There are many options for relief if you suffer from back pain or sciatica caused by a herniated disc. Physical therapy and exercise may be recommended by your doctor. You may need to seek chiropractic care or use steroid injections to treat the inflammation caused by a herniated disc.
You may need to see a neurosurgeon if your persistent or unremitting pain persists after you have tried all other treatments. Surgery is performed to remove any disc material that could be pinching your spinal nerves. This will relieve you of your pain and help improve your mobility.
There are many surgical options available when considering surgery. A traditional approach involves making a large incision with an open field. To visualize your disc, your surgeon will need to dissect your lumbar muscles and remove any herniations that are pinching your nerves.
What is a Herniated Disc?
A herniated disc can cause pain that may impact daily life. Each bone in the spine is called a vertebrae. Intervertebral discs are cartilage discs that lie between the vertebrae. Intervertebral discs support the spine and act between the vertebrae as shock absorbers. Normally, there are 23 discs in the spine. Each disc is composed of three parts:
- Nucleus pulposus (or inner gel-like part of the disc): This gives the spine its strength and flexibility.
- Annulus fibrosus: This outer layer is tough and surrounds the nucleus pulposus.
- Cartilaginous Endplates: These pieces of cartilage are placed between the disc’s adjacent vertebrae.
- The annulus fibrosus can be torn or broken in a herniated disc. This allows a portion of the nucleus pulposus into the spinal canal. Sometimes the herniated material can press against a nerve, causing pain or affecting movement.
Around 5-20% of all 1,000 adults between the ages 20 and 49 suffer from herniated discs each year. Anywhere in the spine can develop a herniated disc. The cervical spine and the lumbar spine are the most common. The cervical spine is located in the neck, and the lumbar spine is the lower back.
Who is a candidate for Herniated Disc surgery?
The majority of herniated discs don’t require surgery. Symptoms will usually resolve in a matter of days or weeks for approximately 95% of people. A herniated disc can cause no symptoms for some people. However, sometimes the herniated disc presses against nerves in the spinal column. This can lead to pain, numbness or weakness in the area where the nerve travels. A person should consult their doctor if the pain doesn’t respond to nonsteroidal anti-inflammatory drug (NSAIDs), and physiotherapy.
Depending on the patient’s level and severity of disability, the doctor might recommend surgery. A herniated disc can affect the nerves controlling the bladder or bowel in rare cases. To relieve the pressure on the nerves, and to restore bladder and bowel function, surgery will be required. A person might prefer to seek out care in a hospital that employs a multidisciplinary approach when making surgical decisions.
A pilot study by Trusted Source found that multiple healthcare professionals, including surgeons and anesthetists as well as physical therapists, are less likely to recommend spinal surgery than one individual who makes the decision.
Procedures
A surgeon can perform a number of procedures to treat a herniated disc. Herniated disc surgery relieves pressure on the nerve and alleviates pain. To relieve pressure on the nerve, a doctor might use one of these three techniques:
- Open discectomy: This is open surgery that removes the herniated disc section.
- Endoscopic spine surgery: A surgeon uses a thin tube (or endoscope) to remove the herniated disc. This procedure is minimally invasive and requires only a small incision. The procedure is quick and requires only a tiny scar.
- Surgery to the core spinal disc: First, the surgeon accesses the spine with instruments. Next, the core is removed using a vacuum. This reduces the pressure on the nerve and makes the spinal disc more compact. Surgery is only possible if there is no damage to the outer disc layer.
Another option for treating a herniated disc is:
Laminotomy and laminectomy
The lamina, a portion of the vertebrae that covers the spinal canal and protects it, is part of the vertebrae. Sometimes doctors will need to remove all or part of the lamina in order to fix a herniated disc. A laminectomy involves the complete removal of the lamina.
Each procedure involves making a small incision at the neck or back to access the herniated disc. The surgeon will perform a discectomy to remove any or all of the herniated disc. Laminotomies or laminectomies may be performed lumbarally or cervically.
- Lumbar procedures: These are used to treat leg pain and sciatica caused by a herniated disc in the lower back.
- Cervical procedures: These are used to alleviate pain in the neck, neck, and upper limbs caused by a herniated disc.
Spinal Fusion
A spinal fusion (SF), which is a procedure to stabilize the spine after a laminotomy, laminectomy or laminectomy may be required. A spinal fusion (SF) involves the joining of two bones with screws. Patients who have had SF can feel pain or restricted movements after the procedure. The location of the herniated disc will determine the likelihood that you will need an SF. Typically, lumbar laminectomies will require an SF.
