There is a variety of reasons why a consultant would choose the surgical approach and carry out Lumbar Disc Surgery. As?osteopaths, we are frequently asked about discectomies and Lumbar Disc Surgery?? an operation used to remove the herniated or bulging disc. On average patients who have either had or may need?Lumbar Disc Surgery account for about 81% of our clinical presentations.
In 2009, a Cochrane review, a respected analysis of medical journals, found exercise programs starting four to six weeks post-surgery seemed to lead to a faster decrease in pain and disability than no treatment. High-intensity exercise programs appeared to lead to a faster decrease in pain and disability than low-intensity equivalents. No significant differences were found between supervised workouts and exercises done at home for pain relief or disability. There was also no evidence that by exercising, you could increase the re-operation rate after first-time lumbar surgery.
How successful is Lumbar Disc Surgery?
Well, there are different types of operation available: some take out the whole disc and some only the bulging part. A 2009 review of the studies found that when only part of the disc was removed, there was an increased chance of further bulging in the future, and a 12 per cent risk of being in pain after two years. Where the entire disc is removed, the risk is 27 per cent of having pain two years later .The last Cochrane review on this was in 1999. It pointed at effectiveness of surgical discectomies, although it highlighted weaknesses in the way the trials were done.
Does it matter when I have Lumbar Disc Surgery?
A 2009 study concluded that early surgical intervention did not result in greater improvement of clinical outcomes for patients with lumbar disc herniation, although again it appears a debatable subject.
In conclusion, it appears that a good aggressive exercise program does help with recovery from a discectomy. Even with an operation, there is a minimum 10% chance you will be in pain in two years? time. There is no improvement from having surgery sooner rather than later. Therefore, it makes sense that before even considering surgery, you should make sure that you?ve tried conservative?management. If after all of that you still decide to go for surgery, in the months preceding the surgery, it is advisable to improve your diet, reduce any stress levels and have a balanced lifestyle as much as possible. It is also best to get exercising four to six weeks after the operation.
For more information about Disc prolapse and?Lumbar Disc Surgery
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Guilbert, T.W., Morgan, W.J., Zeiger, R.S., Mauger, D.T., Boehmer, S.J., Szefler, S.J., et al. Long-term Inhaled Corticosteroids in Preschool Children at High Risk for Asthma.?The?New England Journal of Medicine, 11 May 2006, 354(19):1985?97.
Ostelo, R.W., Costa, L.O., Maher, C.G., de Vet, H.C. and van Tulder, M.W. Rehabilitation After Lumbar Disc Surgery: An Update Cochrane Review.?The Spine Journal, 1 August 2009, 34(17):1839?1848.
Gibson, J.N., Grant, I.C. and Waddell, G. The Cochrane Review of Surgery for Lumbar Disc Prolapse and Degenerative Lumbar Spondylosis,?The Spine Journal, 1 September 1999, 24(17):1820.
Akagi, R., Aoki, Y., Ikeda, Y., Nakajima, F., Ohtori, S., Takahashi, K. and Yamagata, M. Comparison of Early and Late Surgical Intervention for Lumbar Disc Herniation: Is Earlier Better??Journal of Orthopaedic Science, May 2010, 15(3):294?8.
Rushton, A., Wright, C., Goodwin, P., Calvert, M. and Freemantle, N. Physiotherapy Rehabilitation Post First Lumbar Discectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials,?The Spine Journal, 15 June 2011, 36(14):E961?72.
McGirt, M.J., Ambrossi, G.L., Datoo, G., Sciubba, D.M., Witham, T.F., Wolinsky, J.P., Gokaslan, Z.L. and Bydon, A. Recurrent Disc herniation and Long-term Back Pain After Primary Lumbar Discectomy: Review of Outcomes Reported for Limited Versus Aggressive Disc Removal,?Neurosurgery, February 2009, 64(2):338?44; discussion 344?5.