Herniated Disc

Surgical Treatments for a Lumbar Herniated Disk

By: Peter F. Ullrich, Jr, MD

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The goal of surgery for a lumbar herniated disk is to remove the portion of the disk that is impinging on the nerve root (usually about 5% to 10% of the disk).

Surgery Options for a Lumbar Herniated Disk

There are many different options for surgery for herniated disks. Whichever procedure the surgeon uses probably does not matter as much as their comfort level with the procedure, and with their experience.

The gold standard for surgery is an open or microsurgical discectomy.

In the last 10 to 15 years the microdiscectomy surgery has been modified to allow for a relatively small incision and less soft tissue dissection, which provide for significantly less postoperative discomfort and quicker healing.

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See also Lumbar decompression back surgery and Microdiscectomy (microcdecompression) back surgery

Another surgical option to treat a lumbar herniated disk is chymopapain injections that dissolve the disk. This procedure is less invasive than surgery, and has had varied success and popularity among surgeons. It has been available since the 1970’s, but comparison studies have indicated that a lumbar discectomy is a more reliable option.

In the 1990s, an arthroscopic lumbar discectomy procedure was introduced as a less invasive alternative. This procedure carries a steep learning curve for the surgeon and is only appropriate for certain types of disk herniations. Overall, it has not been found to be as useful as anticipated.

New technology to treat a lumbar herniated disk

Lastly, a new technique called microendoscopic surgery is currently being investigated. It uses a new retraction system to allow visualization of the disk herniation through a small incision. Since the approach is similar to a microdiscectomy, the learning curve is not as steep as with arthroscopic procedures, and it should carry a similar success rate as lumbar discectomies. Although it is less invasive than an open lumbar discectomy, it has not been shown to decrease the morbidity of surgery (such as post-operative pain and discomfort) over that of a microdiscectomy.

Laser surgery has not been shown to be an effective alternative to more traditional lumbar disk surgery techniques.