Lumbar decompression surgery is an option if nonsurgical treatment (generally 4 to 6 weeks) fails to relieve pain from a herniated disc. A microdiscectomy (or microdecompression), a type lumbar decompression procedure, is often used to treat nerve pressure from a herniated disc.
To allow nerve pressure relief or better access to the nerve root, a portion of the facet joint can be removed. A minimally-invasive microdiscectomy procedure is used to remove the herniated disc below the nerve root. The nerve root is given more space to relieve pressure and allow the nerve root to heal.
Microdiscectomy is a highly effective procedure for relieving leg pain (sciatica), caused by a herniated disc. While the nerve root can take several weeks to heal completely, patients often feel relief from their leg pain immediately and have very little discomfort after the procedure.
What is microdiscectomy?
Microdiscectomy is a procedure that relieves pain from a herniated disc. The surgeon will remove small pieces of bone, disc and ligament to free the nerve.
Microdiscectomy can be described as minimally invasive spine surgery. It requires only a small incision. The surgeon uses a microscope and surgical glasses called loupes to magnify the area where the injury occurred. To work within the narrow space of the spine, the surgeon uses smaller tools and instruments.
Microdiscectomy can be described as a type or spinal decompression surgery. The term microdecompression, which refers to the surgical removal of any bone or ligament that has compressed a nerve, may also be used. The term “microdiscectomy”, however, refers to the surgical removal of the herniated disc tissue fragment that is causing the patient’s symptoms.
Most patients can recover from a herniated disc without surgery. However, microdiscectomy should only be performed after conservative treatment has been completed. This includes physical therapy and cortisone injections. Motor weakness in some cases may warrant this surgery earlier. Cauda Equina Syndrome patients require immediate surgical intervention.
It is a condition where pressure on the nerves of the lower spine causes problems with bladder and bowel function. However, it affects less than 1% of patients.
Microdiscectomy Techniques
Midline microdiscectomy is a procedure in which the surgeon makes an incision at the back that’s one to two inches in length. This allows the surgeon to lift the surrounding muscles and use instruments to separate the layers of tissue.
Tubular microdiscectomy is when the surgeon inserts small tubes or dilaters through a small incision. This creates a passage through the muscle for the surgeon to operate. Endoscopic microdiscectomy, also called microendoscopic discectomy, is a procedure that involves a smaller incision and uses specialized instruments and cameras. This method causes less tissue damage.
What are the advantages of microdiscectomy?
No matter which microdiscectomy technique is used, the goal of surgery is to remove the disc fragment as well as any bone or ligament that might be compressing the nerve roots. The surgeon makes a small opening in the vertebra to remove the ligamentum flavum and other underlying tissue. This exposes the dura (the covering around the spine) as well as the nerve root. To complete nerve decompression, the surgeon will also remove the herniated disc.
To ensure that the correct surgical site is located, imaging techniques such as X-rays are used, sometimes before and sometimes during surgery.
Although herniated discs can occur at any level of the spine or in almost every part of it, lumbar microdiscectomy is the most common location for this procedure. It involves removing the lower back.
What is the average time for a microdiscectomy?
Microdiscectomy takes on average between 30 and 60 minutes. The average time for microdiscectomy surgery is about two hours due to the fact that patients must be monitored and given general anesthesia.
Nearly all people who undergo microdiscectomy can return home within 24 hours. Patients are usually discharged from the hospital with a small amount of pain medication, including acetaminophen and small amounts of opioid medication. They also receive instructions on post-surgery care and how to adjust these medications. Patients who present with symptoms such as muscle weakness, altered bladder function or severe leg pain should be referred to a doctor immediately.
What complications could microdiscectomy cause?
Multiple safety precautions are taken during surgery to prevent bleeding, infection, and injury to surrounding tissues. Rarely, there may be a tear in dura (the tissue that surrounds the spinal nerves). This can be repaired by the surgeon using a suture or a collagen patch.
How long is the expected recovery time for microdiscectomy?
Many patients feel able to return to work after a two week period of rest. A microdiscectomy recovery usually requires six weeks of modified activity. This includes physical therapy that begins at week two or three.
Physical therapists help patients strengthen their core muscles and loosen stiff joint. They also create a home exercise program that helps protect the spine. Patients are advised to gradually return to their old routines, especially if they have to do physical labor. People with more sedentary jobs need to pay attention to their posture.
Patients who want to drive again after surgery should wait until they feel pain-free and have stopped taking any medication that can cause drowsiness. Before returning to regular roads, it is a good idea to practice driving in a safe place, such as a parking lot, with another driver.
Is microdiscectomy painful?
Most patients tolerate a low dose of non-opioid pain medication after surgery and a medication that relaxes their muscles. Although there may be some discomfort from the incision, most patients feel immediate relief from the herniated disc pain.
Patients who have suffered nerve compression or associated symptoms for a prolonged period of time may experience pain relief that takes longer. Leg pain that has been the main symptom is usually relegated to the lower leg. Patients may also experience mild numbness, tingling, or muscle cramping after surgery. These symptoms usually disappear with time.
Who is eligible to have a microdiscectomy?
Patients with herniated discs who are not responding to physical therapy and medication over time are eligible for a microdiscectomy. Although the majority of patients with this condition are between 30 and 50 years old, it can also occur in people older than that.
Children and young adults are less likely to have herniated discs than those in their 20s. However, they are more often able to heal themselves without the need for surgery. Adults in their 80s and 90s may benefit from microdiscectomy, but they should be aware that this can lead to more serious medical or surgical complications.
What is the success rate of microdiscectomy?
Microdiscectomy success rates are high, with many patients being very satisfied with the results. The success of microdiscectomy is dependent on the patient’s commitment to good spinal health after the procedure.
Noting that herniated discs can also cause nerve-related disability and pain, some people may also have other spine issues. If these conditions are causing their disability, you may need to have a laminectomy (a procedure that removes the bony roof covering the spinal canal).
What can I expect during recovery?
The results of herniated disc surgery are often more effective than other methods and they work faster. Within a few weeks of surgery, you should begin to notice a reduction in pain, weakness, or numbness.
You can recover faster with physical therapy or rehab. You can either go to rehab or do home exercises. Walking can help you to regain mobility in your spine.
Be careful in the first few weeks following your surgery to not:
- Lift heavy objects
- For long periods of sitting,
- Too much bend or stretching
Your doctor will tell you when you are able to drive and return to work. In 2 to 4 weeks, you should be able to return to your desk job. You might need to wait 6-8 weeks if you are required to lift heavy items or operate large machines at work.
What are the risks? What is my outlook?
The majority of herniated disc surgeries are safe. Although risks are uncommon, they can include:
- Infection
- Nerves and blood vessels damaged
- Probleme with the new disc
- Leakage of spinal cord fluid
- Bleeding
There is a chance that surgery will not improve your symptoms. Your pain may get better over time, but then return in the future.
Most people suffering from a herniated disc can get relief from their pain and other symptoms by surgery. However, it is not for everyone. The disc may herniate once more in about 5% of cases.
Surgery is not always the best option. Although it can provide faster relief than other treatments. Before you make a decision about a treatment, talk to your doctor about the risks and benefits.
The Successful Treatment of a Herniated Disc
Because each patient is different, treatment of a herniated disc can be complicated due to the unique nature of their pain and symptoms. One patient might experience pain or discomfort that is not the same for another. Patients can work with a variety of spine specialists to find the best treatment option for their pain. This can help them avoid surgery.