Who is a candidate?
Discectomy is considered for leg pain from a herniated lumbar disc that has not settled with a fair trial of non-operative care, or where weakness is progressing. The best results come when the leg pain clearly matches the nerve compressed on imaging. It is aimed at leg pain rather than back pain, and expectations are set accordingly.
Urgent
Cauda equina syndrome (loss of bowel or bladder control, saddle numbness, or rapidly worsening weakness in both legs) is a surgical emergency and is treated urgently rather than scheduled.
How the procedure works
Through a small incision, a tubular retractor or a small window in the ligament gives access to the nerve. The surgeon gently moves the nerve aside and removes the fragment compressing it, along with any loose material within the disc likely to displace later. Healthy disc, bone, and ligament are preserved wherever possible.
Recovery
Most patients go home the same day, and leg pain is frequently better immediately. Some back soreness at the incision is expected for one to two weeks. Walking starts straight away; bending, lifting, and twisting are limited for a period to reduce the chance of early recurrence. Most people return to desk work within a couple of weeks, with physical work taking longer.
Benefits and alternatives
For well-selected patients, discectomy relieves sciatica more quickly than continued non-operative care. Alternatives include time and physical therapy (most herniations do improve on their own), anti-inflammatory medication, and epidural or selective nerve root injections. Choosing surgery is largely a question of how long symptoms have persisted and how much they are limiting you.
Risks
Risks include infection, bleeding, a tear in the lining around the nerves, nerve injury, recurrent herniation, and persistent symptoms. Longstanding severe compression may leave some numbness or weakness that does not fully recover, which is one reason progressive weakness is not watched indefinitely.