Lumbar discectomy surgery outcomes

Ross Hauser, MD

Many people have very successful lumbar discectomy procedures. These are typically not the people we see at our center. We see the people who had lumbar discectomy with less than hoped-for results and a worsening of their condition. In this article, we will explore failed lumbar discectomy and post-surgical treatment outcomes.

If you had a lumbar discectomy or have been told to consider one, you know that this surgical procedure seeks to remove whole or part of a damaged or herniated disc in the lower back. Your doctors would have told you that the procedure is necessary to remove the disc because it is pressing on your nerves. For some people, this surgery is necessary, especially in instances where there is a loss of sensation, loss of bladder or bowel function, or function in the legs. For others, the surgery was recommended because traditional pain treatments such as painkillers, anti-inflammatories, physical therapy, yoga, and exercise did not alleviate the symptoms. Please see our article Why physical therapy and yoga did not help your low back pain as we expand on the subject of failed treatments.

Types of discectomy surgery

A lumbar discectomy is considered a more traditional “open” surgery meaning a large incision is made. A lumbar microdiscectomy is a surgery that while still an open surgery, is considered minimally invasive as it is performed with a smaller incision. An Endoscopic lumbar discectomy is considered even moreso minimal with less damage to the surrounding tissue. What is the difference between all these procedures? That depends on the extent of your problem. In some instances, doctors will decide that you will need a spinal fusion because once the lamina, the bone of the vertebrae is cut away to allow for the surgical instruments to get to the herniated disc, the spine may become too unstable and screws, plates, and rods will be needed. Screws, plates, and rods will need a bigger incision.

All three of these surgical options have shown very successful outcomes. As stated above, the very successful outcomes people are not the people we see. But how did they become unsuccessful outcomes people? For most, the answer is continued spinal instability.

In the image below we see a general concept of how open discectomy, endoscopic discectomy, laminectomy and laminotomy are performed.

Lumbar discectomy surgeries described

 

Profiles of failed lumbar discectomy cases

Below is a sample of what people tell us in the many emails we get:

Re-herniation

I have a re-herniation at my L5/S1. I already had a partial discectomy, and now my doctor says it is pressing on a nerve, I am looking for other options besides spinal fusion.

Burning nerve pain after L4/L5 microdiscectomy

I had an L4/L5 microdiscectomy 2 and a half years ago. Since that time I have experienced burning nerve pain. I can’t sit for long, lie on my back, or stand for long. As soon as I get out of bed in the morning it starts.

Some mild reoccurrence of symptoms

I had a microdiscectomy at L5/S1 a few months back. The surgery removed a herniated disc that was causing immense pain, mostly with sitting.  Surgery did alleviate the symptoms. I’m mostly better now. However, lately, I have been experiencing some mild reoccurrence of symptoms mostly when I drive or sit for too long. My hip feels very tight.

Unable to bend at the waist

Have had microdiscectomy. It failed. Now facing spinal fusion. I am still unable to bend at the waist, I’m scared to lift more than 10 pounds. Sitting is a major problem.

My pain has returned and surgery is only successful for so long

I had a discectomy in 2019. I’ve had lower back problems, due to degenerative disc, for years. My pain has now returned. The surgery was only successful for so long. I need other alternatives. I want to be able to function normally without pain.

Prolapsed L5/S1 disc

I had a discectomy in 2019 for pain in my left leg and lower back. Now I have a prolapsed L5/S1 disc and the pain has returned.  I am being told I need to remove the remainder of the disc and have fusion. I am afraid of more damage.

Why did the lumbar microdiscectomy fail

When I was in medical school and residency back in the 1980s, the most common spine operation was disc and bone removal, called discectomy and laminectomy, respectively. Both operations make the spine more unstable, especially a laminectomy. As you can imagine, many people who received laminectomy surgeries had initial pain relief ultimately followed by severe, worsening pain. Many later required large spinal fusions, which can be fraught with a separate set of awful long-term consequences.

In many cases we have seen, short-term success and long-term failure of the lumbar microdiscectomy occurred because of degenerative spinal instability. As the spine became more unstable pressure was exerted on the discs and the discs slipped and herniated. This also caused a flattening of the discs. This problem was discussed by researchers at the University of Texas at San Antonio and the University of Connecticut in a February 2022 paper in the journal Computers in Biology and Medicine. (1) As the name of the journal implies the researchers used computer models to predict “consequences from this surgery on the biomechanics of the spine. . . ”

Using a computer model the researchers focused on the L4-L5 spinal segment to:

What they found was: Aggressive-percutaneous transforaminal endoscopic discectomy in a healthy disc decreased facet distances in axial rotation, lateral bending, and flexion  (caused the disc to flatten). Mild and severe disc degeneration increased the stiffness of the spine, resulting in a decrease in the range of motion for all conditions. Severe disc degeneration decreased ROM as high as 57% for lateral bending, while a 13% decrease was observed for mild degeneration. High and abnormal endplate stress distributions were observed due to percutaneous transforaminal endoscopic discectomy.

