Lumbar Disc Herniations

Does nothing seem to work in treating your herniated disc and pinched nerve? Sometimes, medications and exercise aren’t enough to remedy a slipped or bulging disc – what doctors refer to as a herniated disc. If this is the case for you, your doctor may recommend surgery. Keep reading to learn more about surgical treatment options for a herniated disc that is causing pinched nerves.

What is a Herniated Disc?

Rubber-like discs add a cushion between the bones or vertebrae of the spine, which enables motion throughout the spine. When a disc herniates or bulges out into the spinal canal, they can pinch nerves causing pain. This pain can be intense and even debilitating for sufferers. When the herniated disc is located in a person's back, the pain can travel down into the buttocks, hip, and leg. When the herniated disc is in the neck, the pain can travel down the shoulders and arms. 

Herniated Disc Causes and Symptoms

There are many factors that may affect spinal discs, including age, genetics, trauma, and activity. Certain activities like heavy lifting can cause discs to degenerate quicker and eventually herniate. A herniated disc can sometimes be asymptomatic, however, if they put pressure on a nerve, they often cause severe radiating pain. If the disc is in the lower back, it may cause back and leg pain. If it is located in the neck, it can cause pain in the shoulder, neck, and arms.

What is a Pinched Nerve?

In every level of your spine, nerves exit out of the spinal canal and run into your arms and legs. These nerves control the strength and sensation to your entire body. When these nerves become compressed or pinched, they can lead to symptoms of pain, numbness, weakness, and tingling in the arms or legs, known as radiculopathy. The most common cause of nerve compression is a herniated or bulging disc, that pushes on the nerves as they leave the spinal canal. A common nerve that is frequently pinched in the back is the Sciatic nerve. When this nerve is pinched by a disc herniation, it will cause pain, numbness, and weakness shooting down the leg into the foot, known as ‘sciatica.’

Is Surgery Right for You?

Only your doctor can determine if herniated disc surgery in Atlanta is the right choice for you. Most herniated discs do not require surgery and typically improve with time. Surgery is, therefore, the last resort treatment after other options like oral steroids, anti-inflammatories, physical therapy, and even corticosteroid injections may have proven ineffective. Before recommending surgery, the spine surgeon will order tests including an X-ray and MRI to determine the location and severity of the herniated disc. Based on these images, the surgeon may recommend surgery as the next course of action to relieve the pressure the disc is putting on the nerve.

Types of Surgery for the Back and Legs

Based on the size and location of the disc herniation, your surgeon may recommend surgery if non-operative treatments are not providing relief. In the back, this surgery will be a decompression surgery, known as a laminectomy, where a piece of bone known as the lamina is removed. When a piece of a herniated disc is also removed at the same time, this is called a discectomy. Newer techniques and instruments allow surgeons to perform these surgeries from smaller incisions, many times through a small tube using a microscope, known as a microdiscectomy. The benefits of the microsurgery are smaller incisions, less soft tissue dissection, less bleeding, and overall less post-operative pain. Ask your doctor if microsurgery is right for you.

• Laminectomy and discectomy: During this procedure, the surgeon will make an incision in the vertebral arch (known as the lamina) to alleviate the pressure on the nerve roots. Removal of the lamina is known as a laminectomy. The surgeon also removes the part of the disc that is putting pressure on the nerve root to relieve the pain. The traditional open approach requires a larger incision, resulting in greater back muscle damage. This is generally a more painful and slow recovery.

• Microdiscectomy: Sometimes called microdecompression or microdiscectomy, microdiscectomy is a newer and less invasive surgical procedure used to treat a herniated lumbar disc. Microdiscectomy achieves the same objective as discectomy, to remove the portion of a disc that is putting pressure on your nerve and causing pain. However, the use of special instruments and visualization tools used by the orthopedic spine surgeon trained to perform microdiscectomy allows them to make very small incisions, reducing injury to back muscles. This typically results in a faster, less painful recovery than traditional discectomy.  

Types of Surgery for the Neck and Arms

In the neck, traditional approaches called for a fusion procedure to treat disc herniations causing pinched nerves. Fusion procedures remove the entire disc pushing on nerves and place a piece of bone or a cage in the disc space instead. Fusions cause a loss of range of motion in the neck and put more stress on other levels in the neck. Newer techniques, however, have allowed surgeons to instead replace the disc with a mobile prosthesis, maintaining a full range of motion in the neck. Other benefits of a disc replacement are less soft tissue dissection, less bleeding, and no need to wear a collar after surgery. 

• Spinal Fusion Surgery: With spinal fusion surgery, the bulging or herniated disc is removed and two or more vertebrae are fused permanently so that they heal together into a single, solid bone. The procedure may require bone grafts and the use of metal cages, plates, and screws. Spinal fusion immobilizes that section of the spine permanently.

• Artificial Disc Replacement Surgery: With the newer technique of a disc replacement surgery, the herniated or bulging disc pushing on the nerves is completely removed, and a prosthesis is placed in the disc place. The disc replacement maintains all neck range of motion and puts less stress on other levels in the neck.

Post-Surgery Risks and Expectations

As with all types of surgery, there are risks that come with herniated disc surgery. These include bleeding, infection, and nerve damage. When a disc is not completely removed, there is a chance that it can bulge out again. There is always a risk that other discs at other levels can also degenerate and herniate causing nerve compression.

Following surgery, your doctor will provide you with specific instructions about when you can begin exercising and resuming your normal activities. Be sure to follow the doctor’s recommendations closely and ask questions about any part of it that you don’t understand. For most, the recovery outlook after surgery is generally positive.

If you have a herniated disc or pinched nerve and believe you need surgery, contact us at Piedmont Orthopedics | OrthoAtlanta to schedule an appointment today.