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A microdiscectomy is typically performed in the case of a lumbar
herniated disc. The center of the disc protrudes through the outer ring
(annulus) and subsequently puts pressure on a nerve, causing pain to
radiate down the patient’s leg and into the foot. In this procedure,
a small portion of the bone over the nerve root and disc material from
under the nerve root is removed to relieve the pressure and provide room
for the nerve to heal.
A microdiscectomy surgery is more effective for treating leg pain
(radiculopathy) than for lower back pain. The compression on the nerve root
can cause substantial leg pain, and while it may take weeks or months for
the nerve root to fully heal and for any numbness or weakness to get
better, patients normally feel relief from leg pain almost immediately
after a microdiscectomy surgery.
Who should have this surgery?
This procedure is usually recommended for patients who have experienced leg
pain for four to six weeks and who have tried conservative treatment (such
as oral steroids, epidural steroid injections, NSAID’s, and physical
therapy) without successfully relieving the pain. However, it is not
advisable to wait too long before having this surgery, because the results
are not as good if the surgery is postponed more than three to six months.
Besides time, one needs to also factor in the level of the pain and the
amount of disability the patient is experiencing. If the symptoms are mild,
a longer course of conservative treatment may be reasonable, whereas if the
symptoms are severe more immediate surgery is reasonable.
Microdiscectomy success rate
A recurrent disc herniation may occur directly after back surgery or many
years later, although they are most common in the first three months after
surgery. Recurrence rates after a patient has a disc herniation are between
5 and 10%. If the disc does herniate again, generally a revision
microdiscectomy will be just as successful as the first operation. However,
after a recurrence, the patient is at higher risk of further recurrences
(15 to 20% chance). If herniation continues to recur, a fusion procedure
might be considered.
Recurrent disc herniations are probably due to the fact that within some
disc spaces there are multiple fragments of disc that can come out at a
later date. Through a posterior microdiscectomy approach, only about 5 to
7% of the disc space can be removed and most of the disc space cannot be
seen. Also, the hole in the disc space where the herniation occurs
(annulotomy) probably never closes because the disc itself does not have a
blood supply. Without a blood supply, the area does not heal or scar over.
There also is no way to surgically repair the outer portion of the disc
space (the annulus).
Usually, a microdiscectomy procedure is performed on an outpatient basis
(with no overnight stay in the hospital) or with a one night stay in the
hospital. Post-operatively, patients may return to a normal level of daily
activity quickly. The success rates for pain relief are between 90 and 95%.
Following surgery
Some surgeons restrict a patient from bending, lifting, or twisting for the
first six weeks following surgery. However, since the patient’s back
is mechanically the same after a microdiscectomy, it is also reasonable to
return to a normal level of functioning immediately following surgery.
There have been reports in the medical literature showing that immediate
mobilization (return to normal activity) does not lead to an increase in
recurrent lumbar herniated disc. Although a patient may be technically
allowed to resume their normal activities immediately, they should expect
reduced activities due to incisional discomfort for one to three weeks.
Following a microdiscectomy surgery, a program of stretching,
strengthening, and aerobic conditioning is recommended to help prevent
recurrence of back pain or disc herniation.
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