What we have above is a detailed description of the consequences of this surgery on the biomechanics of the spine. The consequences are spinal instability causing disc degeneration.

Microdiscectomy for sciatica pain are the reported outcomes correct?

A team of neurosurgeons in the Netherlands published a February 2022 study in the European Spine Journal (2) suggesting that favorable outcomes for microdiscectomy for sciatica may not have been that favorable. How? This is what the paper said:

“It remains unclear whether the long-term results of randomized control trials regarding the outcome of microdiscectomy for the lumbosacral radicular syndrome are generalizable.” In other words, are the results reported accurate for all patient types, or are they accurate to a specifically smaller group of patients. Are the good results for everyone or a select few?

To answer this question, 246 patients (average age 51 years old) who had a  single-level microdiscectomy for MRI disk-related lumbosacral radicular syndrome answered questionnaires about back pain, leg pain, function, disability, and recovery.

The researchers noted that in their 246 patients, the long-term results after microdiscectomy for lumbosacral radicular syndrome were less favorable than those obtained in randomized control trials, possibly caused by less strict patient selection than in randomized control trials. The findings emphasize that patients, who do not meet the same inclusion criteria for surgery as in randomized control trials, should be informed about the chances of a less favorable result.

In summary: This study was performed on patients at a high-volume spine center. At this center, more advanced cases of spinal degeneration were seen and operated on than those in the published randomized control trials. The more advanced spinal degeneration patients would likely not get the same results and as the published research may not have included advanced spinal degeneration patients in their outcomes, these patients should be told they would likely not have the same outcome.

Successful radiculopathy surgery is not always successful for low back pain and can cause more spinal instability

A January 2022 paper in the journal Medicine (3) examined the question as to whether discectomy improves low back pain as well as radiating pain in patients with lumbar herniated intervertebral disc. In this paper the doctors wrote that “Most postoperative patients with herniated lumbar disc complained of lower leg radiating pain (LRP), referred buttock pain (RBP), and low back pain (LBP). When discectomy is performed, improvement in lower leg radiating pain is observed due to spinal nerve irritation. However, long-term low back pain due to degenerative changes in the disc may occur postoperatively.”

What is being suggested is that the pain radiating into the legs from spinal nerve irritation can be helped by the discectomy, however, degenerative changes in the disc continue on. This can be caused by the degenerative condition causing spinal instability.

Returning to the study the doctors continue:  “limited research has been reported on the short-term (within 1 year) improvement in low back pain after discectomy. This study aimed to evaluate the effectiveness of discectomy in reducing low back pain within 1 year postoperatively.”

Findings:

This according to the paper puts the surgeon in a decision making process, “The surgical spine surgeons may prefer to remove the herniated disc aggressively to reduce recurrence or remove the herniated disc less aggressively to reduce back pain caused by degenerative changes. However, consequential degenerative changes in (disc) may still trigger low back pain, and limited discectomy may cause recurrent (disc) herniation.”

For a further discussion please see our articles Sacroiliac Joint Dysfunction Symptoms and Treatment Options, and Sciatica and lumbar radiculopathy treatments.

Summary and contact us. Can we help you?

We hope you found this article informative and it helped answer many of the questions you may have surrounding discectomy.  If you would like to get more information specific to your challenges please email us: Get help and information from our Caring Medical staff

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References

1 Prado M, Mascoli C, Giambini H. Discectomy decreases facet joint distance and increases the instability of the spine: A finite element study. Computers in Biology and Medicine. 2022 Apr 1;143:105278. [Google Scholar]
2 Lequin M, Verbaan D, Schuurman PR, Tasche S, Peul WC, Vandertop WP, Bouma GJ. Microdiscectomy for sciatica: reality check study of long-term surgical treatment effects of a Lumbosacral radicular syndrome (LSRS). European Spine Journal. 2022 Jan 7:1-8. [Google Scholar]
3 Ko S, Kwon J. Does discectomy improve low back pain as well as radiating pain in patients with lumbar herniated intervertebral disc (HIVD)?. Medicine. 2022 Jan 7;101(1). [Google Scholar]

 

 

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