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 out-patient surgery.
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.
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). 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.
Your surgeon may recommend a microdiskectomy 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 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.
Percutaneous diskectomy is an outpatient procedure that uses x-ray pictures and a video screen as a guide for your surgeon to reach and fix the damaged disk.
To minimize bleeding, your doctor may ask you to avoid aspirin, other anti-inflammatories, or other medications before surgery. You will be given either general or local anesthesia. During the procedure, if you are given local anesthesia, you will be awake and can let your surgeon know if you are experiencing any discomfort. Afterward, you will be monitored in the recovery room until you are ready to go home.
The incision, made in the small of your back, is about the size of a puncture wound. Because your surgeon can see the damaged disk on a video screen, it's not necessary to remove bone to view and reach the disk.
To reach the disk during percutaneous diskectomy, your surgeon may use a suction probe, laser probe, or forceps. After inserting the instrument into the disk, your surgeon removes the damaged disk material. Sometimes an endoscope (a tiny telescope-like instrument with a light) is inserted to view the disk area. After surgery, a small bandage is placed over the incision.
Your doctor will discuss the possible risks and complications of this surgery. These include infection, nerve root damage, and internal bleeding. Sometimes you may have a muscle spasm, or temporary back pain until you heal. Because only a portion of the damaged disk may be removed, disk material could bulge or fragment later.
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