MINIMAL INVASIVE SURGERY

Lumbar Disk Prolapse

Spinal surgery once meant large incisions, long recovery periods, and painful rehab. Fortunately, surgical advances like the microdiscectomy procedure have improved the process.

Microdiscectomy, also sometimes called microdecompression or microdiscectomy, 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 column.

 Extrusion of an intervertebral disc can cause compression of a spinal nerve leading to pain, sensory changes, or weakness of an extremity. When the findings on physical examination correlate with the radiographic imaging and the patient has failed conservative therapy, surgery may be considered an appropriate treatment alternative. The procedure to relieve the pressure on a spinal nerve resulting from a herniated lumbar disc is referred to as a Microdiscectomy. There are several options available that provide access to the herniated disc fragment that vary in the degree of muscle dissection. Typically the more muscle dissection performed; the more post-operative discomfort the patient will experience. Minimally invasive techniques allow access to the herniated disc fragment with a minimal amount of muscle and soft tissue disruption.

Indications for Microdiscectomy Surgery

In general, if a patient's leg pain due to a disc herniation is going to get better, it will do so in about three to four weeks. As long as the pain is tolerable and the patient can function adequately, it is usually advisable to postpone back surgery for a short period of time to see if the pain will resolve with non-surgical treatment alone.

If the leg pain does not get better with nonsurgical treatments, then a microdiscectomy surgery is a reasonable option to relieve pressure on the nerve root and speed the healing. Immediate spine surgery is only necessary in cases of bowel/bladder incontinence (cauda equina syndrome) or progressive neurological deficits (foot drop). It may also be reasonable to consider back surgery acutely if the leg pain is severe.

A microdiscectomy is typically recommended for patients who have:

• Experienced leg pain for at least three weeks
• Not found sufficient pain relief with conservative treatment (such as oral steroids, NSAIDs, and physical therapy).
• Progressive Neurologic deficits

However, after three to six months, the results of the spine surgery are not quite as favorable, so it is not generally advisable to postpone microdiscectomy surgery for a prolonged period of time.

 Surgical Procedure

The procedure is typically performed under general anesthesia. In order to access the spine, a channel is created through the muscles of the back using a minimally invasive approach. Removing a small portion of bone creates a window (5mm in length) into the spinal canal. The inflamed nerve is identified and, utilizing microsurgical technique, the extruded fragment of disc is dissected free and removed, releasing the compressed nerve. The nerves are gently dissected to expose and visualize the diseased disc. 

Depending on the extent of disc herniation, the extruded fragments are freed from the surrounding tissues and removed, alleviating the pressure on the adjacent nerves. The objective is not to remove the entire disc, only the herniated portions that are compressing the exiting spinal nerve. Removal of the entire disc would lead to a mechanically unstable environment and lead to the development of mechanical low back pain. As with any operative procedure there are risks associated with a microdiscectomy; however these risks are minimal.

The incision is typically closed with one to two absorbable sutures and dressed with a Band-Aid sized dressing.

Surgical Procedure

The procedure is typically performed under general anesthesia. In order to access the spine, a channel is created through the muscles of the back using a minimally invasive approach. Removing a small portion of bone creates a window (5mm in length) into the spinal canal. The inflamed nerve is identified and, utilizing microsurgical technique, the extruded fragment of disc is dissected free and removed, releasing the compressed nerve. The nerves are gently dissected to expose and visualize the diseased disc. 

Depending on the extent of disc herniation, the extruded fragments are freed from the surrounding tissues and removed, alleviating the pressure on the adjacent nerves. The objective is not to remove the entire disc, only the herniated portions that are compressing the exiting spinal nerve. Removal of the entire disc would lead to a mechanically unstable environment and lead to the development of mechanical low back pain. As with any operative procedure there are risks associated with a microdiscectomy; however these risks are minimal.

Recovery Time

The recovery time is shorter than other, more invasive procedures. Most people can expect to leave the hospital that same day, or within 24 hours.

You’ll likely meet with a physical therapist and occupational therapist before leaving the hospital. These therapists will give you instructions on how to reduce the bending, lifting, and twisting you do with your back.

Although you won’t be able to resume to normal activities immediately, your lifestyle shouldn’t be greatly impacted. For the first week or two, you may need to reduce your workload or be absent from work while you recover. You’ll also need to avoid lifting heavy objects for two to four weeks after the surgery. 

You may also need to slowly progress your way back to normal physical activity. For example, you may not be able to resume exercise or physical hobbies for two to four weeks after the procedure.

These innovative techniques minimize the extent of tissue disruption, reduce post-operative pain and discomfort, and significantly reduce the recuperation time.

Microdiscectomy Risks and Complications

As with any form of spine surgery, there are several risks and complications that are associated with a microdiscectomy, including:

• Dural tear (cerebrospinal fluid leak) -- this occurs in less than 1% 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 (extremely rare)
• Bowel/bladder incontinence (extremely rare)
• Bleeding
• Infection (less than 0.7%)

However, the above complications for microdiscectomy spine surgery are quite rare.

Talk to Your Doctor

Microdiscectomy is a minimally invasive procedure with an outstanding track record for relieving pain. The microdiscectomy also is a specialized surgery that requires a surgeon with special training. If you’re a candidate for the procedure, you should discuss the risks and benefits of the surgery with your doctor.