Herniated Disc Surgery

Effectiveness of Sciatica Treatment, Herniated Disc Surgeries Compared in Recent Study

cmaynard — Wed, 15 Jul 2009 09:27:47 -0700

July 15, 2009
by: Sylvia Marten

Examining the effectiveness of conventional microdiscectomy and tubular disectomy surgeries for treatment of [url:996,type=|node|,content=|sciatica symptoms|] resulting from a [url:885,type=|node|,content=|herniated disc|], a recent study found and opined that the minimally invasive, tubular surgery did not result in better outcomes for patients despite such claims in the past.

[url:1584,type=|node|,content=|conventional microdiscectomy|]. The most commonly performed surgery for patients with sciatic leg pain from disc herniation, [url:5991,type=|node|,content=|microdiscectomy|] (also known as lumbar decompression surgery) entails the removal of a small portion of the bone over the nerve root and/or disc material under the nerve root to relieve neural impingement and provide more room to heal.
[url:6025,type=|node|,content=|tubular discectomy|]. Introduced in 1997, tubular discectomy involves a similar procedure to the one described above, with the exception that it is performed through a tubular device. This type of herniated disc surgery has been described as producing less tissue damage and resulting in a faster rate of recovery, the latter point serving as the basis of examination for the Sciatica Micro-Endoscopic Discectomy trial.

Performed by researchers in the Netherlands, this trial involved 328 patients (ages 18 to 70 years) who:

had persistent leg pain from lumbar herniated discs for more than 8 weeks
were hospitalized in 7 general hospitals in the Netherlands from January 2005 to October 2006
were randomized to either a tubular discectomy (approximately 167 patients) or conventional microdiscectomy (161 patients).

A blind follow up was conducted a year later, with functional ability, pain and a self-view of recovery assessed via a series of questionnaires and surveys.

Findings on Microdiscectomy and Tubular Discectomy

According to the study, conventional microdiscectomy produced more favorable results than tubular discectomy after one year for:

functionality. The mean score on the Roland-Morris Disability Questionnaire (RDQ), which has a 0-23 score range with higher scores indicative of worse functional status, was 3.4 for conventional microdiscectomy and 4.7 for tubular discectomy.
leg pain. On the visual analog scale, the 1-year mean difference was in favor of conventional microdiscectomy (with scores of 4.2 mm for leg pain and 3.5 mm for [url:145,type=|term|,content=|back pain|]).
self-reports of recovery. 120 of 151 patients (79%) who had conventional microdiscectomy reported good recovery a year later while 107 of 156 of patients (69%) who had tubular discectomy reported good recovery a year after the minimally-invasive procedure.

It should be known that this randomized control trial by no means knocks the validity of tubular disectomy as a minimally-invasive procedure for herniated discs; rather, it challenges certain claims like it increasing the rates of recovery.

Source: JAMA

More on This Topic

[url:1001,type=|node|,content=|Sciatic Nerve Anatomy and Sciatica Symptoms|]
[url:1016,type=|node|,content=|The Truth about Sciatica|]
[url:715,type=|node|,content=|Lumbar Herniated Disc|]
[url:884,type=|node|,content=|Treatment Options for a Lumbar Herniated Disc|]
[url:9574,type=|node|,content=|Surgery Options for a Herniated Disc|]
[url:18207,type=|node|,content=|Lower Back Pain after Surgery|]
[url:7996,type=|node|,content=|Sciatica Treatments|]

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Herniated Disc Treatments vs. Degenerative Disc Disease Treatments

cmaynard — Thu, 30 Jul 2009 13:40:01 -0700

It’s critical that the doctor accurately diagnoses the underlying cause of back pain, neck pain, leg pain or other symptoms, since the diagnosis dictates the treatment options.

Endoscopic Discectomy and Microdiscectomy for Lumbar Herniated Discs

Ben Parr — Mon, 09 Mar 2009 14:19:50 -0700

A physician answers patient questions about endoscopic discectomy and microdiscectomy options for a herniated disc.

Question:Is endoscopic discectomy or microdiscectomy better for two lumbar herniated discs?

I have an MRI that shows two herniated discs in my lower back. After conservative treatments have failed, I am now considering surgery to treat my lumbar herniated discs.

Treating Chronic Pain after Lumbar Herniated Disc Surgery

Ben Parr — Mon, 09 Mar 2009 14:19:44 -0700

A physician answers patient questions about treatment of chronic pain after a lumbar herniated disc surgery.

Question: Who to see about chronic pain after lumbar herniated disc surgery?

