What is a lumbar discectomy?
A lumbar discectomy is a procedure to remove part of a damaged disc in the lower back. It is typically recommended when a lumbar disc has herniated or shifted out of place, putting pressure on nearby nerves and causing pain, numbness and even weakness in the legs.
Traditionally, a lumbar discectomy was performed as an open surgery. However, advancements in surgical techniques now allow for a more minimally invasive approach, known as microdiscectomy. This requires smaller incisions, specialized instruments, and can often be done as an outpatient procedure, so you don’t have to stay at the hospital. Minimally invasive spine surgeries, like lumbar microdiscectomy, can offer several benefits, including reduced tissue damage, faster recovery and less discomfort.
For most people, a lumbar discectomy significantly reduces leg pain, enhances mobility and improves their overall quality of life.
Who is a candidate for lumbar discectomy?
You may be a candidate for lumbar discectomy if you’re experiencing persistent painful symptoms due to a bulging or herniated disc in the lower back. Candidates for surgery typically have ongoing pain, numbness, tingling or weakness in their back and legs that does not improve with conservative treatments. However, not all back pain or herniated discs require this surgery.
Your doctor may recommend surgery if you have:
- Degenerative disc disease or a herniated disc, which is compressing the nerve
- Nonsurgical treatments such as physical therapy, medications or injections have failed to provide sustained relief
- Trouble standing or walking due to nerve-related weakness
- Severe pain, weakness or numbness in your leg or foot
- Leg pain (sciatica) that's worse than back pain
- Symptoms that progressively worsen, affecting daily activities and your quality of life
- Severe neurologic symptoms develop, which include weakness in legs, bowel or bladder dysfunction
A thorough evaluation by a spine specialist will determine whether a lumbar discectomy is the most appropriate treatment option for you.
How to prepare for a lumbar discectomy
Proper preparation before a lumbar discectomy can enhance the outcomes of the surgery and support a smoother recovery. Your doctor will conduct a comprehensive evaluation, which may include a physical exam, blood tests and imaging such as an X-ray or MRI scan, to locate the problem area. Be sure to tell your doctor about any medications, including over-the-counter drugs, herbs or supplements you take, as you may need to stop some of them before surgery, especially blood thinners like aspirin.
If you smoke, it’s a good idea to quit at least four weeks before surgery to reduce risks. Your doctor might recommend some exercises to do before surgery to help with recovery.
After surgery, you’ll be able to walk, but you may need help with tasks like dressing, meal preparation and grocery shopping. It's a good idea to arrange for some support from family or friends and set up a comfortable recovery area at home.
The lumbar discectomy surgery
Lumbar discectomy can be performed using different techniques. Microdiscectomies are common and typically utilize a microscope or other advanced imaging tools to enhance visualization, allowing the surgeon to remove the herniated disc through small incisions while minimizing any disruption to the surrounding tissues.
In some cases, a lumbar discectomy may be performed alongside other spinal procedures. Depending on your condition and imaging results, your surgeon may perform one of the following procedures in addition to your discectomy:
- Laminectomy: Removal of the lamina (the back part of the vertebra) to relieve pressure on the spinal canal
- Foraminotomy: Surgery to widen the openings where spinal nerves exit the spine, reducing nerve compression
- Spinal fusion: A procedure to surgically join two bones in your spine, increasing stability
The choice of surgical technique and any additional procedures will depend upon factors such as the severity of the disc herniation, nerve compression and overall spinal health. Your surgeon will discuss the most appropriate treatment choices based on your specific condition and goals.
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Before the surgery
Your surgery will usually take place in the hospital or an outpatient center, depending on the procedure you need. Be sure to arrive at the time provided by your surgical team.
Follow your surgeon’s instructions for eating and drinking before surgery. You may need to stop eating around six hours and drinking water or clear liquids at least two hours before having anesthesia. Your doctor may also adjust certain medications before surgery, be sure to follow their instructions closely.
Your doctor might give you antibiotics to reduce the chance of infection.
