Herniated Disc Surgery: Discectomy, Laminectomy & Fusion Options

Surgery for symptomatic herniated disc (radiculopathy, myelopathy) after failed conservative care (6–12 weeks).

Procedures

Procedure	Indication	Approach	Key Points
Microdiscectomy	Single-level radiculopathy, concordant imaging	Minimally invasive (1.5–2 cm), microscope/endoscope	Gold standard; 90%+ success; same-day discharge; preserves anatomy
Open Discectomy	Large herniation, revision, need for wide exposure	Larger incision, muscle stripping	More morbidity; rarely needed now
Laminectomy / Laminotomy	Central/paracentral stenosis, multiple levels	Remove lamina ± ligamentum flavum	Decompresses canal; may need fusion if instability
Spinal Fusion	Instability, spondylolisthesis, deformity, revision	Instrumented (pedicle screws) + bone graft	Eliminates motion; adjacent segment disease risk; longer recovery
Artificial Disc Replacement (ADR)	Single-level DDD/radiculopathy, preserved facets	Anterior (cervical/lumbar)	Preserves motion; strict criteria; not for herniation alone

Decision Factors

• Neurologic deficit (progressive = urgent)
• Imaging-pathology concordance
• Patient factors (age, comorbidities, smoking, expectations)
• Surgeon expertise

Outcomes

• Microdiscectomy: 85–95% leg pain relief; 5–15% recurrent herniation.
• Fusion: Back pain relief less predictable; adjacent segment disease 2–3%/year.

Shared decision-making with spine surgeon (ortho/neuro) essential.