microdiscectomy, an open discectomy using an external microscope typically done through a 1-inch or larger skin opening), or endoscopic discectomy (the scope passes internally and typically done through a 2 mm skin opening or larger, up to 12 mm). In conjunction with the traditional discectomy or microdiscectomy, a

laminotomy A laminotomy is an orthopaedic neurosurgical procedure that removes part of the lamina of a vertebral arch in order to relieve pressure in the vertebral canal. A laminotomy is less invasive than conventional vertebral column surgery techniques, ...

is often involved to permit access to the intervertebral disc. Laminotomy means a significant amount of typically normal bone (the lamina) is removed from the vertebra, allowing the surgeon to better see and access the area of

disc herniation Spinal disc herniation is an injury to the cushioning and connective tissue between vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, and physical ...

Endoscopic discectomy

Small or ultra-small endoscopic discectomy (called Nano Endoscopic Discectomy) does not have internal cutting or bone removal and, due to the small size, is not called "open". These procedures do not cause post-laminectomy syndrome (

failed back syndrome Failed back syndrome or post-laminectomy syndrome is a condition characterized by chronic pain following back surgeries. Many factors can contribute to the onset or development of FBS, including residual or recurrent spinal disc herniation, persi ...

Microdiscectomy

Microdiscectomy is a spine operation with a smaller incision than traditional discectomy, in which a portion of a herniated nucleus pulposus is removed by way of a surgical instrument, while using an external operating microscope for lighting and magnification. They may be "open", i.e., with a larger incision, or minimally invasive, i.e., with a 1.5 to 2.0 cm surgical incision.

Indications

Microdiscectomy may be a surgical option for patients with a single-level

and evidence of nerve root compression with residual unremitting

radicular Radicular pain, or radiculitis, is pain "radiated" along the dermatome (sensory distribution) of a nerve due to inflammation or other irritation of the nerve root (radiculopathy) at its connection to the spinal column. A common form of radicul ...

symptoms after failed conservative treatment.

Cauda equina syndrome Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. Signs and symptoms include low back pain, pain that radiates down the leg, numbness around th ...

and progressive or new motor deficits are among the urgent surgical indications for microdiscectomy.

Contraindications

Contraindication In medicine, a contraindication is a condition that serves as a reason not to take a certain medical treatment due to the harm that it would cause the patient. Contraindication is the opposite of indication, which is a reason to use a certain tre ...

s include additional pathologies, including infection, tumor, or segmental instability or vertebral fracture where fusion or instrumentation may be required. However, segmental instability and

spondylolisthesis Spondylolisthesis is the displacement of one spinal vertebra compared to another. While some medical dictionaries define spondylolisthesis specifically as the forward or anterior displacement of a vertebra over the vertebra inferior to it (or t ...

may be considered

relative contraindication In medicine, a contraindication is a condition that serves as a reason not to take a certain medical treatment due to the harm that it would cause the patient. Contraindication is the opposite of indication, which is a reason to use a certain tre ...

s by some physicians.

Discectomy for athletes

Degeneration caused by years of repetitive mechanical stress can cause the disc of an athlete to be herniated.

Lumbar disc herniation Spinal disc herniation is an injury to the cushioning and connective tissue between vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, and physic ...

(LDH) is a critical injury for elite athletes that could cause extreme pain and significantly hinder performance. To relieve the pain, athletes usually go through microdiscectomy. However, the results of treatments in elite athletes differ due to the demand for optimal treatment, short recovery period, and high performance after the operation. Most athletes return to their pre-surgery level after a discectomy. A systematic review of 450 athletes shows that 75–100% of athletes return to play after surgery. The average recovery period ranged from 2.8 to 8.7 months. Athletes recovered an average of 64.4% to 103.6% of their preoperative performance and had reported career longevity of 2.6 to 4.8 years post-return. There are unsuccessful cases of discectomy for certain athletes like

Tiger Woods Eldrick Tont "Tiger" Woods (born December 30, 1975) is an American professional golfer. He is tied for first in PGA Tour wins, ranks second in men's major championships, and holds numerous golf records. * * * Woods is widely regarded as ...

, a world-famous PGA Tour golfer. Woods underwent three microdiscectomy procedures from 2014 to 2015 which failed to alleviate his pain. The removal of disc material due to discectomy meant that Woods eventually had to go through

spinal fusion Spinal fusion, also called spondylodesis or spondylosyndesis, is a neurosurgical or orthopedic surgical technique that joins two or more vertebrae. This procedure can be performed at any level in the spine (cervical, thoracic, or lumbar) and pre ...

to recover.

In the US

In the U.S., it has been estimated that the Medicare system spends over $300 million annually on lumbar discectomies.

References

* {{Central nervous system tests and procedures Neurosurgery Surgical removal procedures