Herniated Disk Surgery

Temple is at the forefront of contemporary spine surgery. If your condition is a herniated disk, minimally invasive and endoscopic spinal treatments may be available to treat the problem.

What is a herniated disk?

A herniated disk is a disk that has bulged out from its proper place in your back. Disks are small, circular cushions between the bones of your spine (vertebrae). Normally, these disks act as shock absorbers to cushion your vertebrae from each other as you move. A herniated disk, however, may press on nearby nerves and cause severe pain.

Most herniated disks are in the lumbar, or lower, section of your back.

Herniated lumbar disks

If a lumbar disk is herniated, your symptoms may develop gradually or suddenly. Symptoms may include:

  • Back pain
  • Numbness
  • Tingling, pain or weakness in one or both legs
  • Changes in bowel or bladder habits

Herniated cervical disks

In your upper spine, there are seven cervical (neck) vertebrae separated by disks. Most cervical disk herniation occurs as a result of sudden stress. This can happen during movements resulting in sudden flexion, extension or twisting of the neck, such as a fall or a vehicle accident. Sometimes herniation occurs gradually over weeks or months.

Symptoms may include:

  • Dull or sharp pain in the neck or between the shoulder blades that can increase with certain positions or after certain movements
  • Pain that radiates down the arm to the hand or fingers
  • Numbness or tingling in the shoulder or arm

Some of the risk factors that can contribute to a disk herniation include:

  • Aging. As we get older, disks gradually dry out, affecting their strength and resiliency
  • History of trauma to the cervical spine
  • Lifestyle choices. Lack of regular exercise, not eating well and smoking substantially contribute to poor disk health
  • Poor posture, repetitive lifting and twisting. These place additional stress on the cervical spine

Treating your herniated disk

Four out of five adults have back pain at some time in their life. Most of the time, back pain gets better in two to four weeks with conservative therapy. When pain limits the quality of your life and other treatments do not help, microsurgery at Temple University Hospital may be the answer.

Microsurgery (microdiskectomy)
A microdiskectomy, also known as an endoscopic diskectomy, is a surgical procedure performed on patients with a herniated disk. It can be performed for most patients.

The microdiskectomy procedure involves a small incision that is usually less than two inches. Using an endoscope—a thin, flexible lighted tube with a camera—a small amount of soft tissue and sometimes bone is removed to gain access to the spinal nerves and disk. The ruptured portion of the disk can be then lifted away and discarded. The remainder of the disk, which is located between the vertebral bodies, usually can be left undisturbed.

Risks of surgery:
The risks of surgery will be reviewed in detail by your surgeon prior to your procedure. Risks include, but are not limited to, infection, bleeding, cerebral spinal fluid leak, failure to improve, residual disk herniation, weakness, numbness, paralysis or death. These risks are highly unlikely, but may occur.

Preparing for your surgery:
You will come to the hospital for a pre-anesthesia evaluation that will include a history and physical examination, as well as all necessary pre-admission testing. This is to ensure your safety under anesthesia. You can expect this visit to the hospital to last one-half to two hours. During this appointment you may be asked to give blood and urine samples, and to have a chest x-ray and an EKG. If these pre-operative tests were completed at your primary care physician's office, please bring the results to your appointment at the Pre-admission Testing Center.

Insurance pre-certification:
The hospital's pre-certification department handles all of the pre-certification needs of your insurance company.

Arrival time:
A representative from the Short Procedure Unit will contact you after 3:00 pm the day before your scheduled surgery to tell you the time you should arrive at the hospital.

The day of surgery:
If you are diabetic, your nurse will have special instructions for you. In addition, please follow these instructions:

  • No food or drink after midnight the night before your procedure
  • Get plenty of rest
  • Avoid smoking and drinking alcohol during the 24 hours prior to your procedure
  • Do not chew gum or eat mints
  • Shower the night before surgery
  • Remove any fingernail polish and artificial nails
  • Avoid use of cosmetics and facial creams or lotions
  • Dress comfortably in loose fitting clothing the morning you arrive
  • Leave all valuables at home or with a family member who will be responsible for those items

Medications
The morning of your procedure, take your usual medications with a small sip of water, unless the physician has given you other instructions. If you are taking any of the following medications, ask your physician if you should discontinue them prior to surgery:

  • Warfarin
  • Aspirin
  • Ibuprofen (such as Advil®)
  • Naproxen
  • Other arthritis medications
  • Herbal medicines/vitamins/supplements
  • Bring all of your medications with you in their original bottle on the day of the surgery. Do not forget to bring inhalers

Before surgery:
An intravenous catheter (IV) will be inserted in your hand or arm. This will stay in place throughout your surgery, delivering a saline (salt) and sugar solution to prevent dehydration. Necessary antibiotics, anesthetics and medications can be injected through the IV system as well.

