Microdiscectomy Spine Surgery
A microdiscectomy is a procedure that removes a small portion of the bone over the nerve root and/or the disc material from under the nerve root. This process alleviates neural impingement and allows sufficient room for the nerve to heal. The procedure is typically performed for a herniated lumbar disc and is much more effective for treating leg pain than lower back pain.
Pressure on the nerve root can cause substantial leg pain. Despite it taking several weeks or months for the nerve root to completely heal and any numbness or weakness to improve, patients often feel relief from leg pain almost instantly following a microdiscectomy.
Why the procedure is performed
If leg pain due to a disc herniation is going to improve, it will do so in roughly 6 to 12 weeks. If the pain is tolerable and/or you can function properly, it is typically advisable to postpone back surgery to see if the pain will subside with non-surgical treatments. If the pain does not improve with nonsurgical treatments, a microdiscectomy surgery may be suggested to alleviate pressure on the nerve root and accelerate the healing process. Immediate spine surgery is only necessary in cases of bowel/bladder incontinence or progressive neurological deficits.
A microdiscectomy is often recommended for patients who have experienced leg pain for a minimum of six weeks or who have not found pain relief with treatments such as physical therapy or oral steroids.
Description of procedure
A microdiscectomy is performed though a 1 inch to 1 ½ inch incision in the midline of the lower back. The back muscles are raised off the bony arch of the spine. The surgeon is then able to enter the spine by eradicating a membrane over the nerve roots, and uses either operating glasses or an operating microscope to see the nerve root. A small portion of the inside facet joint is often removed both to ease the access to the nerve root and to relieve pressure over the nerve. The nerve root is then moved to the side and the disc material is removed from under the nerve root. A microdiscectomy does not change the mechanical structure of the lower spine.
After the procedure
A microdiscectomy is usually performed on an outpatient basis. No overnight stay is required. Some surgeons restrict a patient from twisting, lifting or bending for the first six weeks after surgery. However, it is reasonable to return to a normal level of functioning after a microdiscectomy.
The success rate for microdiscectomy spine surgery is approximately 90% to 95%.
Risks of the procedure
The potential risks and complications for a microdiscectomy are quite rare. They include:
- Dural tear (cerebrospinal fluid leak) -- this occurs in 1% to 2% of these surgeries, does not change the results of surgery, but post-operatively the patient may be asked to lay recumbent for one to two days to allow the leak to seal.
- Nerve root damage
- Bowel/bladder incontinence
- 5% to 10% of patients will develop a recurrent disc herniation at some point in the future. A recurrent disc herniation may occur immediately after back surgery or several years later.
- A recurrent disc herniation is most common in the first three months after surgery.
- After one recurrence, the patient is at higher risk for additional recurrences. For these patients, a spinal fusion may be recommended to prevent further recurrences.
An exercise program of stretching, strengthening, and aerobic conditioning is advised to prevent a recurrence of back pain or disc herniation.