The spine is a column of bones that are separated by spongy intervertebral discs. These discs prevent the bones of the spinal column from grinding against one another by acting as shock absorbers and allow the spine to move. Each disc is made up of annulus fibrosus, which is a strong outer ring of fibers and a soft, gel-like center called the nucleus pulposus.
Herniated discs occur when the strong fibers of the annulus tear or rupture and the gel-like center migrates or pushes out of its normal position and into the limited space of the spinal canal. The displaced disc may exert pressure on the spinal cord or compress nearby spinal nerves. In addition, chemical irritants with the disc material are released that can cause nerve inflammation and pain. Herniated discs are more likely to be found in the neck or lower back but can occur in any area of the spine. Fortunately, Dr. Stieber's NYC herniated disc surgery can treat these symptoms and problems.
When a herniated disc presses on a nerve, you may experience pain, numbness, and/or weakness of the affected area. In contrast, for those patients without significant nerve compression, mild pain or discomfort may be the only symptom. The location and severity of the herniated disc usually dictate the symptoms.
Most disc herniations do not require herniated disc surgery. The condition often resolves within four to six months. In the meantime, there are many non-surgical treatments that can help relieve symptoms including:
For those patients that do not need herniated disc surgery, you will find our outpatient non-surgical microdiscectomy has a multitude of benefits. Click here to learn more.
The following steps can help keep your spine healthy and reduce your chances of experiencing back pain in the future:
Strengthening your back and abdominal muscles can prevent and support the spine.
Reduce pressure on your spine and discs by keeping your back in a healthy alignment. Pay close attention to your posture when sitting down. Lift heavy objects with your legs, not your back.
Another risk for herniation can be linked to being overweight, which places additional pressure on your spine and discs.
As with any surgery, even a relatively small outpatient surgery like a discectomy, there are certain theoretical risks involved. Any time we make an incision in the skin, there are risks of bleeding and infection. While these risks are almost zero for a discectomy, they still exist. Any time we operate around nerves, there is a theoretical risk of nerve injury; however, the real-world risk of further nerve injury is extremely small. In our practice, un-pinching nerves and removing the offending disc fragments typically permits the nerve to recover–hopefully fully; however, the rate and extent of recovery depend on the patient’s own biology and healing. Therefore, there is always some degree of risk for persistent nerve dysfunction even with an optimally performed surgery. Any time surgery is performed around the nerve sac, there is also a theoretical risk of injury to the nerve sac, including a tear or puncture. This happens extremely rarely in our practice. If such an injury were to occur, it might need to be repaired with surgical glue or a very fine suture under the microscope. While it is extremely uncommon, both our experience and the literature demonstrate that there is very seldom any long-term adverse effect from this type of event. With or without surgery, a disc that has herniated or ruptured carries a risk of progression or recurrent disc herniation, as well as degeneration that may result in future back pain or other neurologic symptoms related to disc collapse. Even with an optimally performed surgical microdiscectomy, there is always a risk of recurrent or persistent nerve discomfort or back pain, and some patients may require further future treatment, including additional surgery.
Many herniated discs improve over time with non-surgical treatments such as rest, anti-inflammatory medications, physical therapy, and steroid injections. Surgery is usually reserved for severe or persistent cases–or cases associated with a serious or progressively worsening neurologic deficit (e.g. numbness and/or weakness).
Options include minimally invasive microdiscectomy and endoscopic discectomy, which remove the offending herniated disc material with minimal disruption to surrounding tissues.
The choice depends on the location and severity of the herniation, degree of nerve compression, spinal stability, patient anatomy, and whether previous surgeries have been performed.
Nearly all discectomy patients are treated as outpatients and go home the same day. Most patients can walk immediately after surgery and resume light activities within a few days. Patients with desk-type jobs can usually return to the office within a week. Full recovery with optimal strength and flexibility may take 3-6 months.
Yes, multi-level discectomies or fusions are possible but may require longer operative time, more recovery, and careful preoperative planning. In many cases, multilevel discectomies can be performed through the same small incision by repositioning minimally invasive tube retractors or endoscopic instruments.
Most patients experience significant pain relief and improved function. Most studies put the rate of recurrent lumbar disc herniation after a standard microdiscectomy at roughly 5–15% over time, depending on how “recurrence” is defined and how long patients are followed. After a standard lumbar microdiscectomy, about 1 in 10 patients may eventually need another operation at the same level, and roughly 1–2 in 10 might need some additional lumbar surgery over the next decade or longer.
