If nonsurgical treatments are not effective in relieving pain caused by a herniated disc, in particular if you experience numbness, tingling, or weakness in your arms or legs for more than six weeks, your doctor may discuss surgery. At NYU Langone, your surgical team may include an orthopedic surgeon or a neurosurgeon in addition to radiologists and anesthesiologists who specialize in the spine.
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This team of spine experts collaborates to determine the most effective and least invasive approach to spine surgery based on the severity and location of the herniated disc. The goal of surgery is to remove some or all of the damaged disc and stabilize the spine.
All of these operations are performed under general anesthesia.
Discectomy is the most common surgical treatment for a herniated disc. It involves removal of the injured part of the disc, relieving pressure on the affected nerve. This may be an open procedure, allowing surgeons direct access to the disc through an incision, or a microdiscectomy, allowing surgeons access to the disc through smaller incisions and use of tiny surgical instruments. Either technique may be used to remove a herniated disc fragment in the lower spine or neck.
Your surgeon may perform discectomy on the cervical spine—the vertebrae of the neck—using an anterior approach, in which the herniated disc is accessed through the front of the neck, or a posterior approach, in which it is accessed 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, a surgeon makes an incision in the front of the neck to access the disc space. He or she may remove a portion of the vertebra in order to remove the herniated disc and relieve pressure on the nerves and spinal cord. After the disc has been removed, your surgeon fuses the two vertebrae surrounding the disc space to stabilize the cervical spine. This is called a spinal fusion.
In lumbar discectomy, which is performed to relieve a herniated disc in the lumbar spine, or the vertebrae in the lower back, surgeons make a small incision and use powerful microscopes and other tools to magnify their view of the space around the disc and the surrounding bones and nerves. Surgeons may need to remove a small piece of the bone covering the spinal canal in order to access the herniated disc fragment. This procedure is called a hemilaminotomy.
Surgeons then carefully remove the injured section of the disc, decompressing the nerve. The incision is closed with stitches.
Most people can return home on the day of surgery. If laminotomy—a procedure to remove part of a vertebra—or spinal fusion is performed in the lumbar spine in addition to discectomy, surgery may take longer and require that you stay in the hospital for one or two days for observation as you heal.
Most people can walk within hours of discectomy. An NYU Langone pain management specialist makes sure you have the medications you need to remain comfortable while you recover in the hospital and at home. It may take four to six weeks for you to return to all of your activities, but surgery often provides almost immediate relief from pain that radiated through the arms or legs.
Increasingly, surgeons recommend artificial disc replacement as an alternative to spinal fusion for younger people who have cervical disc herniation. An artificial disc is a prosthetic “spacer” inserted in place of the removed herniated disc. This spacer rests between two vertebrae, preserving spinal flexibility and stability. No screws or plates are needed to keep it in place. In younger 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 bone covering the spinal canal in order 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 for observation.
Many people are out of bed and walking within 24 hours of artificial disc replacement. In the weeks after surgery, you may wear a back or neck brace to provide additional support. A pain management specialist can work with you to customize your medications, depending on how much pain you experience. After four weeks of limited activity, many people resume their everyday routines. It may take a few months for the spine to fully heal.
If a disc has slipped to a large extent, or if the surrounding vertebrae and joints can no longer support that part of the spine, a spinal fusion with discectomy may be performed. Fusion in combination with discectomy is more often required on the neck than on the lower back.
In this procedure, a surgeon removes the disc and the herniated disc fragment and then permanently joins the vertebrae above and below the disc space, eliminating movement between them and stabilizing the lumbar or cervical spine. This 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 age, the extent of surgery, and the severity of postoperative pain.
After going 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. The timeline for returning 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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