If the surgeon is operating from the front of your neck, cervical laminectomies will require an SF. If the surgeon is operating from the back, the same procedures do not require an SF. The exact location of the herniated disc will determine the point at which the surgeon works. People who have undergone laminotomy might be eligible for artificial disc surgery in place of an SF.
Artificial disc surgery
ADS is an alternative to spinal Fusion. ADS involves replacing the disc that has been damaged with an artificial one. This method is often associated with less pain and restricted movement than SF procedures.
Timeline and recovery process
A study found that people who have herniated discs treated sooner than others may recover faster. They may also have better long-term health. Most people are able to return home within 24 hours of a herniated disc operation. Some people may even be able to return home that day. For approximately 4 weeks, doctors recommend that patients who have had herniated discs surgery should avoid these activities:
- Driving
- Sitting for prolonged periods of time
- Lifting heavy weights
- bending over
People who have had herniated disc surgery may find some exercises beneficial. They should always consult their surgeon before undertaking any strenuous activity.
Sometimes doctors will recommend rehabilitation therapy following surgery. A rehabilitation program following herniated disc surgery can help you recover faster and have better mobility.
There are risks
Most discectomies do not cause complications. In rare cases, however, some people might experience the following:
- Bleeding
- Infections
- Tears in the spine’s protective liner
- Nerve injury
Around 5% of people may experience symptoms recurring after the disc ruptures. Many people suffering from severe pain can have herniated disc surgery. Surgeons cannot guarantee that your symptoms will disappear following surgery. Some people may still experience herniated disc symptoms after the healing period. Sometimes, the pain can worsen over time.
There are other treatment options
- A herniated disc can be relieved by taking pain medication.
- A herniated disc can be treated by limiting movement for up to three days. The nerve’s inflammation will be reduced if you limit your movement. It may seem counterintuitive to recommend bed rest.
People with pinched nerves in their neck or legs due to a herniated disc may consider NSAIDs or physical therapy. Doctors may recommend nonsurgical alternatives, such as selective root blocks, if these treatments fail to work. These are local numbing drugs that doctors inject into the spine to relieve herniated disc pain.
Preoperative Preparation
Pre-operative education is a common requirement for many doctors. This session will teach you about your surgery and help you prepare for it. You might be interested in:
- Recovery time for typical herniated disc surgery
- Hospital staff include different healthcare professionals
- Type of surgical and diagnostic equipment used during surgery
- How to manage your pain after surgery
- You can take a virtual or live tour of the hospital/surgical center
- If you have questions, be sure to ask them during the session. Also, let your nurse or doctor know if there are any other questions.
Day of Surgery
You will be required to report at a specific time to the hospital or surgical center on the day of your surgery. Pre-op instructions should be given by your doctor. These instructions should be followed carefully. You will not be allowed to eat or drink before the surgery. Your surgeon will check your vitals and set up an IV line. Your doctor will visit you to check on you and review the surgery once more. You will then be taken to the operating room where general anesthesia will also be administered.
You will feel tired and disoriented when you awaken in the recovery area. Your pain will be treated by your doctors, who will examine your vital signs and neurological status. Your surgical incision will be checked for infection and other problems. You may be moved to another area of recovery or a hospital room if you are awake. The goal of a minimally invasive microdiscectomy is usually to get you home. You will first need to get up from your bed, sit down in a chair, or walk to the toilet.
You can start walking up and down the hospital corridor as you feel better. You will be offered food. You will be allowed to go home if you are able to walk and control your pain. You will usually be admitted for observation overnight if you have had an open microtomy.
The First Week After Herniated Disc Surgery
You should be careful about how you move at home. When sitting or standing, ensure that you maintain a proper posture. Avoid heavy lifting and forward bending. Protect your back to ensure it heals properly. After surgery to repair a herniated disc, you will be encouraged to increase your activity during the first week. Walking after surgery is a great way to increase your aerobic endurance and improve circulation.
You will gradually increase your activity levels over the next week. However, your back will still be protected if you avoid bending, lifting, and sitting slouched during this time. During the first week after herniated disc surgery, you should not return to work. Increase your activity gradually and monitor your incision for signs of infection such as reddening, swelling, or discharge. Your doctor should check your incision every week and keep you informed about your symptoms.
Three Weeks After Surgery
If your job requires you to be sedentary, it is worth returning to work after the three-week herniated disc surgery recovery period. You should practice good posture when you sit or stand in an office. Your doctor might recommend that you stay off work for several weeks if your job is very physically demanding.
Continue to increase your activity tolerance and walking speed. Your goal is to return to daily light activity within three weeks. If you feel the need, you can start a course of physical therapy. However, some patients who have minimally invasive spine surgery experience a quick recovery and no need for rehabilitation.
