Microdiscectomy
What’s a Microdiscectomy?
The clinical term “Microdiscectomy” refers to a minimally invasive surgical procedure that aims to relieve the pressure on a spinal nerve root. Usually, neurosurgeons perform this operation on patients with a herniated lumbar disc and remove the material that causes pain. Microdiscectomy, also known as micro-decompression, involves the removal of a portion of an intervertebral disc that causes pain, numbness, or weakness by stressing the spinal cord.
What’s the Patient Conditions for a Microdiscectomy?
Generally, patients can get relief from a herniated disc with rest, pain medications, and physical therapy. But when other conservative treatments (such as oral steroids, NSAIDs, and physical therapy) fail, neurosurgeons recommend microdiscectomy to get rid of this problem. Basic indications for recommending a microdiscectomy include:
- Severe leg pain that persists for a minimum of 6 weeks;
- Sciatica;
- Herniated Disc;
- Spinal tumor;
- Traumatic injury;
- Degenerative disc diseases;
- Abnormal growth of bones or vertebrae (bone spurs);
- Bulging of the bones and ligaments;
The different types of Microdiscectomy Procedures
Neurosurgeons consider microdiscectomy surgery as an alternative to spinal fusion or disc replacement surgery. Different types of microdiscectomy surgery may include 3:
-
Lumbar (lower back) microdiscectomy: This involves the removal of a small part of the facet joint and the lamina (the bone at the back of the vertebra) in the lower back area (lumbar spine).
- Cervical (neck) microdiscectomy: This involves the repair of a herniated cervical disc in the back of the neck area (cervical spine).
- Keyhole microdiscectomy: This procedure involves using an endoscopic (keyhole) technique to repair the herniated disc from any area (cervical or lumbar spine).
What’s the risks associated with a Microdiscectomy?
Any form of spinal surgery possesses several risks and complications. The most common risk of microdiscectomy includes dural tear or cerebrospinal fluid leak. A study reported the incidence of a dural tear in about 1% to 7% of microdiscectomy surgeries. Neurosurgeons recommend patient lie down for one to two days after surgery for sealing the leak. Other potential risks and complications of microdiscectomy include 4:
- Infection at the surgical site
- Damage of the nerve root
- Hematoma or formation of a blood clot
- Excessive blood loss
- Loss of bowel or bladder control
- Deep vein thrombosis in the leg
- Recurrent disc herniation
- Buildup of fluid in the lungs may lead to pneumonia
- Persistent pain after the surgery
The associated risk factors of a patient for microdiscectomy include genetics, old age, antibiotic prophylaxis, cardio-pulmonary disease, etc.
How should a patient prepare for a Microdiscectomy procedure?
Patients will discuss with their neurosurgeon about their qualifications for the microdiscectomy procedure. Neurosurgeons usually advise not to take any medications such as blood thinners ahead of the time of operation. Patients should avoid eating and drinking food for at least 12 hours before the operation. Prior to the surgery, neurosurgeons will perform additional imaging tests such as X-ray and magnetic resonance imaging (MRI) to diagnose and garner more information about the patient’s spinal column and nerves.
How does a Spinal Surgeon perform Microdiscectomy?
A professional medical team requires for a microdiscectomy operation to perform successfully. This team should comprise an expert neurosurgeon, an anesthesiologist, and a nurse to assist. The overall procedure presents as this 5:
- Patient will lie face down on the operating table for the surgery.
- Anesthesiologists will give general anesthesia to fall asleep so that patient will not feel any pain or sensation during the surgery.
- Neurosurgeons will make a 1- to 1 1/2-inch incision in the midline of the low back.
- Neurosurgeons will lift off the skin, muscles, fascia, and ligaments to expose the compressed area.
- Operating glasses (loupes) or an operating microscope will help the neurosurgeon to see the affected area.
- The neurosurgeon may remove a small portion of bone to facilitate access to the nerve root and to relieve any pressure on the nerve.
- The neurosurgeon will make a small hole in the bony lamina (laminectomy) to get access to the operative site.
- With a scissor-type of tool, the neurosurgeon will remove the fragments of disc material that causes the pain.
- Finally, the neurosurgeon will put the muscles and other tissues back in place and suture the skin together.
How long does a Microdiscectomy typically take?
Usually, a microdiscectomy surgery requires 1 to 2 hours to complete successfully. The surgical team will monitor and evaluate the patient’s condition such as heart rate, respiration, blood pressure, blood oxygen level, etc. throughout the operation. Healthcare providers will carefully look after the possible complication during and after the operation.
What does recovery from a Microdiscectomy look like?
Microdiscectomy requires a shorter recovery time than other spinal surgeries. Most patients can expect to leave the hospital within 24 hours after the surgery. Neurosurgeons suggest the patient to consult with a physical therapist and occupational therapist before going to the home. Patients will get instructions about bending, lifting, moving, and twisting their back after consultation with these therapists. Patients need to avoid driving, sitting for a prolonged time, heavy lifting for 2 to 4 weeks after the surgery. The typical recovery time comprises almost 6 weeks. Contact your physician for any complications.
References
- Aichmair, A. et al. Microdiscectomy for the Treatment of Lumbar Disc Herniation: An Evaluation of Reoperations and Long-Term Outcomes. Evid. Based. Spine. Care. J. 05, 077–086 (2014).
- Anichini, G. et al. Lumbar Endoscopic Microdiscectomy: Where Are We Now? An Updated Literature Review Focused on Clinical Outcome, Complications, and Rate of Recurrence. Biomed Res. Int. 2015, (2015).
- Shriver, M. F. et al. Lumbar microdiscectomy complication rates: A systematic review and meta-analysis. Neurosurg. Focus 39, 1–11 (2015).
- Kovačević, V. et al. Standard lumbar discectomy versus microdiscectomy – Differences in clinical outcome and reoperation rate. Acta Clin. Croat. 56, 391–398 (2017).
- Clinical Outcomes after Microdiscectomy for. 397, 397–401 (2018).