Surgical treatments for a lumbar
herniated disk
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).
Surgery options for a lumbar herniated disk
There are many different options for surgery for herniated disks. Whichever
procedure the surgeon uses probably does not matter as much as their comfort
level with the procedure, and with their experience.
The gold standard for surgery is an open or
microsurgical discectomy. In the last
10 to 15 years the microdiscectomy surgery has
been modified to allow for a relatively small
incision and less soft tissue dissection, which
provide for significantly less postoperative
discomfort and quicker healing.
Another surgical option to treat a lumbar herniated
disk is chymopapain injections that dissolve
the disk. This procedure is less invasive than
surgery, and has had varied success and popularity
among surgeons. It has been available since the
1970’s, but comparison studies have indicated
that a lumbar discectomy is a more reliable option.
In the 1990’s, an arthroscopic lumbar
discectomy procedure was introduced as
a less invasive alternative. This procedure
carries a steep learning curve for the surgeon
and is only appropriate for certain types of
disk herniations. Overall, it has not been
found to be as useful as anticipated.
New technology to treat a lumbar herniated
disk
Lastly, a new technique called microendoscopic surgery is currently
being investigated. It uses a new retraction system to allow visualization
of the disk herniation through a small incision. Since the approach is similar
to a microdiscectomy, the learning curve is not as steep as with arthroscopic
procedures, and it should carry a similar success rate as lumbar discectomies.
Although it is less invasive than an open lumbar discectomy, it has not been
shown to decrease the morbidity of surgery (such as post-operative pain and
discomfort) over that of a microdiscectomy.
Laser surgery has not been shown to be an effective
alternative to more traditional lumbar disk surgery
techniques.
By: Peter
F. Ullrich, Jr, MD
May 8, 2000
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