WHAT AN OPERATION CAN DO: DISCECTOMY

There are three main reasons for operating: to relieve compression on the lumbar and sacral nerve roots; to stabilise one or more adjacent intervertebral joints when there is a mechanical weakness locally; and for intractable pain.

A disc prolapse if massive can compress the spinal cord, or nerve roots; the effects, in addition to pain, can include weakness, loss of feeling in the legs, and partial or total incontinence of urine. Then an operation to relieve the compression must be done with great urgency to control the nerve damage.

Discectomy-This operation is performed in order to free a nerve root. It is done under general anaesthesia. The removal of the prolapsed disc material may be all that is necessary, although the surgeon may decide to remove the whole of the disc nucleus, in order to prevent another prolapse.

Discectomy is not a serious operation, and often produces immediate relief from sciatic pain. The patient is usually allowed up almost at once and is encouraged to move; sometimes it is necessary to wear a corset for a few weeks. Most people are able to return to work, if it is sedentary, within a month or so; but if they do heavy work, they will not be able to return to it for at least two to three months.

In a few centres, orthopaedic surgeons and microsurgeons are speeding up recovery by doing the operation through a small cut and the use of modern optic equipment. This is called microdiscectomy.

Sometimes the surgeon finds it necessary to remove bony thickening and osteophytes from the vertebral arch or body near the joints, if they are causing stretching, angulation, adhesion or compression of the nerve roots. The removal of bone from the articular processes near the vertebral arch is called facetectomy.

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