.DISCECTOMY:

What is a discectomy?

is the surgical removal of part or all of a spinal disc.

treats degenerated, herniated (prolapsed, bulging or slipped), or ruptured spinal

discs.

is a common but major surgery with significant risks and potential

complications.

It can relieve nerve compression and pain.

.Types of discectomy:

The types of discectomy procedures include:

Cervical discectomy is the removal of a disc in the neck area (cervical spine).

Lumbar discectomy is the removal of a disc in the lower back (lumbar spine).

Sacral discectomy is the removal of a disc in the back between your pelvic, or

hipbones (sacral spine).

Thoracic discectomy is the removal of a disc in the middle part of the back

(thoracic spine).

.Why is a discectomy performed?

- may recommend a discectomy to treat certain diseases

and conditions of the spine:

Your doctor may recommend a discectomy for degenerated, herniated or

ruptured discs if you have:

Back or leg pain or weakness or numbness that does not get better with other

treatments in six weeks or more. Other treatments include anti-inflammatory

medications, rest, and physical therapy.

Problems with walking and performing other daily tasks

Inability to control your bowels or bladder.

.Who performs a discectomy?

-The following specialists perform discectomy:

Orthopaedic surgeons specialize in the medical and surgical treatment of

diseases and conditions of the muscles and bones, including the spine.

Neurosurgeons specialize in the surgical treatment of diseases and conditions

of the nervous system, including the spine.

.How is a discectomy performed?

-will be performed in a hospital or surgery center . Your

surgeon will use one of the following approaches:

Open surgery involves making a two-to-four inch incision down the middle of

the affected part of your spine.

Micro discectomy is a minimally invasive surgery.

- It involves inserting special instruments through a small incision, usually less

than one inch, along the side of the affected area of your spine.

Anterior discectomy is the removal of a spinal disc through an incision in the

front part of your body.

.Types of anaesthesia that may be used:

a discectomy using either general anaesthesia or regional anaesthesia,

depending on the specific procedure.

General anaesthesia is a combination of intravenous (IV) medications and

gases that put you in a deep sleep.

Regional anaesthesia is also known as a nerve block. It involves injecting an

anaesthetic around certain nerves to numb a large area of the body.

.What are the risks and potential complications of a

discectomy?

-General risks of surgery:

The general risks of surgery include:

Anaesthesia reaction, such as an allergic reaction and problems with breathing

Bleeding or haemorrhage (heavy bleeding), which can lead to shock

Blood clot, in particular a deep vein thrombosis that develops in the leg or

pelvis. A blood clot can travel to your lungs, heart or brain and cause a

pulmonary embolism, heart attack, or stroke.

Infection and sepiticemia, which is the spread of a local infection to the blood.

.Reducing your risk of complications:

-You can reduce the risk of some complications by following your

treatment plan and:

Following activity, dietary and lifestyle restrictions and recommendations

before surgery and during recovery

Informing your doctor or radiologist if you are nursing or if there is any

possibility of pregnancy

Notifying your doctor immediately of any concerns, such as bleeding, fever,

increase in pain, or wound redness, swelling or drainage

Taking your medications exactly as directed

Telling all members of your care team if you have any allergies .

.How long will it take to recover?

Recovery after surgery is a gradual process. Recovery time varies depending

on the procedure, type of anaesthesia, your general health, age, and other

factors.

Full recovery time takes six to eight weeks. It might take longer for you to

return to full activities if you have a job that requires heavy lifting or operating

heavy machinery.

.WHAT TO EXPECT AFTER THE OPERATION:

Scar

You will have a small scar, about 1-3 inches long for a single disc operation

(longer if required), overlying the lower part of your backbone.

Stitches

Deep stiches beneath the skin will dissolve and do not need removing. Stitches

or clips may be used to close your skin. These will be removed 5-10 days after

your operation.

Dressings

Your stitches may be covered by a simple adhesive dressing - like a large

sticking plaster. Wash carefully until you have your stitches out, so that the

dressing doesn’t get wet. After you’ve had your stitches out, you won’t need a

dressing any more and you’ll be able to bath and shower as normal.

