Patients with radicular pain, weakness, numbness, loss of fine motor skill and strength, and paraesthesias in the arms and neck are candidates for discectomy where the symptoms are a result of a herniated or degenerative disc. The majority of patients will have tried more conservative treatments initially, although some patients with acute loss of motor control, weakness, numbness, and severe pain may be rushed into surgery to prevent permanent nerve damage. Conservative treatments, such as the use of analgesics and NSAIDs, complementary therapies, and physical therapies are usually tried for three to six months before back surgery is considered appropriate.
Prior to a discectomy, patients will undergo a series of diagnostic testing, such as X-Rays and MRI scans, to ascertain the level where the problems exist and the possibility of discectomy relieving those symptoms. Selective nerve root blocks (SNRB – pronounced snerb) may also be used to clarify which nerves are causing the symptoms such as radicular pain or numbness. Patients who have suffered acute trauma to the neck or back, through a whiplash or contact sports injury perhaps, are likely to be candidates for immediate surgeries such as a discectomy if the damage may cause permanent nerve pathology. The presence of osteophytes (bone spurs) in the spinal column, or vertebral slippage may affect the available treatment options and patients with back pain should discuss all of the appropriate procedures with their physician prior to back surgery being scheduled.
Anterior Cervical Discectomy
Those with herniated disc in neck may also be candidates for a discectomy and may undergo a slightly different procedure called an anterior cervical discectomy. This operation accesses the spine from the front of the neck and, therefore, carries a number of unique risks associated with the complex region of nerves, blood vessels, thyroid, larynx, and other cervical spinal structures. The anterior approach is the most common type of discectomy performed for the cervical spine however, as the curvature of the neck makes herniated material most likely present at the front of the spine rather than the back as with lumbar disc herniation.
A back surgery fusion may be required which could necessitate a bone graft made up of the patient’s own bone, thereby adding another procedure to the back surgery itself. Obese or heavily overweight patients may not be able to have minimal access discectomy surgery as the instrumentation might not be able to penetrate the tissue of the back sufficiently to reach the vertebral column; an open procedure is often preferred although this carries with it the associated risks of respiratory complications that in themselves are more likely in larger patients.
Pre-Spine Surgery Testing
Patients will also be tested for signs of infection immediately before any scheduled surgery as this will most likely prevent the procedure from taking place. Pre- and post-operative antibiotics may be given if there is concern over the possibility of infection. Guidance on the cessation of medications will be given prior to surgery, and patients should ensure that any herbal or nutritional supplements they are currently taken are known to their doctor so that advice can also be given on these (some anti-inflammatory remedies may also be blood-thinners, fish oil for example). Patients are discouraged from smoking prior to, and after, back surgery as this can severely impair their recovery, particularly in the cases where patients require spinal fusion after a discectomy.
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