Several years ago, I had surgery for a lumbar herniated disc at L5-S1. After surgery, I still had pain in my right foot when standing or walking. The spine surgeon said the pain would go away with time, although it never did completely go away.

When to Have Surgery for a Lumbar Herniated Disc

Ben Parr — Mon, 09 Mar 2009 14:19:39 -0700

A physician answers patient questions about determining when it is necessary to undergo surgery for a lumbar herniated disc.

Recovery from Herniated Disc Surgery

Ben Parr — Mon, 09 Mar 2009 12:19:51 -0700

A physician answers patient questions about recovering from herniated disc surgery.

Question: How long will pain after herniated disc surgery last?

Leg Pain and Scar Tissue After Herniated Disk Surgery

Ben Parr — Tue, 03 Mar 2009 12:35:50 -0800

A physician answers patient questions about causes of leg pain after herniated disc surgery.

Lower Back Pain after Discectomy Surgery

Ben Parr — Thu, 26 Feb 2009 15:18:15 -0800

A physician answers patient questions about persistent lower back pain after a discectomy.

Question: What's the next step after discectomy surgery?

My 19-year-old son had a discectomy surgery a while ago due to a disk herniation at L4-L5. He still has lower back pain, but no leg pain any more. Now we have no diagnosis.

Surgery for Leg Numbness from a Prolapsed Disc

Ben Parr — Thu, 26 Feb 2009 15:17:38 -0800

A physician answers patient questions about surgery for a prolapsed disc.

Question: Is low back surgery necessary for prolapsed disc?

I have a prolapsed disc at L5/S1 that just happened. After a few steroid injections, the leg pain is mostly gone; however there is still numbness in my lower leg and progressive loss of strength in my right leg.

When Surgery is Necessary for a Herniated Disc

Ben Parr — Wed, 25 Feb 2009 15:24:34 -0800

A physician answers patient questions about when it is necessary to undergo surgery versus conservative care for a herniated disc.

Question: What level does a disc need to herniate to require surgery?

I know that on an MRI, the amount of disc herniation (L5 in my case) is measured in increments of millimeters (mm). Are there studies, opinions or facts that indicate which level (# of mm) of disc herniation warrants which treatment?

Surgery Options for a Herniated Disc

Ben Parr — Wed, 30 Jul 2008 09:22:00 -0700

Spinal Decompression Patients' Advice: Avoiding Herniated Disc Surgery and Decompression Providers

Ben Parr — Mon, 14 Jul 2008 08:17:06 -0700

Back-to-Back: Patients share tips on experiences with spinal decompression

Want to know more about spinal decompression from those who have been affected most? In our Back-to-Back section, patients share tips and advice about using non-surgical spinal decompression to treat their back problems.

Herniated Disc

spine-health — Fri, 04 Jan 2008 07:52:56 -0800

Definition

A herniated disc is a condition in which the annulus fibrosus (outer portion) of the vertebral disc is torn, enabling the nucleus (inner portion) to herniate or extrude through the fibers. The herniated material can compress the nerves around the disc and create pain that can radiate through the back and sometimes down the arms (if the herniation is in the cervical spine) and legs (if the herniation is in the lumbar spine).

Treatment Options for a Herniated Disc

spine-health — Tue, 11 Dec 2007 21:26:50 -0800

Surgical Treatments for a Lumbar Herniated Disk

spine-health — Tue, 11 Dec 2007 21:26:50 -0800

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).

Treatment Options for a Lumbar Herniated Disk

spine-health — Tue, 11 Dec 2007 21:26:50 -0800

Summary of Cervical Herniated Disc Treatment Options

spine-health — Tue, 11 Dec 2007 21:26:49 -0800

Spine Surgery for a Cervical Herniated Disc

spine-health — Tue, 11 Dec 2007 21:26:49 -0800

Most episodes of arm pain due to a cervical herniated disc will resolve over a period of weeks to a couple of months. However, if the pain lasts longer than 6 to 12 weeks, or if the pain and disability is severe, spine surgery may be a reasonable option.

Spine surgery for a cervical herniated disc is generally very reliable and can be done with a minimal amount of postoperative pain and morbidity (unwanted aftereffects).

Lumbar Herniated Disc

spine-health — Tue, 11 Dec 2007 21:16:20 -0800

As a disc degenerates, it can herniate (the inner core leaks out), which is known as a disc herniation or a herniated disc. The weak spot in the outer core of the disc is directly under the spinal nerve root, so a herniation in this area puts direct pressure on the nerve, which in turn can cause sciatica.