Microsurgical Discectomy

Microdiscectomy, also called Microlumbar Discectomy (MLD), is performed for patients with a painful lumbar herniated disc. Microdiscectomy is a very common, if not the most common, surgery performed by spine surgeons. The operation consists of removing a portion of the intervertebral disc, the herniated or protruding portion that is compressing the traversing spinal nerve root. Years ago, most spine surgeons would remove a herniated disc using a rather large surgical incision and surgical exposure without the use of a microscope or telescopic glasses, which would often involve a long hospital stay and prolonged recovery period. Today, many surgeons use a microscopic surgical approach with a small, minimally-invasive, poke-hole incision to remove the disc herniation, allowing for a more rapid recovery.

Return to Work and Sports
Patients may return to light work duties as early as 1-2 weeks after surgery, depending on when the surgical pain has subsided. Patients may return to heavy work and sports as early as 4-6 weeks after surgery, if the surgical pain has subsided and the back strength has returned appropriately with physical therapy.
Wound Care
The wound area can be left open to air. No bandages are required. Small surgical tapes affixing the suture should be left in place. The area should be kept clean and dry.
Brace
Patients are generally not required or recommended to wear a back brace after surgery. Occasionally, patients may be issued a small, soft lumbar corset that can provide additional lumbar support in the early postoperative period, if necessary.
After Surgery
After surgery, the patient is moved into the recovery area. In recovery, nurses and other members of the medical team closely monitor the patient’s vital signs – pulse, respiration, blood pressure, and pain. Some post-operative incisional discomfort should be expected and patients receive pain medication either through their IV (intravenous line) or by mouth.
Driving
Patients may begin driving when the pain level has decreased to a mild level, which usually is between 2-10 days after surgery. Patients should not drive while taking pain medicines (narcotics). When driving for the first time after surgery, patients should make it a short drive only and have someone come with them, in case the pain flares up and they need help driving back home. After patients feel comfortable with a short drive, they can begin driving longer distances alone.
Shower/Bath
Patients can shower immediately after surgery, but should cover the incision area with a small bandage and tape, and try to avoid water hitting directly over the surgical area. After the shower, patients should remove the bandage, and dry off the surgical area. Small surgical tapes affixing the suture should be left in place. Patients should not take a bath until the wound has completely healed, which is usually around 2 weeks after surgery.
Post-Operative Care
Most patients are able to go home the same day or early the next day after surgery. Before patients go home, physical therapists and occupational therapists work with patients and instruct them on proper techniques of getting in and out of bed and walking independently. Patients are instructed to avoid bending at the waist, lifting (more than five pounds), and twisting in the early postoperative period (first 2-4 weeks) to avoid a strain injury or recurrent disc injury. Patients should try to avoid sitting in the same position for more than 45-60 minutes in the first few weeks after surgery. After sitting for 45-60 minutes, patients should get up and stretch or walk for a little bit, then sit down again if desired.
What Are The Indications For A Microdiscectomy?
- Compressed disc, usually with herniation that is causing back or leg pain, or neurological symptoms
- Failure of more conservative treatments, including pain management injections, to provide sufficient long term relief
- High suspicion of discogenic cause on imaging or by diagnostic procedures
Benefits Associated With an Endoscopic Microdiscectomy
- Minimally invasive surgery – less trauma to muscles and soft tissue than with traditional open surgery
- Quick recovery time
- Minimal pain or discomfort following the surgery
- Immediate leg pain relief in most cases
- Fewer complications and risks than open spine surgery
- Small incision and minimal scar tissue
- High success rate and sustained success of the therapy
- No or minimal blood loss
- Use of local anesthesia
- Visual endoscopic control of the treatment
- No hardware placement or loss of mobility
What Is a Minimally Invasive Endoscopic Microdiscectomy?
An endoscopic microdiscectomy is a minimally invasive endoscopic surgery that allows direct visualization of the disc and nerves. This procedure is used for decompressing nerve roots damaged by compressed spinal discs. It is usually indicated in patients with a herniated or compressed lumbar disc, who have not found adequate pain relief with pain management injections or conservative treatment.

Many patients who suffer from sciatica, referred pain down either legs, and/or low back pain may be a candidate for this procedure. This procedure can also help in relieving pain associated with spinal stenosis and low back arthritis.
Results and Outcome Studies
The results of microdiscectomy surgery in the treatment of a painful, herniated disc are generally excellent. Numerous research studies in medical journals demonstrate greater than 90-96% good or excellent results from microdiscectomy surgery. Most patients are noted to have a rapid improvement of their pain and return to normal function.
Doctor’s Visits and Follow-Up
Patients will return for a follow-up visit to see the surgeon approximately 8-10 days after surgery. The incision will be inspected and one stitch will be removed. Patients will be given a prescription to begin physical therapy for back exercises, to start 3-4 weeks after the surgery. Medications will be refilled if necessary.

Treatments

Surgical Technique
The surgery is performed utilizing general anesthesia. A breathing tube (endotracheal tube) is placed and the patient breathes using a ventilator during the surgery. Preoperative intravenous antibiotics are given. Patients are positioned in the prone (lying on the stomach) position, generally using a special operating table with special padding and supports. The surgical region (low back area) is cleansed with a special cleaning solution. Sterile drapes are placed, and the surgical team wears sterile surgical attire such as gowns and gloves to maintain a bacteria-free environment. A 1-2 centimeter longitudinal incision is made in the midline of the low back, directly over the area of the herniated disc. Special retractors and an operating microscope are used to allow the surgeon to visualize the region of the spine, with minimal or no cutting of the adjacent muscles and soft-tissues. After the retractor is in place, an x-ray is used to confirm that the appropriate disc is identified. A few millimeters of bone of the superior lamina may be removed to fully visualize the disc herniation. The nerve root and neurologic structures are protected and carefully retracted, so that the herniated disc can be removed. Small dental-type instruments and biting/grasping instruments (such as a pituitary rongeur) are used to remove the protruding disc material. All surrounding areas are also checked to ensure no additional disc fragments are remaining. The wound area is usually washed out with sterile water containing antibiotics. The deep fascial layer and subcutaneous layers are closed with a few strong sutures. The skin can usually be closed using special surgical glue, leaving a minimal scar and requiring no bandage. View

Surgical Technique

The surgery is performed utilizing general anesthesia. A breathing tube (endotracheal tube) is placed and the patient breathes using a ventilator during the surgery. Preoperative intravenous antibiotics are given. Patients are positioned in the prone (lying on the stomach) position, generally using a special operating table with special padding and supports. The surgical region (low back area) is cleansed with a special cleaning solution. Sterile drapes are placed, and the surgical team wears sterile surgical attire such as gowns and gloves to maintain a bacteria-free environment.

A 1-2 centimeter longitudinal incision is made in the midline of the low back, directly over the area of the herniated disc. Special retractors and an operating microscope are used to allow the surgeon to visualize the region of the spine, with minimal or no cutting of the adjacent muscles and soft-tissues. After the retractor is in place, an x-ray is used to confirm that the appropriate disc is identified.

A few millimeters of bone of the superior lamina may be removed to fully visualize the disc herniation. The nerve root and neurologic structures are protected and carefully retracted, so that the herniated disc can be removed. Small dental-type instruments and biting/grasping instruments (such as a pituitary rongeur) are used to remove the protruding disc material. All surrounding areas are also checked to ensure no additional disc fragments are remaining.

The wound area is usually washed out with sterile water containing antibiotics. The deep fascial layer and subcutaneous layers are closed with a few strong sutures. The skin can usually be closed using special surgical glue, leaving a minimal scar and requiring no bandage.

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