During surgery:
When it is time for your surgery, you will be taken to the "holding area" outside the operating room. Just before surgery, the anesthesiologist will explain the risks and benefits of the type of anesthesia that will be used for your surgery. General anesthesia is almost always used for spine surgery. If you have previously had general anesthesia and experienced nausea afterwards, tell the anesthesiologist and anti-nausea medicine may be ordered for you. During the procedure, it may be necessary to place a urinary catheter. This will be removed as soon after surgery as possible.

Your family and friends will be directed to the Family Lounge located on the second floor of the hospital near the Short Procedure Unit. The surgeon will make arrangements to meet them there and speak with them immediately after surgery to answer any questions.

After surgery:
Immediately after surgery, you will be cared for in the Post-Anesthesia Care Unit. Nurses will attend to you as the anesthesia wears off and monitor your blood pressure and pulse. As soon as possible, we will ask you to begin moving your feet in circles and to take deep breaths to help get your respiratory and circulatory systems working as efficiently as possible. If you are having pain, you will be given pain medication.

You will need to stay overnight at the hospital for observation. Your hospital stay may be extended if the need arises.

You may take aspirin, ibuprofen or Tylenol® for mild to moderate pain. A stronger medication may be prescribed if necessary.

Care of your incision:
If your surgical site has a surgical dressing, you may remove it after two days. You may cover it with clean gauze if you feel more comfortable. You may have Steri-Strips™ which look like small pieces of tape, over your incision. The Steri-Strips™ fall off naturally as your incision heals. Do not tug or pull on them before they are ready to fall off.

Follow-up visits:
You will return to the office about one to two weeks after your surgery for follow-up examination.

Showering:
Ask your surgeon how soon after surgery you may shower. Usually it is allowed within one to three days. Avoid scrubbing the area and do not let the water run directly over your incision. If you are having any drainage from the wound, contact your surgeon and don't shower.

Activity:
Walking is your only exercise for the first few weeks. You may increase your activity level slowly. Realize that some days you will feel better than others. It helps to go for short frequent walks each day. You may walk up and down the stairs.

Listen to your body. If you are having a great deal of discomfort, then you are doing too much. Some recurrence of leg pain a day or more after surgery is normal but should improve with time. Prolonged sitting or riding in a car puts pressure on your disk and incision. We do not recommend driving or riding in a car for one to two weeks after surgery, except for trips to the doctor.

Diet:
Return to your normal diet. Pain medication and inactivity can lead to constipation. Drinking fluids and adding fruit and fiber to your diet can help to avoid this. A stool softener such as Colace®, which is available without prescription, is recommended for the first week after surgery.

When to call your surgeon:
Contact your surgeon if you have any of the following symptoms:

  • Increased pain, or pain unrelieved by your prescription pain medicine
  • Fever greater than 100.5ºF or shaking chills
  • Redness, drainage of blood or fluid or swelling at the incision site

It is normal to have some numbness after spine surgery, but if you experience increasing pain, numbness, or weakness in your legs, contact your surgeon immediately.

Return to work:
Those people who have non-strenuous jobs usually return to work within a few weeks of their surgery. If you do more active work, you may need to wait 6 to 8 weeks before going back. Discuss your activities with your surgeon.

Back Precaution Do's and Don'ts:
Contact your surgeon if you have any of the following symptoms:

  • Do keep a balanced, aligned position of comfort at all times. When lying on your side, place a pillow between your knees and your back
  • Do arrange work areas so they are above your hips and below your shoulders to prevent bending, stooping or reaching
  • Do lie down when you rest. Lying down puts less stress on your back than sitting
  • Do walk as much as a mile each day. As you start to feel stronger, you can walk outside, but be careful to avoid the risk of falling
  • Do bend your hips and knees when lifting; do not bend at the waist. Lift with your legs, not with your back
  • Don't twist your spine when turning; turn your whole body
  • Don't reach, stoop, or bend forward at the waist or from side to side
  • Don't lift anything heavier than three pounds; hold objects close to your body
  • Don't strain your abdomen as in coughing, sneezing or using the toilet
  • Don't do excessive physical activity until your surgeon says it is okay

Advil® is a registered trademark of Wyeth, Madison, NJ

Colace® is a registered trademark of Purdue Pharma, L.P., Stamford, CT

SteriStripis a registered trademark of 3M, St. Paul, MN

Tylenol® is a registered trademark of McNeil Laboratories, Fort Washington, PA

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