A spinal disc herniates when the covering of the disc cannot hold the gel-like material inside, due to injury, overuse or aging. Often the inside portion of the disc will rupture through the covering, kind of like a jelly doughnut that is squished. Because the spinal nerves are right next to the spinal discs, the ruptured disc material may then put pressure on a spinal nerve, causing leg pain. There are many treatments which improve pain and function, including physical therapy to move the nerve away from the disc, medications or injections to decrease the inflammation of the compressed nerve or spinal surgery to physically remove the piece of disc from compressing the nerve.
Most patients understand that surgically removing the disc herniation will remove the pressure on the nerve and cause the pain to go away. As this is the most expeditious, but also an invasive way to pain reduction, patients often want to hear the details about this surgical option before proceeding with other treatments.
Disc herniation surgery (microdiscetomy) is one of the least invasive spine surgeries I perform. When I speak with patients and families about surgery, our discussion tends to revolve around the procedure, recovery and potential complications. Most patients understand the concept of the surgery, but are worried about the potential for something to go wrong.
A new study from Norway, (The Bone and Joint Journal, April 2019) looked at over 34,500 microdiscectomy surgeries to determine the rates of complications, re-operations and re-admissions to the hospital. (Norway has a unique, socialized healthcare system that allows the government to track any person in the system for their whole lives. As the country is small, and people don’t tend to leave, the healthcare system is able to follow patients for long periods of time). It was determined that the most common surgical complication was a tear in the covering of the nerve (dural tear) which occurred during surgery in just over 1% of surgeries. Other surgical complications (including infection, bleeding, anesthesia complications and wound problems) occurred in less than 0.5% of patients.
Patients also express concern about needing an additional spine surgery down the road. For decades, a commonly held perception was that spine surgery, specifically disc surgery, would provoke a need for further disc surgery in the future. This worry was proven to be unfounded in this study, as only 2.1% of patients with a microdiscectomy surgery needed further disc surgery in the future. Causes for a second surgery at the same level were multi-factorial, including a re-rupture of the disc, wound problems and infection that happened exclusively in the first 90 days post-operatively from the original surgery. Over the fourteen years of this study, the long-term rate of having another operation on the spine, for any reason, was only 3.4%.
No patients died during surgery or within 90 days of the surgery, which is one of the greatest fears of patients who undergo general anesthesia. The overall complication rate for any reason for this large group of surgical patients was 6.6%, over the fourteen years of the study.
More complications occurred in older patients, as they were more likely to have other medical ailments. As we age, it makes sense that our bodies don’t heal as well as we did when we were young. Older folks typically have more medical problems, including heart disease, lung disease or diabetes, which increase their risk of having a surgical complication.
This very large and well-coordinated study should give patients significant comfort knowing that the surgical risks in these minimally-invasive disc surgeries are very low with the long-term risk for needing another surgery at 3% over fourteen years. In other words, 97% of patients won’t need another surgery. These are all positive aspects that should be considered when contemplating disc surgery. Your surgeon should be able to discuss their specific surgery complication rate with you, prior to making your decision.