Suppose you have a herniated disc and have been told that surgery is your only option. In that case, it’s crucial to understand the various surgical procedures for treating herniated discs, their costs, and both short-term and long-term effects. I have colleagues from many of the significant surgical groups here in Indianapolis. Our conversations usually revolve around spine surgery. I didn’t know this before I started treating herniated discs, but many surgeons have a selection process. They are trying to qualify if a patient would be a good fit for one of their surgical procedures.
The spine surgeon wants the very best outcome for their patient. Anyway, here is what I’ve learned…
Discectomy
Procedure:
1. An incision is made over the affected area of the spine
2. Muscles are retracted to expose the vertebrae
3. A small portion of bone (laminotomy) may be removed to access the disc
4. The herniated portion of the disc is cut out
5. Any loose disc fragments are removed
6. The incision is closed with sutures
Average Cost: $20,000 – $50,000[1]
Short-term Effects:
– Immediate relief of nerve compression symptoms
– Reduced pain and improved mobility
– Risk of infection, bleeding, and dural tear
Long-term Effects:
– Potential for re-herniation (5-18% of cases)[2]
– Accelerated disc degeneration
– Increased risk of spinal instability
– Possible chronic back pain
Negative Lasting Impacts:
– Altered biomechanics of the spine
– Increased stress on adjacent discs
– Potential for failed back surgery syndrome
Microdiscectomy
Procedure:
1. A small incision (1-1.5 inches) is made
2. Muscles are split rather than cut
3. A microscope or endoscope is used for visualization
4. Minimal bone removal is performed
5. The herniated disc material is removed
6. The incision is closed with minimal tissue damage
Average Cost: $15,000 – $45,000[1]
Short-term Effects:
– Faster recovery compared to open discectomy
– Less postoperative pain
– Lower risk of infection
Long-term Effects:
– Similar long-term outcomes to open discectomy
– Slightly lower risk of spinal instability
Negative Lasting Impacts:
– Altered spinal biomechanics
– Potential for incomplete disc removal
– Risk of recurrent herniation
– Potential for failed back surgery syndrome
Laminectomy
Procedure:
1. An incision is made over the affected vertebrae
2. Muscles are retracted
3. The entire lamina is removed from one or more vertebrae
4. Herniated disc material is excised
5. The spinal canal is decompressed
6. The incision is closed
Average Cost: $50,000 – $90,000[1]
Short-term Effects:
– Significant decompression of neural elements
– Improved spinal canal diameter
– Risk of cerebrospinal fluid leak
Long-term Effects:
– Potential for spinal instability
– Increased risk of spondylolisthesis
– Possible chronic back pain
Negative Lasting Impacts:
– Irreversible alteration of spinal anatomy
– Accelerated degeneration of facet joints
– Increased risk of adjacent segment disease
– Potential for failed back surgery syndrome
Artificial Disc Replacement
Procedure:
1. An anterior approach to the spine is used
2. The damaged disc is completely removed
3. An artificial disc is inserted into the disc space
4. The incision is closed
Average Cost: $45,000 – $110,000[1]
Short-term Effects:
– Preservation of motion segment
– Reduced stress on adjacent discs
– Risk of vascular injury due to anterior approach
Long-term Effects:
– Potential for device failure or displacement
– Heterotopic ossification
– Possible need for revision surgery
Negative Lasting Impacts:
– Difficulty in revision surgeries
– Limited long-term data on device longevity
– Potential for failed back surgery syndrome
– Potential for metal ion release and allergic reactions
Spinal Fusion
Procedure:
1. Disc material is removed
2. Bone graft or synthetic material is placed in the disc space
3. Adjacent vertebrae are fixed with screws and rods
4. The incision is closed
Average Cost: $80,000 – $150,000[1]
Short-term Effects:
– Immediate stabilization of the spine
– Reduced motion at the operated level
– Risk of pseudarthrosis
Long-term Effects:
– Altered spinal biomechanics
– Increased stress on adjacent segments
– Potential for adjacent segment disease
Negative Lasting Impacts:
– Permanent loss of motion at the fused level
– Accelerated degeneration of adjacent discs
– Potential for failed back surgery syndrome
– Increased risk of future surgeries
Long-term Negative Impacts
1. Altered Spinal Biomechanics: All surgical procedures for herniated discs alter the natural biomechanics of the spine to some degree. This can lead to compensatory mechanisms and increased stress on other spinal segments [2].
2. Adjacent Segment Disease: Particularly in fusion procedures, the loss of motion at one level can accelerate degeneration at adjacent levels, potentially requiring additional surgeries in the future [2].
3. Chronic Pain Syndromes: Failed back surgery syndrome is a significant concern, with up to 40% of patients experiencing persistent or recurrent pain after spinal surgery [3].
4. Irreversibility: Many of these procedures involve permanent changes to the spinal anatomy that cannot be undone, limiting future treatment options.
5. Accelerated Degeneration: Removal of disc material or alteration of spinal structures can lead to faster degeneration of the remaining disc and surrounding tissues [2].
6. Psychological Impact: The long-term effects of spinal surgery can have significant psychological impacts on patients, affecting their quality of life and potentially leading to depression or anxiety.
7. Opioid Dependence: Long-term pain management following these procedures can lead to opioid dependence in some patients, contributing to the ongoing opioid crisis.
8. Economic Burden: The high costs of these procedures, potential future surgeries, and ongoing pain management can place a significant economic burden on patients and the healthcare system.
In conclusion, while surgical interventions for herniated discs can provide significant short-term relief, the long-term impacts on spinal health and overall patient well-being must be carefully considered. Many patients are now seeking non-invasive, non-surgical treatment options more than ever. Suppose you are considering spine surgery of any kind. In that case, you may want to look into Non-Surgical Spinal Decompression utilizing the DRX-9000. This FDA-cleared technology is designed to help herniated discs heal naturally without addictive opioids, risky epidural injections, and invasive spine surgery.
Citations:
[1] https://www.mayoclinic.org/tests-procedures/diskectomy/about/pac-20393837
[2] https://www.ncbi.nlm.nih.gov/books/NBK544281/
[3] https://www.webmd.com/back-pain/surgery-for-herniated-disk
[4] https://www.medicalnewstoday.com/articles/326780
[5] https://www.healthline.com/health/bone-health/herniated-disk-surgery
[6] https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/minimally-invasive-lumbar-discectomy
[7] https://www.aans.org/patients/conditions-treatments/herniated-disc/
[8] https://www.ncbi.nlm.nih.gov/books/NBK279471/
