Defending Diskectomy Cases

What is a Diskectomy?

A diskectomy is a surgical procedure to remove the damaged portion of a herniated disk.  Herniated disks can irritate or compress a nerve, which can cause pain, numbness or weakness in the neck, back, arms or legs.  A diskectomy is best used in the treatment of radiating symptoms but is less helpful for the treatment of actual neck and back pain, which are more susceptible to conservative treatment such as physical therapy or medication. 

Essentially, a diskectomy is performed to relieve the pressure that a herniated disk places on a spinal nerve.  If a patient has trouble standing or walking because of nerve weakness, the procedure may be recommended.  The procedure may also be recommended if conservative treatment fails to improve the symptoms, if a disk fragment lodges in the spinal canal and presses on a nerve, or if the patient has pain radiating into the buttocks, legs, arms or chest, which becomes overwhelming.

Typically, medical providers will recommend a diskectomy when conservative, nonsurgical treatment has not worked and symptoms worsen.

There are several types of diskectomy procedures:

• Original diskectomy
• Micro diskectomy
• Endoscopic diskectomy

Many surgeons prefer the micro or endoscopic procedures as they are minimally invasive, using small incisions and a tiny camera for viewing.

About the Procedure

A diskectomy is performed under general anesthesia.  Typically, just the fragment of a disk that is pinching upon the nerve is removed, relieving the pressure on the nerve while at the same time leaving most of the disk intact.  Sometimes the entire disk must be removed.  In such instances a piece of synthetic bone substitute is used to fill the space.  The adjoining vertebrate will then be fused together with metal hardware.

Post operatively, the patient may be able to return to work between two to six weeks.  The patient will also be prescribed physical therapy in order to improve strength and flexibility of the muscles and the spine.

The micro diskectomy procedure is significant as it is performed through a small incision in the midline of the back, typically one to one and a half inches long.  After the incision is made, a series of progressively longer tubular retractors tunnel through the muscles to gain access to the spine.  The procedure typically takes 30 minutes or so (including the anesthesia).  Furthermore, the procedure leaves the joints, ligaments and muscles intact, and, therefore, does not change the mechanical structure of the spine.

The majority or favored procedures are currently the micro endoscopic discectomy since it is a minimally invasive procedure that causes less disruption of the cervical or lumbar spine muscles and significantly decreases recovery time.

Success Rate and Potential Complications

Good results are achieved in 80 to 90 percent of patients who undergo the procedure.  Further, minimally invasive diskectomy techniques have a success rate in outcomes comparable to the open diskectomy procedures, and as such, the micro diskectomy procedures have become the procedure of choice.

Like all procedures, there can be complications as a result of a diskectomy, such as a nerve root injury, injuries to the dura with resultant SSF leakage, and possible damage to the underlying vessels plus infections and possible nerve palsies.  These complications, however, are atypical. 

Evaluating a Diskectomy Claim

In evaluating a claim, it is important for the claims examiner or attorney to confirm whether the procedure was a “full” or “open” procedure or a minimally invasive micro-diskectomy procedure as the difference in procedures will impact the value of the injury.  For example, open procedures are more invasive and have a longer recovery time and are therefore higher in value than the less invasive micro procedure.  The individual evaluating the claim must take this information into account during the evaluation process.  Further, the micro procedure can be performed in a surgi-type center, which would not require hospital admission, thus lowering the value of the claim compared to a claim with a hospital admission.

The evaluator must be cognizant of the fact that the micro procedure is still a surgical procedure, with some potential complications.  However, the evaluator cannot get caught up in the argument that may be raised by a plaintiff’s attorney that his or her client “had surgery,” as not all surgical procedures are alike.  It is important to review the operative report as well as the billing and diagnostic codes to confirm the type of procedure that was performed in order to properly evaluate the claim.  Please also be aware there is a possibility that photographs and video records of the procedure have been taken by the surgeon during the procedure as those photographs and/or videos may have an impact on a potential jury who will not care about the difference between an open and micro procedure if they have been forced to watch the surgery on a big screen high definition television.

In short, the evaluator who does their homework early with regard to the nature of the procedure, the outcome and post-surgical treatment will be in a better position to adequately evaluate a claim in order to position the claim to its optimal result.