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microdiscectomy

A herniated disc can cause compression of a spinal nerve leading to pain, sensory changes, or weakness of an extremity. When non-operative measures fail to relieve symptoms, surgical intervention may be indicated. A lumbar microdiscectomy is a surgical procedure done to remove part of a herniated disc that is causing leg symptoms. This is to treat lumbar radiculopathy, or a 'pinched nerve', and is done by minimally invasive techniques that allow a surgeon to access the herniated disc fragment with minimal muscle and soft tissue disruption. There are many advantages to a microdiscectomy when compared to a traditional discectomy. Innovative techniques minimize the extent of tissue disruption, reduce post-operative pain, and significantly reduce the healing time.



Anatomy

The spine is composed of individual bones called vertebrae. There are typically five lumbar vertebrae. They are stacked one on top of another and are separated by discs, which act as an elastic cushions or shock absorbers. Discs have a soft center, the nucleus, surrounded by a tough outer ring, the annulus. Discs allow motion between the vertebrae. The interbody space is the disc space that is located between the vertebral body bones. Each vertebral segment creates a bony circle, called the spinal canal that protects the spinal cord and spinal nerves.  The spinal cord, which is the nerve center of the body, connects the brain to the rest of the body. The spinal cord and nerves travel from the cervical spine down to the lowest point of your spine, the sacrum. Spinal nerves exit the spinal canal between the vertebrae at each level. Two nerves exit each level, one on the left and one on the right. These nerves exit through openings called foramen. The discs, bony structures, ligaments and strong muscles all work together to stabilize the spine.

Surgical Procedure

The surgery 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. A window into the spinal canal is created by removing a small portion of bone. Nerves are gently moved out of the way to visualize the herniated disc. Using microsurgical technique, the disc fragment is dissected free and removed. This alleviates pressure on the compressed nerve. The objective is not to remove the entire disc, only the herniated part that compresses the exiting spinal nerve. Removing 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. Read about Possible Complications from Spine Surgery. The incision is typically closed with one to two absorbable sutures and dressed with a band-aid sized dressing. Patients are usually discharged on the day of surgery or the next morning. Patients are instructed to limit activities to walking for the first several weeks and avoid prolonged sitting. The patient is at risk for re-herniation during the healing process so it is important to follow restriction that try to minimize excess pressure on the discs. If necessary, physical therapy for strengthening and range of motion is usually started following the first follow-up visit, four to six weeks after surgery. All patients should stop smoking prior to any surgery, as smoking is extremely detrimental to your spine health, potential bone healing and successful surgical outcomes. 

 

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