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Posterior Lumbar Discectomy

 

What Is a Posterior Lumbar Discectomy?

Posterior lumbar discectomy is a surgical procedure performed to remove a herniated or degenerative disc in the lower spine. Discectomy means “cutting out the disc” and can be performed anywhere along the spine – from the neck to the low back. The surgeon reaches the damaged disc from the back of the spine – through the muscles and bone.

Causes for a Posterior Lumbar Discectomy

Your provider may recommend a discectomy if noninvasive treatments, like physical therapy or medication have failed to relieve pain caused by inflamed and compressed spinal nerves. It may also be recommended if you have signs of nerve damage, such as weakness or loss of feeling in your legs. You may be a candidate for a discectomy if you have:

  • Diagnostic tests that show a herniated disc.
  • Significant pain, weakness or numbness in your leg or foot.
  • Leg pain that is worse than back pain.
  • Symptoms that have not improved with therapy or medication.
  • Leg weakness, loss of feeling in the genital area, and loss of bladder or bowel control.

Posterior lumbar discectomy may be helpful in treating leg pain caused by:

  • Bulging or herniated disc – occurs when the gel like material within the disc can bulge or rupture through a weak area in the surrounding wall. Irritation and swelling occur when this material squeezes out and painfully presses on the nerve.
  • Degenerative disc disease – as discs naturally wear out, bone spurs form and the facet joints inflame. The discs dry out and shrink, losing their flexibility and cushioning properties, making them smaller.

Most herniated discs will heal within a few months of nonsurgical treatment. If these treatments do not improve pain, your provider may discuss whether surgery is right for you. Be sure to consider all the risks and benefits associated with the procedure. Only 10% of people with herniated disc problems have enough pain after 6 weeks to consider surgery.

Preparing for a Posterior Lumbar Discectomy

Before surgery, your provider will perform a physical exam and review medical history. You may also be scheduled for presurgical tests, like blood tests, ECG, or chest X-rays prior to the procedure. Some medications may need to be continued or stopped the day of surgery. Stop taking all non-steroidal anti-inflammatory medicines and blood thinners 1-2 weeks prior to surgery. Additionally, stop smoking, chewing tobacco, and drinking alcohol 1 week before surgery and 2 weeks after surgery as they can cause bleeding problems. No food or drink is permitted past midnight the night before surgery.

The morning of surgery, you should:

  • Shower using anti-bacterial soap.
  • Dress in freshly washed, loose-fitting clothing.
  • Wear flat-heeled shoes with closed backs.
  • Take medications (if instructed to do so) with small sips of water.
  • Remove make-up, hairpins, contacts, body piercings, and nail polish.
  • Leave all valuables and jewelry at home.
  • Bring a list of medications with dosages and times taken.
  • Bring a list of allergies to medications or food.

What to Expect in a Posterior Lumbar Discectomy

There are a variety of surgical tools and techniques to perform a discectomy. An “open” technique uses a large skin incision and muscle retraction to allow the surgeon to directly view the area. A “minimally invasive” technique uses a small skin incision.

With the aid of fluoroscope, the surgeon will pass the thin needle through the skin down to the bone to locate the affected vertebra and disc. In an open discectomy, a skin incision is made down the middle of your back over the affected vertebrae. The length of the incision will depend on how many discectomies will be performed. In a minimally invasive, a small incision is made to one side of your back. Next a series of larger dilators are passed, one around the other, to gradually separate the muscles and create a tunnel to the bony vertebrae.

Next, with the lamina removed, the surgeon will look through the surgical microscope to find the herniated disc. Only the ruptured portion of the disc is removed to decompress the spinal nerve root.  Bone spurs or a synovial cyst that may be pressing on the nerve root is also removed.

Following surgery, most patients can go home the same day. Other patients will be released in 1 to 2 days. Pain is managed with medication. You may need help with daily activities for the first few days. Fatigue is common. Gradually return to your normal activities as tolerable. You may shower 1 to 4 days following surgery, but it is important to follow your providers instructions on when it is safe to do so.

The recovery time varies from 1 to 4 weeks, depending on the underlying disease treated and your general health. You may feel pain at the site of the incision. Most people can return to work in 2 to 4 weeks or less, depending on the physical activity your job requires. Recurrences of back pain are common, but to avoid recurrences of back pain you should:

  • Use proper lifting techniques.
  • Have good posture when standing, sitting, moving or sleeping.
  • Exercises appropriately.
  • Maintain a healthy weight.
  • No smoking.

Risk Factors of a Posterior Lumbar Discectomy

No surgery is without risks. Besides the general complications of bleeding, infection, blood clots and reaction to anesthesia, there are specific complications related to a discectomy, including:

  • Deep vein thrombosis – potentially serious condition caused when blood clots form inside the leg veins. If the clots break free and travel o the lungs, lung collapse or even death is a risk. To prevent DVT, get up and move out of bed as soon as possible to allow your blood to start moving. Support hose can keep blood from pooling in the vein.
  • Lung problems – Lungs need to be working their best following surgery to provide tissues with enough oxygen to heal. If the lungs have collapsed areas, mucus and bacteria build up, this can lead to pneumonia. Breathe deeply and cough often.
  • Nerve damage or persistent pain – Any operation of the spine comes with the risk of damaging nerves or the spinal cord. Damage can cause numbness or even paralysis. The most common cause of persistent pain is nerve damage from the disc herniation itself. Some disc herniations may permanently damage a nerve, making it unresponsive to decompressive surgery. In these cases, your provider may recommend alternate treatment options, like spinal cord stimulation.

If your temperature exceeds 101°F, or if the incision begins to separate or show signs of infection, contact your healthcare provider immediately.