By the fourth week, you should feel almost fully recovered from surgery. You can gradually return to your daily activities with a gradual increase in intensity by the sixth or eighth week. A trusted neurosurgeon can guide you through any surgery to repair a herniated disc. Knowing what to expect following surgery will help you to focus on your recovery and allow you to quickly and safely return back to your normal level of activity and function.
What can you do to take care of yourself at home?
Incision care
You can leave tape on any incisions (cuts) made by the doctor for up to a week, or until it falls off. Use warm soapy water to wash the area and then dry it. Avoid alcohol and hydrogen peroxide as they can slow down healing. If the bandage rubs against clothing or weeps, you may use a gauze wrap to cover it. Every day, change the bandage. Make sure the area is clean and dry.
Medicines
Your doctor will let you know if you are allowed to restart your medication. Your doctor will also provide instructions on how to take any new medications. Take precautions when taking medication. Use pain medication exactly as prescribed. Take the prescribed medication for pain if it was given to you by your doctor.
Ask your doctor if an over-the-counter medicine is available if you don’t take a prescription pain medication. You think your pain medication is making your stomach sick? Unless your doctor tells you otherwise, take your medication after eating. Ask your doctor if you need a different type of pain medication.
Follow the instructions of your doctor if you were prescribed antibiotics. You should not stop taking antibiotics just because you feel better. It is important to complete the entire course of antibiotics.
Diet
You can continue eating your regular diet. You can eat bland foods such as plain rice, broiled chicken, toast, or yogurt if your stomach is upset. Drink lots of fluids – unless your doctor says otherwise.
After your surgery, you may notice a change in your bowel movements. This is normal. Avoid constipation and straining your bowel movements. A fiber supplement may be a good idea. Ask your doctor if you still haven’t had bowel movements after a few days.
Activity
When you are tired, rest. You can recover by getting enough sleep. Every day, walk. Begin by walking just a little bit more each day than you did yesterday. Gradually increase your walking. Walking improves blood flow, prevents constipation, and increases blood flow.
Do not lift anything that could cause strain. You should not lift heavy grocery bags or milk containers, heavy briefcases or backpacks, cat litter or dog food bags or vacuum cleaners, or children. You can change your position every 30 minutes, whether you are sitting or standing. This will reduce your back pain and speed up the healing process.
You should avoid strenuous activities like jogging or weight lifting until your doctor allows it. Ask your doctor when it is safe to drive again. For the first 2 to 4 weeks following surgery, you should not drive a car more than 30 minutes. You may need to ride a car longer distances, so make sure you stop frequently to stretch your legs and walk.
The type of work that you do and how quickly you feel well will affect the amount of time you take off work. You are more likely to return to work faster if you work in an office than if your job is very active. Discuss your work requirements with your doctor.
While you may want to have sex whenever you feel like it, avoid positions that cause pain or stress.
Exercise
Follow your doctor’s instructions and do back exercises. A physiotherapist may be recommended by your doctor to increase the strength and flexibility in your back.
Additional instructions
Warm water bottles, a heating pad on low or a warm blanket on your back can reduce stiffness and sore muscles. Heat should not be applied directly to the incision. You should not put a heating pad on top of your skin before you go to bed. Your safety and treatment will not be complete without follow-up care. If you have any questions, make sure you attend all appointments. It is a good idea also to keep track of your tests and the medications you are taking.
What should you do if you need help?
If you feel you might need emergency medical attention, call 911 immediately. Call 911 if you think you may need emergency care.
- You lost consciousness (passed out).
- Chest pain, shortness of breath, or bloody cough are all symptoms.
- It is impossible to move your arm or leg.
If you need immediate medical attention, call your doctor or nurse line immediately
- Pain that doesn’t improve after taking pain medication isn’t going away.
- There are loose stitches or an incision that is open.
- Your incision has been contaminated by bright red blood.
- There are signs that your leg is suffering from deep vein thrombosis (also known as blood clots).
- Pain in the calf, back, knee, hip, or groin.
- Your leg may experience reddening or swelling.
Symptoms of infection include:
- Redness, pain, swelling, warmth or other symptoms.
- The incision is marked by red streaks.
- Pus drainage from the incision
- A fever.
New or worsening symptoms are present in your arms and legs, abdomen, belly, buttocks, chest, stomach, or chest. You may experience the following symptoms:
- Tingling or numbness
- Weakness.
- Pain.
- You lose bladder or bowel control.
Pay attention to any changes in your health and contact your doctor immediately.
- It doesn’t always go as planned.
