A herniated disc occurs when the outer layer of an intervertebral disc tears, allowing the gel-like inner nucleus pulposus to bulge out. This can press on nerves and cause pain. While most herniated discs heal on their own, surgery may be recommended if conservative treatments like medication and physical therapy do not provide relief. Common surgical procedures to treat a herniated disc include endoscopic spine surgery, discectomy to remove the bulging disc material, and laminectomy to remove part of the vertebrae pressing on nerves. Recovery from herniated disc surgery typically involves avoiding strenuous activities for 4 weeks to prevent re-injury while allowing time to heal.

1. HERNIATED DISC SURGERY
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2. INTRODUCTION
WHAT IS HERNIATED DISC?
The spine is made up of individual bones known as
vertebrae.
Intervertebral discs are discs of cartilage that sit between
the vertebrae.
The function of the intervertebral discs is to support the
spine and act as shock absorbers between the vertebrae.
Nucleus pulposus: This is the inner gel-like portion of the disc that gives the spine its flexibility
and strength.
Annulus fibrosis: This is a tough outer layer that surrounds the nucleus pulposus.
Cartilaginous endplates: These are pieces of cartilage that sit between the disc and its
adjoining vertebrae.
There are normally 23 discs in the human spine. Each disc is made up of three components:

3. In a herniated disc, the annulus fibrosis is torn
or ruptured.
This damage allows part of the nucleus pulposus
to push through into the spinal canal.
Sometimes, the herniated material can press on
a nerve, causing pain and affecting movement.
Each year, herniated discs affect around 5–20 of
every 1,000 adults between the ages of 20 and 49
years old.
A herniated disc can occur anywhere in the
spine.
The two most common locations are the
lumbar spine and the cervical spine.
The lumbar spine refers to the lower back, while
the cervical spine refers to the neck region.

5. Most herniated discs do not require surgery. In approximately 9 out of 10 people, symptoms will
resolve over days to weeks.
Some people who have a herniated disc do not experience any symptoms at all.
Sometimes, however, the herniated disc presses against a nerve in the spinal column. This
can cause pain, numbness, or weakness in the part of the body where the nerve travels.
If the pain does not respond to conservative treatments, such as nonsteroidal anti-
inflammatory drugs (NSAIDs) and physiotherapy, a person should speak to their doctor.
The doctor may recommend surgery, depending on the person’s level of pain and disability.
In rare cases, a herniated disc may affect the nerves that control the bladder and bowel.
Surgery will be necessary to relieve pressure on the nerves and restore bladder and bowel
function.
If possible, a person may want to seek care at a hospital that uses a multidisciplinary approach
to making decisions about surgery.
WHO NEEDS SURGERY?

6. SURGICAL PROCEDURES
The purpose of herniated disc surgery is to ease pressure on the nerve, thereby alleviating
pain and other symptoms. A doctor may use one of the following three techniques to
alleviate pressure on the nerve:
Endoscopic spine surgery:
The surgeon uses a long thin
tube, or endoscope, to remove
the herniated section of the
disc. The procedure is
minimally invasive, requiring a
tiny incision. Only a small scar
will form, resulting in a quicker
recovery.
Surgery on the core of the
spinal disc: The surgeon uses
instruments to access the core of
the spinal disc then uses a
vacuum to remove the core. This
makes the spinal disc smaller,
which reduces pressure on the
nerve. The surgery is only possible
if the outer layer of the disc is not
damaged.
Open discectomy:
The surgeon
performs open
surgery to remove
the herniated
section of the disc.

8. OTHER SURGICAL INTERVENTIONS

9. LAMINOTOMY OR LAMINECTOMY
The lamina is a part of the vertebrae that covers
and protects the spinal canal. Sometimes, doctors
need to remove part or all of the lamina to repair
a herniated disc.
A laminotomy involves the removal of part of
the lamina, while a laminectomy is removal of
the entire lamina.
Both procedures involve making a small incision
down the center of the back or neck over the area
of the herniated disc. After removing part or all of
the lamina, the surgeon performs a discectomy to
remove the herniated disc.
Lumbar procedures: These help
to relieve leg pain or sciatic pain
that a herniated disc causes in the
lower back region.
Cervical procedures: These help
to relieve pain in the neck and
upper limbs that a herniated disc
causes in the neck region.
Laminotomies and laminectomies can
be lumbar or cervical:

11. SPINAL FUSION
Following a laminotomy or laminectomy, a
spinal fusion (SF) may be necessary to
stabilize the spine.
An SF involves joining two bones
together with screws.
People who have undergone an SF may
experience pain and feel as if the
treatment is restricting certain movements.
The likelihood of needing an SF depends
on the location of the herniated disc.
Typically, lumbar laminotomies require an
SF.
Cervical laminotomies require an SF if
the surgeon operates from the front
of the neck.
The same procedures rarely require
an SF if the surgeon operates from the
back of the neck.
The point the surgeon works from
depends on the exact location of the
herniated disc.
Some people who undergo
laminotomy may be candidates for
artificial disc surgery instead of an SF.

13. ARTIFICIAL DISC SURGERY
Increasingly, surgeons recommend artificial disc replacement as an
alternative to spinal fusion for people younger than 65 with a herniated
disc in the neck.
An artificial disc is a prosthetic “spacer” inserted in place of the
removed disc. It is placed between two vertebrae, preserving spinal
flexibility and stability. No screws or plates are needed to keep it in place.
In young people, a cervical disc replacement may provide better long-
term results and fewer complications than fusion.
To perform artificial disc replacement, your surgeon makes an incision
above the affected area of the spine and may remove part of the vertebra
to access the disc space.
A surgeon uses small surgical tools to remove the entire herniated disc,
insert the artificial disc into the disc space, and close the incision with
stitches.

15. RECOVERY PROCESS AND TIMELINE
According to the North American
Spine Society, people who
undergo surgery for a herniated
disc earlier rather than later may
have a faster recovery time. They
may also experience improved long
term health.
Typically, most people can go
home 24 hours after a herniated
disc operation. Some may even be
able to go home the same day.
driving
sitting for long periods
lifting heavy weights
bending over
Doctors recommend that people recovering from
herniated disc surgery avoid the following activities for
around 4 weeks:
Some exercises may be beneficial for people who have
had herniated disc surgery. However, they should
consult their doctor or surgeon before attempting any
strenuous activities.

16. RISKS
bleeding
infections
tears in the spine’s protective
lining
injury to the nerve
Discectomies hardly ever result in
complications. However, in rare cases,
people may experience the following:
In around 5% of people, the problematic disc
may rupture again, causing symptoms to recur.
Herniated disc surgery can be an effective
treatment for many people with challenging
pain.
However, surgeons cannot guaranteeTrusted
Source that symptoms will disappear after
surgery.
Some people may continue to experience
herniated disc pain after the recovery period. In
some cases, the pain may worsen over time.