Microsurgical Laminoforaminotomy and Disc Excision
Often referred to as the “gold standard”, by which other treatment modalities are measured, the microsurgical removal of disc material, by means of an open, operative procedure, is the most commonly performed treatment for ruptured discs and related pathology. This technique permits the most unrestricted access to the area(s) of abnormality, and is suitable for the treatment of a wide variety of spinal conditions, and multiple levels of pathology.
Because the operating microscope permits great magnification, and the delivery of intense light to the depths of the operative field, handling of the nerves and other delicate tissues can be very precise, using fine, microsurgical instruments. The skin incision can be made very small, with minimal retraction of muscle, and postoperative healing is rapid. However, surgical manipulation of the nerve root(s) is required, and there may be some concerns about the postoperative development of epidural cicatrix (scar tissue).
The procedure is customarily performed in a hospital environment, under general anesthesia, although other variations have been reported. Patients are generally allowed up to walk within a few hours, and are usually hospitalized overnight.
Laminectomy and Decompression
Open surgical approach to the spine, with or without the use of magnification (loupes or operating microscope), is a traditional surgical procedure, dating to the earliest description of disc pathology, in the 1930’s. Although less frequently used today for the surgical treatment of single level disc protrusion (“ruptured disc”), it may be the procedure of choice in more extensive surgical procedures for the treatment of spinal stenosis, spinal cord tumors, and incident to the placement of interbody fusion devices.