Spine Surgery for Herniated Discs: What Are Your Options?

A herniated disc, also referred to as a slipped or ruptured disc, occurs when the soft inner core of a spinal disc protrudes through its outer layer. This condition can put pressure on nearby nerves, leading to pain, numbness, and weakness, often affecting the lower back (lumbar spine) or neck (cervical spine).

Where Do Herniated Discs Occur?

Herniated discs can impact two main areas of the spine:

• Lumbar Spine (Lower Back): The most common location for herniated discs. Symptoms here often include lower back pain, sciatica, and sometimes weakness or numbness that radiates down the legs.
• Cervical Spine (Neck): When a disc herniates in the neck, you may experience neck pain, tingling, or numbness that can travel down the arms.

How Are Herniated Discs Treated Surgically?

Depending on the location, different surgical approaches may be used to address a herniated disc:

Cervical Discectomy

For herniated discs in the cervical spine (neck), a surgeon may use either an anterior approach—accessing the disc through the front of the neck—or a posterior approach, entering from the back. Each method aims to remove the problematic disc fragment and relieve pressure on spinal nerves.

Lumbar Discectomy

If the herniated disc is in the lumbar region (lower back), a lumbar discectomy may be performed. Surgeons make a small incision and use specialized microscopes and precision tools to carefully remove the herniated disc material, minimizing disturbance to surrounding tissues and nerves.

Understanding where a herniated disc is located and the available treatment options can help guide your next steps toward relief. While conservative treatments like physical therapy, pain management, and lifestyle modifications can help many patients, some cases require surgical intervention.

At Big Apple Spine & Orthopedics, Dr. Arutyunyan, a leading NYC orthopedic spine surgeon, specializes in state-of-the-art surgical techniques for herniated disc treatment. If you suffer from persistent back pain and conservative treatments have failed, understanding your surgical options can help you make an informed decision.

Non-Surgical Treatments: The First Line of Defense

Before considering surgery, most patients undergo non-surgical treatments, including:

• Physical Therapy: Exercises and stretches to strengthen the muscles supporting the spine.
• Pain Management: Anti-inflammatory medications, muscle relaxants, and epidural steroid injections.
• Chiropractic Care and Acupuncture: Alternative therapies that may provide temporary relief.
• Lifestyle Adjustments: Weight management, ergonomic corrections, and low-impact exercises.

If these approaches fail to relieve pain and mobility issues, surgical options should be explored.

Cervical Discectomy: Anterior vs Posterior Approaches

When it comes to treating a herniated disc in the neck, surgeons can use two main approaches: from the front (anterior) or the back (posterior) of the neck. The choice depends on which nerves are affected and the exact location of the disc problem.

• Posterior Approach:
  If the herniated disc is pressing on a nerve root but the spinal cord itself isn’t involved, your surgeon may recommend a posterior approach. In this technique, a small incision is made at the back of the neck. The surgeon removes a small section of bone (typically via laminotomy or foraminotomy) to access the pinched nerve and remove the disc material, relieving pressure and restoring function.
• Anterior Approach:
  For cases where both the nerve roots and the spinal cord are compressed, an anterior approach is usually preferred. This involves making an incision at the front of the neck to reach the damaged disc. After removing the problematic disc, the surgeon often places a bone graft or implant to fuse the two adjacent vertebrae together. This spinal fusion helps stabilize the neck and protects the nerves and spinal cord.

These techniques are meticulously chosen to match the patient’s specific anatomy and symptoms, aiming for maximum relief with minimal disruption.

Laminotomy and Foraminotomy in Cervical Discectomy

When addressing herniated discs in the neck, your spine surgeon may recommend a procedure called laminotomy or foraminotomy—especially if the disc is pressing on nerve roots but the spinal cord remains unaffected.

• Laminotomy: This technique involves making a small opening in the lamina, the bony arch at the back of your vertebra. By creating this window, the surgeon gains better access to the affected disc and can remove the herniated portion without destabilizing the spine.
• Foraminotomy: Here, the surgeon widens the neural foramen, the channel where nerves exit the spinal column. This helps relieve pressure on nerves pinched by bulging or displaced disc material.

Both procedures are often performed through a posterior (back of the neck) approach and are sometimes combined with microdiscectomy for optimal nerve relief. By strategically removing small amounts of bone and the problematic disc fragment, these minimally invasive options can significantly reduce pain and restore mobility—often with a shorter recovery period compared to more extensive surgeries.

Spine Surgery Options for Herniated Discs

1. Microdiscectomy: The Gold Standard for Herniated Disc Surgery

A microdiscectomy is a minimally invasive procedure designed to remove the portion of the herniated disc pressing on the nerve root.

• How It Works: The surgeon makes a small incision and uses a microscope or endoscope to access the affected disc, minimizing damage to surrounding tissues.
• Recovery Time: Most patients experience significant pain relief and return to normal activities within a few weeks.

For many, walking is possible within hours of surgery. While some people are up and about the same day, others may need a little more time—especially after procedures like spinal fusion. You might be fitted with a back or neck brace for extra support during the first few weeks, and a pain management plan helps keep you comfortable both in the hospital and at home.