Before your procedure, you will meet with your anesthesiologist, who will explain the type of anesthesia you’ll receive and what to expect.
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During the surgery
Your surgery depends on the type of technique your surgeon uses. All procedures involve removing part of the herniated disc or any loose fragments pressing on the nerves.
- Open Surgery: Your surgeon will make a larger incision on your lower back and gently move your muscles and soft tissues aside to access the disc.
- Microdiscectomy: A smaller incision will be made, and a special microscope will be used to visualize the spine and the nerves. This allows the surgeon to preserve the surrounding tissues, which may lead to a shorter recovery time.
- Endoscopic or Tubular Discectomy: Another minimally invasive approach that involves inserting specialized retractors and/or a special camera to access the spine. These hold your muscles open and tiny surgical instruments are used to remove the problematic disc.
Your incision will then be closed with either staples or sutures. Surgery usually takes between one and two hours, although this can vary depending on its complexity and any additional procedures that are performed.
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After the surgery
After surgery, you will be taken to a recovery room, where medical staff will monitor you and ensure you are stable. Once anesthesia wears off, you will be encouraged to walk as soon as possible. You can usually go home on the day of the surgery, although you might have to stay in the hospital for a day or two.
You may experience some pain or numbness around the incision, which can be managed by prescribed pain medications. Your healthcare provider may want you to wear a back brace as you recover.
It usually takes a few weeks to recover from a lumbar discectomy, although this will depend on your age and overall health. You might be advised to limit physical activity and strenuous activities like bending, twisting or lifting. Typically, you should avoid driving for the first two weeks after surgery.
Your surgeon may recommend physical therapy to help you recover and minimize pain. Your therapist can show you how to carry out daily activities, such as getting out of bed, dressing and lifting things safely.
What are the risks of posterior lumbar discectomy surgery?
A lumbar discectomy is generally safe, but like any surgery, there are potential risks and complications. These include:
- Bleeding
- Infection
- Blood clots
- Nerve injury
- Complications from anesthesia
- Spinal fluid leak
- Recurrent disc herniation
- Need for further surgery
Recovery
After your lumbar discectomy surgery, it’s important to protect your back while staying active. Take short walks each day and avoid sitting for long periods or lifting anything heavy or repetitive.
It's normal to feel some discomfort or mild pain around the incision site as it heals, but have a family member check for any signs of infection, like redness or drainage. Contact your healthcare provider immediately if you notice these symptoms.
Around two weeks after surgery, you'll have a follow-up with your healthcare provider to discuss your progress. By then, you should be walking with more ease and feeling better. Your doctor will check your incision, remove any stitches and encourage you to slowly increase your activity.
Within a month, you should feel close to normal, with your sciatic pain gone and walking regularly. If your job is mostly sitting, you may be able to return quickly. If it involves heavy lifting, you may need more time off.
Some people need physical therapy to help with mobility and prevent future back issues. Full recovery typically takes four to six weeks, but you may start feeling better before that. Be sure to follow your doctor’s advice to make sure your recovery stays on track.
Frequently asked questions
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How long does a lumbar discectomy surgery take?
A lumbar discectomy usually takes about one to two hours to complete. However, the exact time can vary depending on factors like the type of surgery being performed, the complexity of the condition and your overall health. Your surgeon will explain what to expect before the procedure so you can feel prepared.
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How much should I walk after lumbar discectomy?
After a lumbar discectomy, start with short, easy walks at home and gradually increase to 15–30 minutes a few times a day as you feel comfortable. Avoid uneven surfaces, stop if you feel pain and follow your doctor’s advice to help your recovery go smoothly.
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Is lumbar discectomy major surgery?
A lumbar discectomy can be a major surgery, however advancements in techniques have led to smaller incisions, shorter recovery time and fewer risks. The complexity and invasiveness of the procedure depend upon your particular condition. While it is a significant procedure, many patients experience relief from symptoms and improved quality of life after recovery.