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Open decompression for herniated disk
By Mayo Clinic staffAbout one in 10 people with herniated disks eventually need surgery. If you've tried conservative treatments and they've failed, you and your doctor may talk about a number of surgical options to treat your herniated disk, including the following:
Diskectomy
A diskectomy involves the removal of part of a disk to relieve pressure on a nerve. If you have leg pain, rather than back pain, you may achieve better surgical results from diskectomy.
What to expect. You receive general anesthesia or spinal anesthesia for this procedure. An incision is made, and the herniated portion of the disk and any pieces that have broken loose are removed. Ideally, just the fragment of disk that is pinching the nerve is removed, leaving most of the disk intact. That's preferred, as it preserves your normal anatomy as much as possible. Often, a partial facetectomy also is performed during a diskectomy. This involves removing a small part of an area of the spine called the facet joint that may be compressing the nerve.
You may stay in the hospital for one to three days, though diskectomy can also be performed as an outpatient procedure. Your pain may not be relieved immediately after the surgery, and you may also feel pain at the incision site. Your doctor may prescribe pain medication for pain following the procedure.
Interpreting results. Overall, satisfactory results are achieved in most cases. You'll be able to return to light or sedentary work in two to four weeks, but you may need to wait six to eight weeks to return to physical work.
Microdiskectomy
A microdiskectomy is similar to a standard diskectomy except that the procedure is performed through a smaller incision while the surgeon looks through a microscope. Microdiskectomy is the most common surgery for herniated disk.
What to expect. Some doctors say that the smaller incision of a microdiskectomy isn't as effective at revealing decreased space (stenosis) or herniation that occurs at the sides of the disk. The smaller incision may also make it more difficult to remove large fragments of disk and make it more likely to operate at the wrong level or miss some fragments that need to be removed.
Microdiskectomy may be performed as an outpatient procedure, or you may stay in the hospital for one to three days.
Interpreting results. The success rate is about equal to standard diskectomy, approximately 80 percent to 90 percent. Microdiskectomy can result in reduced time spent in the hospital and a quicker return to work, when compared with diskectomy. The decision of whether to use a microscope when performing a diskectomy is based on the anatomy of the herniated disk, individual preference and training of your surgeon.
Spinal fusion
This procedure rarely is used to treat herniated disks. It may be used if you've had spinal instability or have had several recurrent disk herniations at the same level. If your doctor has recommended only this procedure for treatment of herniated disk, get a second opinion.
Rehabilitation after herniated disk surgery Minimally invasive procedures to treat herniated disk