CONTD.

Discomfort

Immediately after the surgery you will have some pain in and around the area

of your operation, but your surgeon will ensure that you have pain relief to

make you comfortable and help you to move. Usually the original pain in the

leg improves almost immediately, but if it does not, be sure to tell the nurses

and your doctor. A very small number of people may experience difficulty

passing urine after the operation. Usually this is simply a temporary

disturbance

of bladder function, but very rarely complications may cause the nerves to the

legs or bladder to stop working.

CONTD.

Rehabilitation

After your operation, you will be working with a physiotherapist, who will monitor

your specific needs and help you safely to regain strength and movement.

Exercising the spine as prescribed will help you to make a much swifter recovery than

if you remain inactive.

Tiredness & Feeling Emotional

Your body uses a lot of energy to heal itself, so you will feel more tired than normal -

sometimes it can come upon you suddenly. If you feel upset or

emotional in the days and weeks after your operation, don’t worry - this is a perfectly

normal reaction which many people experience.

.CERVICAL DISCECTOMY:

. Cervical Discectomy : Introduction:

-THE DISC: is the pad that separates the neck

vertebrae; ECTOMY: means to take out.

- is a surgical procedure to treat damaged

cervical discs.

- Its goal is to relieve pressure on the nerve

roots or on the spinal cord by removing the

ruptured disc.

- During the surgery, the soft tissues of the

neck are separated and the disc is removed.

.CERVICAL DISCECTOMY:

NORMAL CERVICAL SPINE: ABNORMAL CERVICAL

SPINE:

.TYPES:

Anterior Discectomy:

done through

the anterior (front) of the

neck. This is called anterior

cervical discectomy.

Posterior Discectomy:

to operate through the back of the

neck using a procedure

called posterior cervical

discectomy.

.INDICATION:

-You may be a candidate for discectomy if you have:

• Significant weakness in your hand or arm

• Symptoms that have not improved with physiotherapy or

medication

.Bulging or herniated (slipped) disc: The gel-like material

within the disc can bulge or rupture through a weak area in

the surrounding wall (annulus). Irritation and swelling

occurs when this material squeezes out and painfully

presses on a nerve.

• Degenerative disc changes: As discs naturally wear out,

bone spurs form and the facet joints inflame. The discs dry

out and shrink, losing their flexibility and cushioning

properties. The disc spaces get smaller. These changes lead

to central stenosis or disc herniation

Stages of a Cervical Herniated

Disc:

.COMPRESSIVE FLEXION INJURY :

motor vehicle accidents and

shallow drive . injury level C4-

5,C5-6.compressive loads applied

to the flexed spine result in

compression of the anterior

column of the spine and

distraction of the posterior column

. if cord compression with disc

disruption present then

discectomy method ,we choose.

.DISTRACTIVE FLEXION INJURY :

caused by motor vehicle accidents

and falls from height . injury level

C5-6,C6-7.distractive load applied to

the spine in flexed position cause

tensile failure(ligamentous and

bony) and lengthening and

compression of posterior column and

shortening of the anterior column .

have an associated with acute disc

herniation at the level of injury .

should undergo anterior cervical

discectomy.

.CERVICAL RADICULOPATHY:

-dysfunction of the nerve root.

-may occur from postero lateral.

- operative approaches-anterior decompression with discectomy.

.CERVICAL SPONDYLOTIC MYELOPATHY(CSM):

-resulting from a decreased in the space available for the cervical spinal cord .

- can be produced by single or double level compression

- -treatment-anterior cervical discectomy.

cervical spinal stenosis:

-the narrowing of the spinal canal in

the neck.

-squeeze and compress the nerve roots

Cervical spine instability :

-is defined as the loss of ability of

cervical spine under physiological loads

to maintain relationships between

vertebrae in such a way, that spinal

cord or nerve roots are not damaged or

irritated and deformity or pain does

not develop.

