What is Microdiscectomy?
A microdiscectomy is a procedure which is typically indicated when a herniated, protruded, or extruded disc in your spine presses against a central nerve causing leg pain, numbness, or weakness. Microdiscectomy, also sometimes called microdecompression or microdiskectomy, is a minimally invasive surgical procedure performed on patients with a herniated lumbar disc. During this surgery, a surgeon will remove portions of the herniated disc to relieve pressure on the spinal nerve. This technique uses a special microscope to visualize the disc and nerves. Larger the view, smaller the cut, resulting in less damage to the surrounding tissues.
Who is a Good Candidate for Microdiscectomy?
You may be a candidate for discectomy if you have:
- Diagnostic tests (MRI, CT, myelogram) that show a herniated disc
- Significant pain, weakness, or numbness in your leg or foot
- Leg pain (sciatica) worse than back pain
- Symptoms that have not improved with physical therapy or medication
- Leg weakness, loss of feeling in the genital area, and loss of bladder or bowel control (cauda equina syndrome)
Surgical Technique: How is Microdiscectomy Done?
A lumbar microdiscectomy surgery is performed to remove the portion of a herniated disc that is irritating or inflaming the nerve root.
A microdiscectomy is performed through a small incision in the midline of the low back.
First, the back muscles, called erector spinae, are lifted off the bony arch, called the lamina, of the spine. Since these back muscles run vertically, they can be moved out of the way rather than cut.
The surgeon is then able to enter the spine by removing a membrane over the nerve roots. This membrane is called the ligamentum flavum.
Often, a small portion of the inside facet joint is removed both to facilitate access to the nerve root and to relieve pressure over the nerve.
The nerve root is then gently moved to the side and the disc material is removed from under the nerve root. Only the herniated portion of the disc is removed; the healthy portion of the disc is left intact.
After the piece of the disc that is irritating or inflaming the nerve root has been removed, the pressure is off the nerve immediately and it has room to heal.
A herniated disc pressing on a nerve root can cause severe leg pain. While it may take weeks or months for the nerve root to fully heal and any numbness or weakness to get better, patients normally feel relief from the leg pain almost immediately after a microdiscectomy.
Recovery Time Following Microdiscectomy or What to Expect After Microdiscectomy Surgery?
Following Microdiscectomy, the patient is encouraged to walk as soon as the numbness is gone. Prescription medicines can be used to overcome pain during the recovery period after Microdiscectomy. Slowly, you can resume exercises and you activities of daily living. Other things you need to take care about are:
- Initially during the recovery period following Microdiscectomy, you may have difficulty sitting. But over the time sitting will be more comfortable.
- You will be advised to walk as much as you can. It will lower the risk of scar tissue formation after microdiscectomy.
- Many people are soon able to resume their daily activities. In other cases patients may be advised to undergo rehabilitation program or physical therapy to aid in early recovery following microdiscectomy surgery.
- Depending on the amount of lifting, walking and sitting your job involves, you may be able to return to work in two to six weeks after microdiscectomy surgery. If you have a job that includes heavy lifting or operating heavy machinery, your doctor may advise you to wait six to eight weeks before returning to work.
Risks & Complications of Microdiscectomy
The microdiscectomy may sometimes not work any better than other treatments. There is a slight risk of damaging the nerve or the spine. There is risk of infection and risk of anesthesia. Other risks of microdiscectomy include bleeding, leaking spinal fluid, bowel/bladder incontinence etc.
Success Rate of Microdiscectomy
An extensive medical study has shown good to excellent results with 84% people who have undergone microdiscectomy procedure.
With varied estimates, about 1% to 20% people may have another disc herniation at some point. This can occur either directly after the surgery or years after the microdiscectomy surgery.
A microdiscectomy is generally considered the gold standard for removing the herniated portion of a disc that is pressing on a nerve, as the procedure has a long history and many spine surgeons have extensive expertise in this approach.
While technically an open surgery, a microdiscectomy uses minimally invasive techniques and can be done with a relatively small incision and minimal tissue damage or disruption.