Discectomy Q&A PTP

Q : Is video-assisted surgery better than non-video-assisted surgery?
A : Video-assisted discectomy has the advantage that there is less tissue damage during surgery, since this surgery cuts through the muscles to insert a camera to perform the operation rather than removing muscle tissues from the bones. As a result, there is less risk of fibrosis after surgery. This stands apart from traditional open surgery, which requires the removal of muscle tissues from the bones, and some patients might require the partial removal of their bones, which can increase the time it takes for muscles and bones to heal as well as the risk of developing fibrosis. Accordingly, fibrosis can cause back pain to recur and may even affect the surrounding muscles, leading to loss of strength, especially in younger people, athletes and people who need to exert a lot of force when performing physical activities.
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<li>Wound size. Video-assisted surgery produces wounds ranging from 0.8-1 centimeter in size, while open surgery will create wounds about 3.5-4 centimeters in size.</li>
<li>Post-surgery behaviors. While there are no clear differences between each type of surgery, video-assisted surgery leads to faster recovery due to smaller wound sizes.</li>
<li>Length of hospitalization. Open surgery requires a longer hospital recovery time by about 1-2 days when compared to video-assisted surgery.</li>
<li>Surgery success rate. The success rate of complete removal of the problematic spinal disc in the case of open surgery is about 93%, while the success rate of video-assisted surgery is about 89%.</li>
<li>Video-assisted discectomy relies more heavily on the skill of the surgeon than open surgery. The surgeons who perform this type of surgery require training and sufficient experience.</li>
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Q : Can elderly people undergo this surgery? What are the risks involved and how can these risks be controlled?
A : Elderly patients can undergo discectomy operations. In most cases, the patients who arrive to the doctor for spinal problems are elderly patients rather than pediatric or young adult patients. Meanwhile, in terms of risks, some elderly patients arrive with chronic illnesses such as diabetes, hypertension or heart disease. These chronic diseases need to be controlled. Therefore, when a patient decides to undergo surgery, the patient needs to be physically prepared beforehand. For example, if the patient has to regularly take medications such as anti-clotting drugs, the patient might have to stop the drug in order to prepare the patient’s body. All of these preparations also require confirmation from the doctors that are treating these chronic illnesses of the patient. If chronic diseases are effectively controlled, the elderly patient will be able to undergo surgery.
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Q : What are the essential components to accompany decision-making that will lead to a successful surgery?
A : The success of surgery requires many components as follows:
<ul>
<li>The medical team performing surgery. Experienced surgeons who are skilled in the particular operations to be undertaken along with the readiness of the associated personnel and modern equipment are required in order to support each surgical operation.</li>
<li>The patient. After the surgical operation is completed and the patient has to recover at home, the doctor cannot provide follow-up care to every patient. Therefore, self-care after surgery is essential. Much depends on whether or not the patient follows the doctor’s recommendations. If the patient follows the doctor’s advice and is disciplined, recovery will occur smoothly with reduced risk of complications.</li>
<li>The patient’s relatives. While the patient still cannot walk conveniently, relatives have to pay attention to the patient. They have to understand the patient’s restrictions, including the activities that the patient may not perform, and must keep reminding and monitor the patient.</li>
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Q : How much blood loss is there after surgery?
A : Open surgery might lead to more blood loss than video-assisted surgery, which causes less blood loss. Moreover, this also depends on the site and level of surgery. For example, there is less blood loss in the case of spinal surgery in the neck section. However, blood loss is greater for surgeries to correct scoliosis, which creates larger wounds. Accordingly, this all depends on the length of the wounds and duration of surgery.
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Q : Is a single operation enough?
A : A single operation might be enough for some patients, depending on the age of the patient and the spinal condition. For example, a 30-year-old patient undergoing surgery for disc herniation or nerve compression might be able to solve the problem in just a single operation. However, if the patient’s bones are significantly worn out overall, or worn rapidly due to behaviors, the patient might require additional surgery to fuse the joints. On the other hand, it is also for some people to experience bone degeneration and experience no problems in their daily living. Everything depends on their behaviors, function and muscle strength.
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Q : Can you walk normally after surgery? What factors contribute to pain after surgery?
A : After surgery, 90% of cases where the patient is no longer able to walk are due to the patient. Usually, by the time the patient undergoes surgery for the disease, it is due to the patient’s older age, and their muscles also deteriorate with time. In addition, if the patient does not exercise and does not move around, the patient’s muscles will continue to deteriorate. After surgery, it is inevitable that there will be wound sand wound pain. As a result, some patients refuse to move their bodies when instructed by their doctors due to pain. Moreover, as their caregivers notice that the patient experiences pain, they stop encouraging the patient to move and to instead lie still until the wound is healed. Lack of muscle movement around this time causes the muscles to gradually atrophy, so by the time the external wounds have recovered after about 2-3 weeks, the muscles have already significantly atrophied, and when the patient wants to walk again after no longer feeling pain, the patient discovers that the patient cannot put weight on the muscles, feels week and goes back to lying in bed. Eventually, the gradual loss of muscles lead to the patient to truly lose the ability to walk.
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Q : What causes pain to persist after surgery?
A : If there is pain in the legs after surgery, it is possible that this is due to ongoing inflammation due to compression in the first 1-2 months after surgery. This might cause the patient to experience pain, tightness or sensitivity in the legs. This is normal. Another thing to consider is that, if the patient continues to experience pain later on, it is necessary to determine whether or not nerve injury has occurred or whether this is due to incomplete removal of the damaged spinal disc.

Video-assisted discectomy has the advantage that there is less tissue damage during surgery, since this surgery cuts through the muscles to insert a camera to perform the operation rather than removing muscle tissues from the bones.

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