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Lumbar MicrodisectomyLumbar Microdisectomy

What is a Lumbar Microdiscectomy? 

The low back area is also called the lumbar spine. The discs are the shock absorbing cushions in between each of lumbar bones or vertebrae. The disc can become injured or worn resulting in a herniation. Sometimes people refer to this as a slipped or ruptured disc. When this happens, it can become a cause of back and/or leg pain.   

During a lumbar microdiscectomy the surgeon makes a 1-2 inch incision and uses a microscope or loupes along with micro-surgical techniques to remove the part of the disc that is putting pressure on the spinal nerve. This minimally invasive technique spares the bones, muscles, ligaments and surrounding soft tissue from trauma making recovery easier and faster.

Who is a Candidate for a Microdiscectomy? 

Less than 10% of patients with disc herniations require surgery. Most of these conditions will resolve with basic care measures. However, in some cases, the back and leg symptoms become unmanageable. This occurs when the damaged disc puts pressure on the spinal nerve producing pain that goes to your leg. Pressure on the nerve may cause pain, numbness and/or weakness in the leg. This is sometimes called “sciatica.” Sciatica is usually felt as a sharp, shooting pain through the buttock, down the leg and may go into the foot. When leg pain does not resolve with basic care measures, and the ability to perform daily activities is severely restricted, the patient may be a good candidate for a microdiscectomy.

What are the Alternatives to a Microdiscectomy?

Most of the time conservative therapies will relieve the symptoms resulting from the herniated disc. Treatments such as medication, bed rest, steroid injections and physical therapy are effective and return the majority of patients to normal daily activities.

How are Back Problems Evaluated? 

Your doctor will use a number of approaches to evaluate and diagnose back problems such as a herniated disc. These include:

A Detailed History – Your role in providing a detailed history is very important. Your doctor will need to know where and when it hurts, if there was a recent injury or fall, and a description of the symptoms. Are there positions or activities that make it feel worse? What makes it feel better? All of these details can help your doctor pinpoint the problem.

A Physical Exam – Once your history is given, a thorough exam by a spine expert is another important step in getting a good diagnosis.

Diagnostic Imaging – Xrays can show the structure and alignment of the vertebrae, as well as the presence and size of bone spurs or other bony abnormalities.

MRI or “magnetic resonance imaging” – MRI is probably the most utilized study for disc evaluation. MRI uses a powerful magnet and radio waves. The images produced are very helpful in visualizing the soft tissues such as the spinal cord, as well as the discs and nerve roots.

CT or “computerized tomography” – This is a special kind of xray machine. Rather than a single xray, a CT scanner sends out a number of beams at different angles. These images are then read by a computer, producing detailed cross-sections or “slices” that can show the shape and size of the spinal canal and the surrounding structures.

Bone Scans – These are useful in revealing certain abnormalities such as infections, fractures, tumors and arthritis. Because bone scans are unable to differentiate between these problems, they are usually performed in conjunction with other diagnostic tests.

How Long is the Hospital Stay? 

After surgery, you are encouraged to walk as soon as you recover from anesthesia. Once safe mobility is confirmed, you will be discharged to home. This usually occurs the same day of surgery, or within 24 hours.

How Long Will it Take to Recover?

Recovery after a microdiscectomy varies depending on your particular situation. However, recovery from microdiscectomy surgery is faster because there is minimal soft tissue damage and the mechanics of the spine are not affected. You can quickly return to normal activity provided you use good body mechanics and regain adequate trunk strength. During the early healing phase, you should avoid bending, lifting and twisting and prolonged sitting. If you work in an office you should be able to return to work in 2-4 weeks. If your job requires heavy physical work, you may not be able to return for up to 3 months.

Frequently Asked Questions

Lumbar Laminectomy / Discectomy

What is wrong with my back?

You have a “pinched nerve.” This can be produced by one or more herniated discs and/or areas of arthritis in your back. The discs are rubbery shock absorbers between the vertebrae, and are close to nerves that originate in the spine and then travel down to the legs. If the disc is damaged, part of it may bulge (herniate) or even burst free into the spinal canal, putting pressure on the nerve and causing leg pain, numbness or weakness. Bone spurs associated with arthritis may cause similar pressure.

What is required to fix the problem?

The discs or bone spurs pressing on your nerve can be removed. This is done by making an incision (usually about two inches long) in the middle of your lower back, moving the muscles covering your spine to the side, and making a small window into your spinal canal. The nerve is exposed, moved aside and protected; and the protruding disc or bone spur is then removed. This decompresses the nerve and, in most cases, leads to improvement in nerve pain, numbness and/or weakness. Sometimes the abnormality may be more extensive, extending over several disc segments, requiring a longer incision for decompression.

