19 Feb Microdiscectomy Procedure for Painful Herniated Discs
Microdiscectomy is a procedure used for patients with painful low back (lumbar) herniated discs. This procedure is a commonly performed surgery that is done by neurosurgeons and orthopedic spine surgeons. The operation consists of removing a part of the intervertebral disc that is protruding into the spinal canal and compressing nerves. Today, surgeons can perform this procedure using telescopic glasses and computer technology, which means the procedure only involves a tiny incision.
The microdiscectomy procedure is performed using general anesthesia. The minimally invasive doctor inserts a small breathing tube (called an endotracheal cannula) into the mouth and down the trachea. This is used to provide breathing during surgery. After positioning the patient face down (prone) on a padded operating table, the skin of the back is cleaned and prepped with an antiseptic. Sterile drapes are positioned around the surgical site.
A small 2-centimeter incision is made in the middle of the lower back, right over the region of the herniated disc. A special retractor device is used to open the site. The surgeon uses a tiny microscope to visualize the area of the spine in question, so there is little need to cut or remove adjacent muscles and soft tissues. Once retractors are positioned, an x-ray is done to confirm the disc.
To visualize the disc herniation, the surgeon removes a few millimeters of bone of the superior lamina. The nerve root and other structures are protected using the retractor, so the herniated disc material can be removed from the spinal column. Small, specialized instruments are used to grasp and remove the protrusions. All surrounding areas are cleansed with saline/antibiotic solution to remove disc fragments as well. The surgeon closes the deep fascial layer and subcutaneous tissues using strong sutures. A bandage is applied over the surgical site.
Immediate after surgery, a nurse will monitor you in the recovery room for 60-75 minutes. Expect numbness of the lower back for a few hours. After the anesthetic wears off, you may experience mild soreness of the surgical site. The nurse will administer pain medications to relief your discomfort.
Most patients will go home the same day of surgery, or the very next day. Before going home, the patient meets with the physical therapist who will work with him/her at home. The therapist also instructs the patient on getting in and out of bed, and using a walker or assistive device. Because of the manipulation of tissues and healing spine, patients must avoid lifting more than five pounds, bending at the waist, and twisting for 2-4 weeks. In addition, patients should avoid sitting in the same position for more than 45 minutes during the first 2 weeks after the procedure.
Occasionally, patients are given a small, soft lumbar corset to offer support of the lower back in the early postoperative period. The wound area is usually covered with a bandage for the first 24-48 hours, but can be left open to air once you go home. The sutures are removed within 7-14 days after you return to the follow-up appointment.
The wounds are to be kept clean and dry. Patients may shower right after surgery, but should cover the incision with a bandage to avoid water hitting the wound. The surgical sutures must be left in place. The patient cannot soak in a tub or pool until the wound is healed and sutures are removed.
Does microdiscectomy work?
A recent study evaluated 197 patients who had a single-level lumbar microdiscectomy surgery. All patients failed with physical therapy, epidural steroid injections, and medications. After surgery, researchers concluded that the procedure was successful, with 84% of patients returning to unrestricted activities on the job. In addition, 80% of patients reported decreased pain, and overall, 85% of patients were satisfied with the procedure.
Inspired Spine covers the whole spectrum of back pain relief. The Inspired Spine team of providers includes specialists in pain management, interventional procedures and minimally invasive spine surgery. When it comes to surgery, our doctors offer microdisctomies, spinal fusion and more. Call us today for help!
Dewing CB, Provencher MT, Riffenburgh RH, et al. (2008). The outcomes of lumbar microdiscectomy in a young, active population: correlation by herniation type and level. Spine Surgery.