What is a discectomy?

What a discectomy removes

Discs are the cushion-like pads between the vertebrae (the bones of the spine). They act as shock absorbers and spacers. A discectomy (also spelled diskectomy) is surgery to remove all or part of one of these discs, according to MedlinePlus. Cleveland Clinic says a herniated disc, in which the soft gel inside a disc leaks through a tear, is the main reason people have the operation. It adds that lower back discectomies are more common than neck ones, and that a surgeon may remove one disc or several.

The operation is sometimes one part of a larger one. MedlinePlus says a lower back discectomy may be combined with a laminectomy or foraminotomy (both are described on the spinal decompression page) or with spinal fusion. In the neck, it is most often done along with a foraminotomy or fusion. The condition behind most discectomies is covered in what a slipped disc is.

Microdiscectomy and open surgery

NIAMS describes discectomy and microdiscectomy as surgeries that remove part of a herniated disc to relieve pressure on a nerve root or the spinal canal. It says the only difference is that a microdiscectomy uses a smaller incision. MedlinePlus gives the incision as 1 to 1.5 inches (2.5 to 3.8 centimeters), with a special microscope used to see the disc and nerves. The surgeon gently moves the nerve root aside and removes the injured disc tissue. The operation takes about 1 to 2 hours under general anesthesia.

Cleveland Clinic calls the larger version an open or standard discectomy. The surgeon makes a skin incision of 1 to 2 inches over the affected disc and moves the back muscles to one side to see the disc directly.

What minimally invasive means

Cleveland Clinic describes a minimally invasive discectomy as one done through a small skin incision, followed by a series of progressively larger tubes called dilators that tunnel through the muscles. Special instruments, including an endoscope (a thin tube with a light and camera), let the surgeon see and work in a small space. Micro-endoscopic and full endoscopic discectomy are versions of the same idea. AANS describes the tubes as tubular retractors that hold muscle aside instead of cutting it.

AANS says that, compared with open surgery, minimally invasive approaches can be faster, safer and need less recovery time, but it also says that in some situations they may not be as safe or effective as open surgery. Cleveland Clinic says an endoscopic discectomy is typically an outpatient procedure, meaning the person goes home the same day, while an open operation may need a day or two in hospital. Which approach suits a given person is a decision for the surgeon.

Who has one, and what to expect

Most people with a herniated disc do not need the operation. Cleveland Clinic reports that about 60% to 90% recover well with nonsurgical treatment, and MedlinePlus says only a few people need surgery. Reasons a provider may recommend a discectomy include severe or persistent leg or arm pain or numbness, severe weakness in an arm, lower leg or buttock, and pain that spreads into the legs. The wider question of timing is covered in when spine surgery is considered.

Cleveland Clinic gives a success rate of 60% to 90% for lumbar discectomy and says the disc herniates again in 5% to 15% of cases, sometimes needing another operation. It puts recovery at one to four weeks, depending on the person. MedlinePlus says most people go home the day of surgery. Further risks are listed in what the risks of spine surgery are, and the whole subject sits under surgery in outline.

When to get help

Sudden weakness or numbness together with bladder and bowel control problems can signal cauda equina syndrome, which Cleveland Clinic says needs surgery right away. That calls for emergency care. After any discectomy, Cleveland Clinic advises contacting a provider right away for signs of infection at the incision (swelling, skin discoloration or fever), severe or worsening pain, sudden numbness or weakness, difficulty breathing, or difficulty passing urine or stools. Practice varies by country and by clinician, so a person's own surgical team gives the instructions that apply to them.