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Herniated Disc

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Surgery for a Herniated Disc

Surgery for a slipped disc has come a long way recently with the development of minimal access, minimally invasive techniques. Although traditional open surgery may sometimes be necessary, the Weill Cornell Brain and Spine Center is a leader in newer, minimally invasive options.

Starting with only a tiny incision (top right) a neurosurgeon inserts the endoscope into the herniated disc using an endoscope, a long, slim tool that includes a camera and a channel for small tools. A tool threaded through the channel is used to repair the disc.

Endoscopic Discectomy: The least invasive option available, this advanced technique requires only the tiniest of incisions (7 mm, or less than a quarter of an inch). A specially trained neurosurgeon inserts a slender endoscope into the incision, and the wafer-thin camera and tools are guided to the herniation under X-ray navigation. There is no cutting into muscle, making the procedure essentially painless, and patients go home the same day. Many patients who would previously have required fusion surgery can now avoid that by having an endoscopic discectomy instead. More about endoscopic spine surgery

Artificial disc replacement: This is a minimally invasive surgery, most often performed on the cervical spine. The surgeon makes a small incision on the front of the neck, and, with the aid of a microscope, locates the affected disc and removes it, thus decompressing the nerve. The disc that was removed is then replaced by a synthetic disc substitute, which eventually is able to serve the function of a healthy disc. This surgery takes 1-1.5 hours, and recovery for patients is often rapid. (Watch video here.)

The goal of microdiscectomy is to remove the bulge from the herniated portion of the disc and to relieve pressure on the affected nerve.

Minimally invasive microdiscectomy: This minimal-access technique reduces the trauma associated with open surgery and allows patients a shorter recovery time, less post-operative pain and scarring, and a faster return to normal activities. Minimally invasive spine surgery requires only tiny incisions and often takes less than an hour. The goal of minimally invasive microdiscectomy is to remove the bulge from the herniated portion of the disc and relieve pressure on the affected nerve. The surgeon makes a half-inch incision and uses x-ray guidance to insert a circular retractor tube. The surgeon uses a microscope to carefully remove the herniation and free the nerve. The surgeon then removes the retractor  and closes the incision, using plastic surgery techniques to reduce scarring.

Dr. Eric Elowitz and Noah Emmerich discuss the microdiscectomy that relieved the actor's pain

Video: Dr. Eric Elowitz and Noah Emmerich on Microdiscectomy

Patients are walking within a few hours of the procedure and will typically have either complete or near complete relief of their pain following recovery from their surgery. Patients are often discharged the same or the next day and can often return to work in a few days.

Minimally Invasive Fusion: This surgery fuses vertebrae together so that there is no longer any motion between them. This reduces spinal pressure, pain, and nerve damage. Minimally invasive fusions do not require the large incision or the muscle retraction typically used in conventional fusions. Patients undergoing this procedure have a fast recovery time. A recent advance is the use of a computerized image guidance system for many patients undergoing fusion. This has the advantage of aiding the surgeon in optimal placement of screws and avoiding injury to delicate nerve tissue. (See more about TLIF minimally invasive spine fusion.)

At the Weill Cornell Brain and Spine Center, individuals treated for a herniated disc have only a brief hospital stay (usually not even overnight), and 95 percent of patients will have complete relief of their pain. (Find Doctors Who Treat Herniated Discs.)

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See also: Dr. Elowitz's article on surgery for herniated cervical discs on spine-health.com

Reviewed by: Eric Elowitz, MD
Last reviewed/last updated: September 2020
Illustration by Thom Graves, CMI