If conservative treatments for a prolapsed disc or disc damage are no longer sufficient, disc surgery is used as a treatment option. There are now gentle surgical procedures available to this end. For example, microsurgery or endoscopy. Open back surgery or spinal fusion is only carried out in exceptional cases.
Discs consist of a soft inner core and a firmer outer ring. They lie as "shock absorbers" between the individual vertebrae of the spine.
In the event of disc damage or a prolapsed disc, also known in medical terms as a discus hernia, tissue presses out of the inner core through the outer ring onto the nerve roots which protrude from the disc of the spinal cord. The pressure of the prolapsed disc on the nerve roots causes typical symptoms such as back pain and sciatic pain which radiates into the leg.
A prolapsed disc is usually treated conservatively with physiotherapy, rest and medication. If such treatment does not bring the desired reduction in pain, surgery is then considered. An operation generally becomes crucial if the pressure of the prolapsed disc on the nerve root (nerve root compression) is too strong. As it could cause permanent damage.
There are various surgical treatments available. A prolapsed disc is normally fixed microsurgically or endoscopically with keyhole technology. A disc prosthesis may sometimes need to be inserted or the affected section of the spine fused.
What preparations are carried out before the procedure?
Different clarifications and examinations are undertaken before the procedure. The tumour is precisely localised with medical imaging procedures such as CT and MRI. Based on the examination results and the symptoms, the surgical procedure will be decided together with the patient.
He or she will usually be admitted to hospital on the day before the surgery. All the usual pre-operative assessments, such as a blood test, blood pressure measurement and an ECG, are also required beforehand. All blood-thinning medication must be discontinued beforehand and the patient must have an empty stomach when they go into surgery.
How is the operation carried out?
The location and severity of the prolapsed disc will determine which surgical procedure is used. In the case of smaller prolapses and if the disc is still somewhat intact, it can be removed microsurgically or endoscopically and the disc repaired. If the disc is badly damaged, it can be replaced with an artificial disc. Spinal fusion (spondylodesis) is sometimes an unavoidable final treatment option.
Endoscopic disc surgery
During endoscopic treatment, the endoscope is inserted via an incision in the skin. This is carefully pushed to the disc under x-ray control. Thanks to the camera built into the endoscope, the disc damage can be depicted. This is necessary to gently remove or vacuum it out with delicate instruments. This procedure is particularly suitable if the prolapsed disc is located side on to the spinal canal. The procedure is carried out under general anaesthesia or spinal anaesthesia, and takes half an hour to one hour.
Microsurgical disc surgery
Microscopic disc surgery is also a gentle surgical procedure. In comparison to endoscopic treatment, the skin incision is not made in the patient's side but rather in their back. The surgical microscope with different instruments is inserted via a skin incision and the disc can be removed microscopically. The operation is usually performed under general anaesthetic and takes approx. one hour.
Disc replacement, disc prosthesis
If the disc is badly damaged, an artificial disc made of metal with plastic core can be used as a replacement. The prerequisite for this is that the remaining space between the vertebrae is sufficient and the vertebrae are intact. Access to the lumbar spine is gained from the lower abdomen with a lengthways, a crossways or a bevel incision. It is thus an open operation. The damaged disc is excised and replaced with the artificial disc. Thanks to the disc prosthesis, spinal fusion can be avoided. The operation is performed under general anaesthetic and takes approx. two hours.
Spinal fusion, spondylodesis
Spinal fusion is a surgical procedure to stabilise the spine in the area of the disc damage. It is usually only done if conservative treatment measures have been exhausted and other surgical treatment methods are not possible.
Spondylosis is usually carried out from the back. After an incision is made in the skin, the back muscle is pushed to the side to allow the surgeon access to the spine. Disc or bone material which is pressing on the nerves is removed. Afterwards, the surgeon joins the affected vertebra with long rods and titanium screws. These are tasked with stabilising the spine until the spinal bones have grown together. As titanium is well tolerated by the body, the metal does not usually need to be removed at a later date. The operation is performed under general anaesthetic and takes approx. two hours.
What is the success rate of this procedure?
The decision to operate on disc prolapses must be weighed up carefully. There is no guarantee that the patient will be pain-free after the surgery. However, the operation can reduce their pain levels more often than not and allow them to keep working.
What are the possible complications and risks of this procedure?
This is a low-risk operation and generally proceeds without complications. As with all surgery, the operation may occasionally lead to infections, nerve damage, post-operative haemorrhaging or blood clots.
In rare cases, the disc prosthesis may shift or case a fracture in the spine.
Spinal fusion can sometimes cause the screws to loosen prematurely before the vertebrae have grown together stably.
What happens after the operation?
After the surgery, the patient is monitored during the recovery phase as they wake up from the anaesthesia. If everything proceeds normally, you can leave the hospital two or three days after the endoscopic and microsurgical procedures. During disc prosthesis or spinal fusion, the hospital stay is somewhat longer.
In any case, people who have undergone this operation should avoid lifting heavy objects and major physical exertion for several weeks after the surgery. Strengthening of the weakened back muscle is the most important prerequisite for a successful treatment. Therefore, targeted back exercises and physiotherapy should be undertaken early in small amounts. The spine should not be placed under undue strain for approx. six months. Strain through incorrect lifting should be strictly avoided.