Dr. Gold's Orthopedic Surgery Blog

Surgeon and Author, Dr. Stuart Gold,
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About Dr. Stuart Gold, MD


Back Surgery for Bulging or Herniated Disc

March 24th, 2011

Discs are like pillows or donuts between the vertebrae that act as shock absorbers and also provide for movement as they are positioned between the vertebrae (bone blocks of the neck and back). These discs consist of a tough outer layer (annulus) surrounding a filling of softer spongy/jelly material (nucleous pulposis). A disc can be bulging minimally (1-3mm) or in some cases very significantly (6-10mm). A herniated disc exists when the tough outer layer of the disc ruptures and the soft spongy jelly material has been pushed out or extruded.

A bulging disc, which can affect any part of the spinal column, is one that protrudes beyond the vertebrae. The bulge is normally part of the outer layer. Many physicians consider a bulging disc as a normal part of aging. Most of the time, the patient experiences little or no pain from the bulge. However, others may find the condition painful if the bulge is in a position to exert pressure on a nerve. In many situations the soft spongy jelly material is pushed out(herniation) and places more significant pressure on the nerve root. This pressure may also cause numbness and weakness in an arm or a leg. If the pain is severe and the numbness and weakness persists and there has been no response to conservative treatments, surgery may be necessary.

One common procedure used for a large bulging or herniated disc is a minimally invasive technique called a microdiscectomy. In this procedure, the surgeon makes a small incision, normally two inches or less, and inserts a tiny microscope through which he can see the nerves and discs. He then removes a small part of the disc that is placing pressure on the nerve or spinal cord. Scarring is usually minimal, and recovery can be less than a few months in many cases. In fact, many patients are able to walk within hours of the procedure. Patients may need to start an exercise program about one month after the procedure to strengthen the back and maintain flexibility. In some case this procedure is carried out in an outpatient facility and no hospital stay is needed.

Should a microdiscectomy fail to relieve the pain or a larger procedure be necessary, there are two surgical procedures that can be used for a herniated disc, a laminectomy or a laminotmy. These procedures are performed under general anesthesia. The surgeon makes an incision near the disc problem and moves any tissue or muscles that obstruct his view. He then removes the lamina, the back part of the vertebra, and, if needed, part of the disc or damaged tissue. This gives the disc more space so that it does not press against a nerve. The second surgery is called a laminotomy. It is identical to a laminectomy except that only a portion of the lamina will be removed.

Complications from surgery for a herniated disc can happen. Potential risks include damage during surgery to nerves and dura, infection, and, if the surgery is performed on the lower back region, nerve damage that causes incontinence. Nerve damage can be temporary or permanent, depending on which nerve suffers the injury.

I hope this helped you learn more about back surgery for bulging or herniated discs.

Until next time,

Stuart

About the Author: Dr. Stuart Gold, M.D. is a board certified orthopedic surgeon who has 23 years experience specializing in sport injuries, joint replacement, arthritis and limb salvage. As the Director of the Orthopedic Institute, Dr. Gold recently published The Patient's Guide To Orthopedic Surgery to help patients better understand the challenges, risks and opportunities of orthopedic care.

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