Laminotomy and Discectomy
The traditional way of treating a herniated disc is to perform a laminotomy and discectomy. The term laminotomy means "make an opening in the lamina." This procedure is used to give your doctor room to see and work inside your spinal canal. The term discectomy means "remove the disc."
The laminotomy is performed through an incision down the center of your back over the area of the herniated disc. Your muscles are moved to the side so your doctor can see the back of your vertebrae. X-rays may be required during surgery to make sure the correct vertebra is located. Once the correct vertebra has been confirmed, your doctor will cut a small opening through the lamina bone on the back of your spinal column. The nerve roots are moved out of the way so the problem disc can be located.
Upon locating the herniated disc, your doctor will remove it to ease pressure and irritation on the nerves of your spine. Small instruments that fit inside the disc are used to remove as much of the nucleus as possible. This prevents the remaining disc material from herniating in the future.
Advances in Discectomy Surgery
Improvements have been made in the tools available to your doctor for performing a discectomy. These improvements include:
Microdiscectomy is essentially the same as traditional discectomy, but this newer approach has several advantages. A much smaller incision is needed when performing a microdiscectomy. Also, there is less damage to nearby parts of your spine, and recovery tends to be faster. With microdiscectomy, a small incision is made in your back just above the area where the disc is herniated. Muscles are moved aside to see the vertebrae. Your doctor positions a microscope in the small incision. The remainder of the surgery is performed like the traditional method.
Many surgical procedures have been revolutionized by the use of special TV cameras. In endoscopic discectomy, the procedure is still the same, but even smaller incisions (1/4 inch) are made to insert a special magnified TV camera into your spinal canal so your doctor can actually see the disc material. Through these tiny incisions, the camera and several other surgical instruments are inserted. Rather than looking through a microscope, your doctor watches the TV screen while working with specially designed instruments to remove the disc material.
Torn cartilages of the knee are now routinely removed with an arthroscope, and gallbladders are routinely removed with a laproscope. These small scopes give doctors a method of doing surgery with smaller incisions and with less risk to the nearby tissues. The same approach is evolving with spine surgery. Endoscopy of the spine is still in experimental stages and is not yet widely used. It might eventually give doctors a way to remove a disc with even less risk of injury than microdiscectomy.