Surgical Treatments for a Lumbar Herniated Disc

Surgical Treatments for a Lumbar Herniated Disc

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

Surgery Options for a Lumbar Herniated Disc

There are many different options for surgery for herniated discs. 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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Another surgical option to treat a lumbar herniated disc is chymopapain injections that dissolve the disc. 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. Currently, chympopapain is no longer manufactured in the US and is generally not an available surgery.

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 disc herniations. Overall, it has not been found to be as useful as anticipated.

New technology to treat a lumbar herniated disc

Lastly, a new technique called microendoscopic surgery has become available. The surgery is done through a tube rather than through a traditional incision with a microscope. The results are similar and as for a microdiscectomy.

Laser technology does not add any additional advantage over traditional means of removing disc herniations causing nerve root compression.

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Article written by: Peter F. Ullrich, Jr., MD