A recurrent disc herniation is the major cause for concern with this type of surgery as 10-15% of patients will require additional spine surgery to remove another disc fragment following herniation. Those patients who have had nerve compression for some time prior to back surgery are less likely to achieve a full resolution of their symptoms, with the success of the procedure around 85-90%. Discectomy has all of the usual risks associated with back surgery including:
- dural tear
- spinal fluid leakage
- muscle and nerve damage
- failure of the surgery to resolve the symptoms
Patients who undergo an open discectomy will usually incur larger degrees of tissue damage, experience more blood-loss, and take longer to get back on their feet than those having minimally invasive back surgery. If some of the back muscles were severed to allow access to the spine during the procedure then recovery is liable to take longer and be more painful as the spine settles down and the other back muscles compensate for the loss. Scarring is more apparent with open discectomy with a larger incision externally, and potential fibrosis internally where ligaments, nerves, and muscles were impacted by retractors and other instrumentation.
Patients with clear-cut compression of nerves due to herniated or bulging disc material are excellent candidates for a discectomy and will likely experience a significant relief from symptoms once the offending material is removed by this type of back surgery. Relief may be felt instantaneously if patients undergo the procedure under a local anaesthetic, although symptoms of numbness and weakness are likely to take a little longer to dissipate as the nerve heals over time. Inflammation from tissue trauma may need to reduce before experiencing the full effects of the procedure for some patients and they may be prescribed NSAIDs to achieve this more quickly.
Minimally-invasive back surgery carries approximately a 4% risk of infection, with other risks including transient dysaesthesia, and nerve root irritation, although incidence of these in two reviews of a small number of patients were 2.3% (Ahn, 2004), and 1.1% (Hoogland, 2008) respectively. None of the patients in these studies had permanent nerve damage. There is, as always, a risk that the surgery will not correct the symptom the operation was performed to address. Ahn (2004) found that 81.4% of patients undergoing a minimal access lumbar discectomy had an excellent or good outcome.
Watch this video that explains the risks and complications of spine surgery
Next read about: Endoscopic Discetomy