Who is a candidate for lumbar decompression and when is it necessary?

The primary reason for this operation is pain that is intolerable to the patient. Sometimes increasing nerve dysfunction (particularly weakness) or loss of bowel or bladder control may make the surgery necessary even if pain is not severe. In most cases, nerve dysfunction is not severe and pain can be controlled by non-surgical means. If this doesn't happen, and if the pain and subsequent disability become intolerable, surgery is a reliable way to address the problem. Since the patient is the one feeling the pain, the patient is usually the one who decides when he or she is ready for surgery.

Who performs this surgery? Is my entire disc removed?

Both orthopedic surgeons and neurosurgeons are trained in spinal surgery and both specialists may perform this surgery. It is important that your surgeon specialize in this type of procedure.

No, only the ruptured part and any other obviously abnormal disc material are removed. This generally amounts to no more than 10 percent of the entire disc.

How long will I be in the hospital? Will I need a blood transfusion?

Laminectomy patients are usually out of bed within an hour or two after their operation, and some can go home on the day of surgery. The remainder almost always goes home the next morning. Disectomy patients usually go home the day of surgery.

Transfusions are rarely needed after this kind of surgery. We do not recommend pre-operative donation of your own blood.

What can I do after surgery?

You may get up and move around as soon as you feel like it, and may drive short distances when you feel able and are no longer taking pain medication. You are encouraged to get up and walk a half mile every day. You should avoid back bending, twisting and lifting anything greater than 5 to 10 pounds for 4-6 weeks to allow for healing of the surgical area.

When can I go back to work? Could this ever happen to me again?

That depends on the kind of work you do, and how long you have to drive to get there. Surgical patients can return to sedentary (desk) jobs that they can reach with a drive of 15 minutes or less whenever they feel comfortable, (usually two or three weeks). You should not drive long distances (30 minutes or more) for about one month after surgery. If your job requires physical labor, you should consult your surgeon.

Unfortunately, yes, it could happen again. As mentioned above, only part of the disc is removed and there is no way to return the disc to normal again, which means recurrent herniations do occasionally occur. Also, adjacent discs may be abnormal, too, and could rupture in the future. This procedure, unfortunately, cannot prevent future problems.

What is the likelihood that I will be relieved of my pain? Will my back be normal after surgery?

The primary objective of these procedures is to improve leg symptoms. 90-95 percent of patients get relief of their leg pain. Back pain is less reliably improved with these procedures and may require additional treatment.

Though you may have excellent relief of pain, a disc is never completely normal after it has herniated, and if your problem has been caused by arthritis, the arthritis cannot be cured even if the bone spurs have been removed and the nerves decompressed. You may have residual back pain, and there is an increased risk of re-herniation of the damaged disc or a different disc. However, most people can resume almost all of their normal activities after recovering from surgery.

Could I be paralyzed? What other risks are there?

The chances of neurological injury with spine surgery are very low; and the possibility of catastrophic injury, such as paralysis, impotence or loss of bowel or bladder control are highly unlikely. However, injury to a nerve root with isolated numbness and/or weakness in the leg is possible.

There are general risks with any type of surgery. These include, but are not limited to, the possibility of wound infection, uncontrollable bleeding, collections of blood clots in the wound or in the veins of the leg, dural tear/spinal fluid leak, pulmonary embolism (a blood clot to the lungs) or heart attack. The chances of any of these happening, particularly to a healthy patient, are low. Rarely, death may occur during or after any surgical procedure.

What should I do after surgery? What shouldn't I do after surgery?

You should resume low-impact activities as soon as possible, starting with walking. Try to walk a little farther each day, building up to a brisk three-mile walk each day by six weeks after surgery. Once your wound is healed, which can take up to a month, you may swim, which is very back friendly. Talk to your surgeon about aerobics and jogging. Physical activity is good for you, if done properly.

You should avoid lifting greater than 5 to 10 pounds, back bending, twisting and high impact physical activities, including contact sports. Consult your surgeon for details.

Should I avoid vigorous physical activity?

No. Exercise is good for you! You should get some sort of vigorous, low-impact aerobic exercise at least three times a week, once you are fully healed. Walking either outside or on a treadmill, using an exercise bike and swimming are all examples of exercise that is appropriate for spine patients.

Contact Us

Make an appointment with our Spine Care Coordinator to learn more about our patient-centered process for back surgery or to schedule a tour.

Dave Smith, Spine Care Coordinator

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