-leads to degenerative changes which

effects the motion segment but may

not be confused with severe incapacity

or other signs of spinal cord

compression.

.PHYSICAL REHABILITATION:CONTENTS:

BRACE AND COLLAR

COLD THERAPY

MASSAGE

ELECTRICAL STIMULATION

POSTURAL AWARENESS

STRENGTHNING EXERCISES

ACTIVE EXERCISES

AEROBIC EXERCISES

ISOMETRIC

STRETCHING

RESISTANCE TRAINING

BRACE AND COLLAR: a neck collar to wear.

- the need for external immobilization of the neck.

- worn for 4-12 weeks.

-in patients who have specific indications for a longer immobilization period.

.

BODY MECHANICS : Our physiotherapist also works with

you on how to move and do activities. This form of

treatment, called body mechanics, is used to help you

develop new movement habits. This training helps you

keep your neck in safe positions as you go about your

work and daily activities. At first, this may be as simple

as helping you learn how to move safely and easily in

and out of bed, how to get dressed and undressed, and

how to do some of your routine activities. We will teach

you how to keep your neck safe while you lift and carry

items and as you begin to do other heavier activities.

POSTURAL AWARENESS : Maintain

proper postural alignment

throughout the day in order to

decrease any strain created on your

neck 1.correct neck

posture2.correct sitting posture.

AB

COLD THERAPY:COLD PACK AND ICE CUP MASSAGE: control pain and

inflammation

MASSAGE :

Increasing local blood circulation;

Muscle re-education;

- to ease muscle spasm and pain.

- Improves your range of motion, muscle tone, co-ordination and flexibility.

- Increases blood flow, which aids in the healing process & allows muscles to work more

efficiently.

- To re-educate the muscles into pain free habits.

1.TRIGGER POINT MASSAGE2.TRIGGER POINT OVER CERVICAL AND SCAPULAR REGION

1.TRIGGER POINT MASSAGE

OVER CERVICAL

2.LEVATOR SCAPULA

MASSAGE

3.TRAPEZIUS MASSAGE

ELECTRICAL STIMULATION:

-electrode positioning(a)2 pole sitting position(b)4 pole

- Immediate post-surgical stimulation to prevent thrombosis , blood clot.

-Maintaining or increasing range of motion.

-to help control pain and inflammation

c.2 pole prone position d.4 pole over scapular region

EXERCISES WILL START AROUND 6

WEEK:BEF0RE EXERCISE:

STRENGTHNING EXERCISES:1.SCAPULA SUEEZE2.a.CHIN

TUCK.3.SHOULDER SHRUG: will help maintain improved

posture, which in turn will eliminate recurrent flare-ups

of pain.

ACTIVE EXERCISES:

- keep your joints flexible (bending and moving in the right

way).

- keep good blood flow going to the joint area.

- help prevent blood clots.

AEROBIC EXERCISES:

- increase blood flow to the muscles and

soft tissues of the neck and upper back,

which can help loosen the muscles and

increase range of motion.

- -to improve body conditioning.

- 1.WALKING2.CYCLING3.SWIMMING

- 4.TRAINNER5.PLAYING GAMES(OUTDOOR)

ISOMETRIC :

- to help tone and control the muscles that

stabilize the neck and upper back.

STRETCHING EXERCISES(a) levator scapula stretch(b)trapezius stretch:

- are performed to provide flexibility

AB

RESISTANCE TRAINING:1.THERA BAND2.PENDULUM CHIN:

- with weights, improves strength and stability to the body, and especially the neck.

3.BLUEPRINT-helps the cervical spine stay in balance.

4.CURVE RESTORER-strengthen the major muscles of the neck

and upper back.

.REFERENCES:

TEXT BOOK OF ORTHOPAEDIC AND TRAUMA VOL 3 2ND

EDI,GS KULKARNI

www.healthgrade.com

www.beaconhospital.cervicaldiscectomy

www.understandspinesurgery.com/rehabilitation

www.mayfieldclinic.com