Discectomy is a spine procedure to remove all or part of the herniated spinal disc to relieve pressure caused by compressed spinal cords and nerves. Microdiscectomy is a minimally invasive spine surgery using a microscope to remove fragments from herniated discs.
Microdiscectomy surgery is performed to relieve leg pain or weakness (sciatica) and nerve pain and pressure resulting from herniation of the intervertebral discs which have placed pressure on surrounding nerves or have herniated into the spinal canal.
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-Microdiscectomy is a very successful procedure when performed on properly selected patients. As many as 90-95% of patients are better and many return to pre-injury level of activity. -May improve or eliminate leg pain caused by a pinched nerve from a disc herniation -Can be done through a very small incision, making it a minimally invasive procedure -Healthy disc material remains in place and can continue its normal function -Does not damage neighboring discs
-The risks of surgery include but are not limited to infection, dural tear (resulting in leaking of clear spinal fluid), neurologic injury, recurrent disc herniation, and chronic back or leg pain, numbness, tingling, or weakness. In addition there are potential medical risks for anyone undergoing general anesthesia which may necessitate a preoperative medical evaluation.
Microdiscectomy may be performed under a local anesthetic combined with intravenous sedation, which means you would be awake during the back surgery. A general anesthetic may also be used. A small incision (about two inches) is made between the bones of the vertebrae on the back. The surgeon will then move the back muscles to the side. A flexible tube containing surgical implements and a high powered telescope is used to perform the spine surgery and guide the doctor as herniated disc tissue and fragments are removed.
Before surgery, you will meet with the back surgeon to discuss your options. Once you and the surgeon decide on the procedure, the doctor will discuss the risks and benefits and have you sign a consent form. Because bleeding could occur, you will need to hold all blood thinning agents for 3-7 days before your surgery. In addition, you need to arrange to have someone take you home after you are discharged. You will likely meet with a physical therapist for an evaluation 1-2 weeks before your procedure, and you should arrange to have someone help out at home for a couple of days once you are released from the hospital.
Following your surgery, you are monitored in the recovery room for 1-2 hours. Once you are alert, awake, and stable, you are moved to a hospital room for overnight stay. The physical therapist will work with you on getting in and out of bed and using a walking assistive device. After going home, you continue to meet with the therapist to improve strength and flexibility.
Complications in back surgeries such as this are infrequent and usually minor. However, as with any spine surgery, there are risks, including the possibility of: Nerve root damage leading to a sensation of numbness, tingling or weakness in the legs Tears to the protective coating around the nerves and spinal cord Re-herniation of the same disc Pain that persists or worsens after surgery Reaction to the anesthesia Risks from any surgery can be reduced by following the surgeon's instructions before and after the back surgery.
Why do spinal discs go bad?
Discs are the soft tissue pads between your lumbar vertebrae. They act as a cushion or shock absorber for the bones of your spine. As such, they are subject to extreme mechanical forces. As we age, they begin to wear or deteriorate. They can also be injured. A worn or damaged disc can cause back pain. A disc herniation is simply a piece of disc material that has broken loose and pushed its way into a place it does not belong. If it pushes up against a nerve root, it can cause severe pain.
What is the success rate of a lumbar microdiscectomy?
In a recent prospective study, researchers evaluated surgical outcomes of lumbar microdisccectomy in young, active patients. All patients had single-level lumbar microdiscectomies and were followed for 3 years. At the final follow-up, researchers found that the procedure had an 84% success rate, with most patients returning to military duty. In addition, 80% of patient had a significant decrease in pain. Overall, 85% of people said they were very satisfied with their surgery.
What is the average time I will be off work?
On average, desk work may take between 3-6 weeks and heavy work from 6 to 12 weeks. Some patients may return to work sooner than others depending on their response to surgery and ability to temporarily perform lighter tasks in the work place. Physician approval is required prior to returning to work.
Who benefits from the lumbar microdiscectomy procedure?
By performing a microdiscectomy, a neurosurgeon can alleviate a patient’s pain and allow the patient to enjoy an improved quality of life. While this procedure will offer significant relief for those affected by spinal nerve compression, it is not the best choice for everyone. Patients who have severe degenerative disease will need a full discectomy and spinal fusion versus a microdiscectomy procedure. Additionally, because only a small part of the disc is removed, the patient has a slight chance for future herniation, which requires another procedure.