If back or neck pain caused by degenerative disc disease doesn’t respond to medication or therapeutic injections, NYU Langone doctors may recommend a surgical procedure. Surgeons may remove some or all of a damaged disc, take pressure off a pinched nerve, or eliminate movement between the bones of the spine.
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Discectomy is the most common surgical treatment for a herniated disc, which often occurs as a result of degenerative disc disease. It involves removing the injured part of the disc, relieving pressure on the affected nerve.
Discectomy may be an open procedure, which gives surgeons direct access to the disc through an incision. NYU Langone surgeons may instead recommend a minimally invasive microdiscectomy, in which they use tiny instruments and small incisions to gain access to the disc. Either technique may be used to remove a herniated disc fragment in the lower spine or neck.
Your surgeon may perform a discectomy on the cervical spine—the vertebrae of the neck—in one of two ways. With an anterior approach, surgeons access the herniated disc through the front of the neck. With a posterior approach, doctors access the disc from the back of the neck.
If a herniated disc in the neck compresses nearby nerves but not the spinal cord, surgeons may use a posterior approach. In this procedure, your surgeon makes an incision in the back of the neck and removes a small portion of the vertebra to access the disc space. This is called a laminotomy or foraminotomy. Your surgeon then removes the herniated disc fragment, relieving pressure on the affected nerves.
If the herniated disc compresses nerves and the spinal cord, your surgeon may use an anterior approach. In this procedure, he or she makes an incision in the front of the neck to access the disc space. He or she may remove a portion of the vertebra to remove the herniated disc, relieving pressure on the nerves and spinal cord. After the disc has been removed, your surgeon fuses the two vertebrae to stabilize the cervical spine. This is called spinal fusion.
Surgeons may perform a lumbar discectomy to relieve pain from a herniated disc in the lumbar spine, or the vertebrae in the lower back. Spine specialists make a small incision and use powerful microscopes and other tools to magnify their view of the space around the disc, as well as the surrounding bones and nerves.
Doctors may need to remove a small piece of vertebra to access the herniated disc fragment. This procedure is called a hemilaminotomy. Surgeons then carefully remove the injured section of the disc, removing pressure from the nerve.
Most people can return home on the day of surgery. If laminectomy—a procedure to remove part of a vertebra—or spinal fusion is performed in addition to discectomy, surgery may take longer. You may need stay in the hospital for one or more days for observation as you heal.
Most people can stand up and walk within hours of a discectomy. An NYU Langone pain management specialist ensures you have the medication you need to remain comfortable while you recover. It may take four to six weeks to return to all of your usual activities, but surgery often provides almost immediate relief from pain that radiates to the arms or legs.
Increasingly, surgeons recommend artificial disc replacement as an alternative to spinal fusion for people younger than 65 with a herniated disc in the neck. An artificial disc is a prosthetic “spacer” inserted in place of the removed disc. It is placed between two vertebrae, preserving spinal flexibility and stability. No screws or plates are needed to keep it in place.
In young people, a cervical disc replacement may provide better long-term results and fewer complications than fusion.
To perform artificial disc replacement, your surgeon makes an incision above the affected area of the spine and may remove part of the vertebra to access the disc space. A surgeon uses small surgical tools to remove the entire herniated disc, insert the artificial disc into the disc space, and close the incision with stitches.
Doctors typically recommend an overnight hospital stay so they can monitor your recovery.
Many people are able to walk within 24 hours of an artificial disc replacement. In the weeks after surgery, you may wear a back or neck brace for additional support. A pain management specialist can work with you to help you remain comfortable while you recover.
After four weeks of limited activity, many people resume their everyday routines. It may take a few months for the spine to heal fully.
If a disc has degenerated or slipped to a large extent, or if the surrounding vertebrae and joints can no longer support that part of the spine, doctors may recommend spinal fusion with discectomy. This combination tends to be required on the neck more often than on the lower back. Doctors may also recommend these procedures if osteoarthritis of the spine causes chronic neck pain.
In this procedure, a surgeon removes the disc and the herniated disc fragment. He or she permanently joins the vertebrae above and below the disc space. This eliminates movement and stabilizes the lumbar or cervical spine. It can alleviate pain by eliminating contact between the slipped disc and the nearby nerve, as well as by preventing the vertebrae from moving in a way that irritates the spinal cord or nerves.
After a spinal fusion, most people spend one or more days recovering in the hospital. Doctors and nurses ensure the incision is healing properly, and pain management specialists are available 24 hours a day to make sure you’re comfortable.
Many people are able to walk on the same day of surgery, though this depends on your age, the extent of the surgery, and the severity of postoperative pain.
Once you are home from the hospital, you may wear a back or neck brace for a few weeks to provide additional stability while the spinal fusion heals. During this time, you can gradually begin to move and walk more.
When you can return to work depends on how much activity is required in your job. People who work in an office often return sooner than those whose jobs require physical labor. Those in more strenuous occupations might not return for three months or longer.
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