The recovery timeline can vary depending on the procedure and your individual circumstances. For example, after discectomy or artificial disc replacement, many people resume their everyday routines in about four weeks, though it can take a few months for the spine to fully heal. If your job is office-based, you may be back to work sooner than those with more physically demanding roles, who might need up to three months to return safely.

Throughout the process, gradual movement is encouraged as your body heals. Most importantly, while surgery often brings immediate relief from radiating pain, full recovery is a journey—so listen to your body and your care team as you make your way back to normal life.

• Best For: Patients with severe nerve compression causing sciatica or radiculopathy.

Open Discectomy vs. Microdiscectomy: What Sets Them Apart?

While both procedures are designed to relieve nerve pressure by removing the problematic portion of the herniated disc, the main difference lies in their approach and invasiveness.

• Open Discectomy: This traditional technique involves making a larger incision in the back to give the surgeon direct access to the affected disc. The greater exposure allows for manual removal of disc material but typically results in a longer recovery period and more disruption to surrounding muscles and tissues.
• Microdiscectomy: By contrast, a microdiscectomy is performed through a much smaller incision, often with the help of a surgical microscope or an endoscope (a slender tube equipped with a light and camera). This minimally invasive method allows for greater precision, less muscle damage, and usually a faster recovery with less postoperative pain.

Both approaches aim to decompress the nerve and relieve symptoms, but the choice depends on factors like the disc’s location, the severity of symptoms, and a patient’s overall health. Discussing these options with your spine specialist ensures the chosen technique aligns with your needs and goals.

Hemilaminotomy: Enhancing Access During Lumbar Discectomy

In some cases, a procedure known as hemilaminotomy is performed alongside a lumbar discectomy to improve surgical access and effectiveness. This technique involves removing a small segment of the lamina—the thin layer of bone that forms part of the vertebral arch. By taking away only a portion of this bone, the surgeon gains better visibility and maneuverability to reach the herniated disc fragment without destabilizing the spine.

• How It Works: Using advanced surgical microscopes and minimally invasive instruments, the surgeon carefully removes part of the lamina on one side of the vertebra. This creates more space to safely access and extract the disc material pressing on the nerve.
• Surgical Precision: Hemilaminotomy allows for precise decompression of the affected nerve with minimal disruption to the surrounding tissues and bone structure.
• When Used: This approach is especially beneficial in cases where the herniated disc is difficult to reach or when conservative microdiscectomy alone would not provide adequate relief.

By tailoring the procedure to each patient’s needs, Dr. Arutyunyan at Big Apple Spine & Orthopedics ensures optimal outcomes and a smoother recovery for those suffering from lumbar disc herniations.

2. Laminectomy: Creating Space to Relieve Nerve Pressure

A laminectomy involves removing part of the vertebral bone (lamina) to create more space and relieve nerve compression.

• How It Works: A small portion of the lamina is removed to alleviate pressure from the spinal cord or nerve roots.
• Recovery Time: It typically requires a few weeks to a couple of months for full recovery.
• Best For: Patients experiencing spinal stenosis along with a herniated disc.

3. Artificial Disc Replacement: Preserving Mobility

Artificial disc replacement (ADR) is an alternative to spinal fusion that preserves motion in the spine.

• How It Works: The damaged disc is removed and replaced with an artificial disc that mimics natural movement.
• Recovery Time: Patients often return to normal activities faster compared to fusion surgery.
• Best For: Younger patients with single-level disc disease who want to maintain flexibility.

4. Spinal Fusion: Stability for Severe Cases

Spinal fusion surgery is recommended for patients with extensive spinal degeneration or instability.

• How It Works: The surgeon removes the damaged disc and fuses adjacent vertebrae using a bone graft or implant.
• Recovery Time: Longer compared to other procedures, typically several months.
• Best For: Patients with severe spinal instability, multiple herniated discs, or recurring disc issues.

What to Expect After Spine Surgery

Regardless of the surgical procedure, post-operative care is essential for a successful recovery. Patients can expect:

• Physical Therapy: Helps restore strength and mobility.
• Pain Management: Medications and other pain relief methods.
• Gradual Return to Activities: Patients should follow their surgeon’s guidelines for resuming physical activities.
• Follow-Up Appointments: Regular check-ins with Dr. Arutyunyan at Big Apple Spine & Orthopedics ensure optimal healing.

Choosing the Right Spine Surgeon in NYC

When considering spine surgery, selecting an experienced and reputable spine surgeon is crucial. Dr. Arutyunyan at Big Apple Spine & Orthopedics is a leading NYC orthopedic spine surgeon with extensive experience in treating herniated discs using advanced, minimally invasive techniques.

If you are struggling with chronic back pain and need expert back pain treatment in NYC, schedule a consultation with Dr. Arutyunyan to explore the best treatment options for your condition.

Final Thoughts

Living with a herniated disc can be debilitating, but you don’t have to suffer in silence. Whether through non-surgical treatments or advanced surgical interventions, Big Apple Spine & Orthopedics is dedicated to helping patients regain their quality of life. Understanding your options and consulting a top NYC orthopedic spine surgeon like Dr. Arutyunyan can help you make the best decision for your spinal health.