The word microdiscectomy stands for ‘micro’ meaning that the surgery is performed by making a small, “micro” incision. While ‘discectomy’ means “removal” of a herniated intervertebral disc material.
Microdiscectomy is a minimally invasive surgery to treat a herniated disc in the spine. The herniated disc can put pressure on a nerve. This can cause severe pain, weakness, and numbness in the area that the nerve supplies. The surgery aims to relieve the pressure on the nerve so it can recover and help the patient resume normal activities.
Many people may find relief from symptoms without any surgery. Alternate treatment may include:
Step by step procedure:
The patient is settled on the operating table. The surgeon will administer anaesthesia. They will clean prepare the site of the incision. General anaesthesia is used while performing the microdiscectomy procedure. It is very well tolerated by most patients.
Using a X ray in theatre, the surgeon will locate and mark the affected vertebra and disc. He or she will make a single level incision of 1 to 2 inches. The surgeon will retract back muscles on one side so the bony vertebra is exposed.
In a minimally invasive discectomy, the incision is less than 1 inch. The surgeon will use a series of progressively larger dilators to gradually separate the muscles to create a tunnel to the affected vertebra. The rest of the surgery is performed under magnification using a microscope.
The surgeon will use a drill or bone-biting tools to perform a laminotomy. This creates a small opening of the lamina – above and below – the spinal nerve. It can be done on just one side (unilateral) or both sides (bilateral). It can be even done on multiple vertebrae levels, so the nerve root and spinal cord can be reflected gently to expose the herniated disc.
The protective sac of the nerve root is gently retracted by the surgeon. A surgical microscope is used to find the herniated disc. The affected portion of the disc is removed, thus decompressing the spinal nerve root. Any bone spurs or synovial cysts pressing on the nerve root are also removed. Fusion is rarely performed for a single-level lumbar microdiscectomy.
The surgeon removes the retractor that is holding the muscles back. Muscle and skin incisions are sewed together using sutures .
Most patient should be able to go home the same day of surgery or the day after. They should follow their doctor’s home care instructions for 6 weeks after surgery or until the follow-up appointment.
Regular exercise helps the patient return to normal activities very soon. A patient must ask their healthcare team or GP for medical advice before starting an exercise routine.
Microdiscectomy surgery is a very safe surgery. However, some small risks are associated with it.
General complications of any surgery may include:
Specific complications of this surgery are:
More than 90% of patients undergoing microdiscectomy for a disc herniation have shown good-to-excellent outcomes. Microdiscectomy is an extremely effective surgery to improve, especially the symptoms of leg pain.
For some patients, the nerve pain goes away immediately. For most patients, there is a significant reduction in pain which progresses to complete relief over days to weeks.
It is fine to sleep in whichever position is most comfortable. Some may prefer to sleep on one side while others may prefer using a pillow between their knees and behind them to provide support to their backs.
You should check with your doctor on what activities are feasible for you based on your case. At Neuroaxis, we provide patients with a plan for physiotherapy and return to normal exercise. This includes discussion with your general practitioner and chosen physiotherapist.
Prolonged sitting , bending and lifting of weights is discouraged for the first 4-6 weeks after surgery.
The incision area should remain dry and covered with a waterproof surgical dressing. This means you can shower. Should the dressing gets wet, it needs to be changed by your healthcare provider. Most patients are independent and self caring prior to discharge from hospital.
To be able to play a full round of golf, the patient needs to wait for around 16 weeks to recover.
A return to driving is recommended only after 4-6 weeks post surgery . This is to minimise the twisting and turning movement of the spine, to enable good healing of the scar and to reduce the chance of recurrent disc prolapse.
An exercise program of stretching, aerobic exercise, strengthening and conditioning is recommended. Additionally hydrotherapy and maintenance of good posture will help prevent the recurrence.
Patients are advised to have a healthy diet. If needed, they should consult with a dietician especially if weight loss is one of the goals. There are no specific dietary restrictions to reduce the chance of recurrence.
If the incision area shows signs of infections, the patient should consult their physician. Signs to look out for include pain, drainage, swelling, redness or when your temperature increases over 38.5 degrees. If the preoperative symptoms were to come back or if you develop any new numbness or weakness, your surgeon needs to be notified urgently.