Lumbar discectomy surgery outcomes

Ross Hauser, MD and Danielle Matias, PA-C

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.

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:

determine changes in facet joint distance during physiological motions of a lumbar spine in a:
- healthy-normal condition,
- after conservative and aggressive percutaneous transforaminal endoscopic discectomy (PTED) to correct lumbar disc herniation,
- and during mild and severe (disk degeneration);
determine spine instability and endplate stresses under various physiological motions.

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.

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

Diagnosing lumbar instability & treatment with Prolotherapy, PRP, cortisone, nerve blocks

Ross Hauser, MD and Danielle Matias, PA-C discuss the types of cases we see at Caring Medical Florida for low back pain and spinal instability.

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]