Talk:Discectomy

When to Have Surgery

If you suffer from sciatica pain, it's important to know that, no matter how severe the symptoms are, it will often resolve on its own. That said, of people that do get better spontaneously, most do so in the first 6 to 8 weeks.

Early discectomy surgery is recommended for people that have such severe pain that they cannot function, have significant neurologic deficits (like leg weakness or bowel or bladder incontinence). For pretty much every one else, a 6-8 week trial of non-operative management is recommended. Typically, this treatment includes physical therapy, medications, and, occasionally, shots in the back called epidural steroid injections. —Preceding unsigned comment added by Truumees (talk • contribs) 21:38, 1 March 2009 (UTC)

Alternatives to Discectomy

For the purposes of this article, the term discectomy will be used to imply modern approaches to disc decompression, which include a laminotomy (expanding the window between the lamina bones in the back) and a microscopic, partial discectomy (removing only the piece of disc that's out of place, typically under microscopic or loupe (surgical telescopes) magnification). A laminectomy requires removing the entire lamina bone. This is not usually needed for a discectomy, but the same term if often used. Similarly, the whole disc is not typically removed, just the part out of place, hence a partial discectomy, but, usually the term discectomy is used. While the term micro- is not always used, most of these procedure are done with magnification of one kind or another.

Non-operative management is not really an alternative in that patients should not have discectomy surgery unless they have failed to get better with non-operative treatment. That said, unless you have major weakness or bowel and bladder problems, one option is to wait.

Laser surgery is often recommended for patients with disc problems. Unfortunately, there is little evidence that LASER adds anything of value to the procedure. In fact, LASERS provide heat, which the nerves do not like. Most respected neurosurgical and orthopaedic spine surgeons do NOT use lasers.

Chiropractic may offer short term pain relief in some, but a number of studies have shown that it does not change the outcomes in disc herniation patients. Most people get better simply because they would have gotten better no matter what.

Spine fusions are offered to patients with disc problems and have a legitimate role in those who keep herniating the same disc or those that have instability of the spine (a slippage or spondylolisthesis). Fusions are also considered in patients with months or years of severe low back pain. A fusion is a much bigger operation than a microdiscectomy.

Disc replacement surgery is not done in lieu of discectomy, but rather in lieu of spine fusion. Unfortunately, disc replacements are reasonable in only a small percentage of patients. In the low back, these procedures are done for back pain, not for sciatica.

Disc/Annular techniques include a whole host of procedures in which a catheter is inserted into the disc through a needle. Various modalities like heat, radiofrequency energy or UV light are used to "cook" the disc. Theoretically, these techniques tighten the colagen in the disc and the material retracts, thereby taking pressure off the nerve. For sciatica patients, evidence supporting these procedures is pretty sparse. Moreover, to "fix" the displaced part of the disc that's causing pressure, these techniques harm the remaining disc that the body needs as a shock absorber. —Preceding unsigned comment added by Truumees (talk • contribs) 21:50, 1 March 2009 (UTC)

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