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Microdiscectomy surgical procedure
A microdiscectomy is performed through a small (1 inch to 1 1/2 inch)
incision in the midline of the back.
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First, the back muscles (erector spinae) are
lifted off the bony arch (lamina) of the spine. Since these back muscles
run vertically, they can be moved out of the way rather than cut.
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The surgeon is then able to enter the spine
by removing a membrane over the nerve roots (ligamentum flavum), and uses
either operating glasses or an operating microscope to visualize the nerve
root.
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Often, a small portion of the inside facet
joint is removed both to facilitate access to the nerve root and to relieve
pressure over the nerve.
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The nerve root is then moved to the side and
the disc material is removed from under the nerve root.
Microdiscectomy risks and complications
As with any form of spine surgery, there are several risks and
complications that are associated with a microdiscectomy procedure.
Complications are quite rare in this procedure, but possibilities include:
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Dural tear (cerebrospinal fluid leak). This
occurs in 1% to 2% of these surgeries. It does not change the results of
surgery, but post-operatively the patient may be asked to lay recumbent for
one to two days to allow the leak to seal.
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Nerve root damage (1in 1,000)
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Bowel/bladder incontinence (extremely rare)
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Infection (1%)
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Recurrent disc herniations (5-10%)
Postoperative Care
Follow-up care for a microdiscectomy usually includes a combination of the
following:
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Pain management. Immediate
post-operative pain can be managed with a combination of non-steroidal
anti-inflammatory drugs (ibuprofen such as Advil, Nuprin, or Motrin; or naproxen
such as Naprosyn or Aleve) and a mild pain pill such as Darvocet or
Vicodin. As the discomfort subsides (usually about 1 to 2 weeks) the
patient can move toward substituting Tylenol for the narcotic pain
medications. Ice may also be applied to the back to decrease pain within
the first 48 hours after surgery.
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Stretching program. Most surgeons
feel that to minimize tethering of the nerve root by scar tissue, gentle
stretching exercises should be done in the early postoperative period. Scar
tissue in and of itself is not painful, but if it tethers the nerve root
short as the patient heals this can result in chronic pain. The stretching
should be done about 5 to 6 times a day for 6 to 12 weeks, since this is the
time period in which the scarring occurs. It is generally advisable to do
the stretching exercises frequently and gently. Stretching too hard may
result in pain, and one should only take the stretch to the point of pain
to avoid inflaming the nerve. If a patient feels too much pain after
surgery to do any stretching, it would be wise to wait until he or she is
more comfortable.
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Back strengthening exercises. After
the soft tissue has healed (usually 2 to 3 weeks after surgery), it is
important to start back strengthening exercises.There are a wide variety of
possible exercises to achieve the desired results, and it is important to
choose exercises that are safe and well tolerated so that they will be done
on a regular basis. About 15 minutes of appropriate stretching and
strengthening exercises per day is advisable for the first one to three
months.
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Early return to activity. Early
mobilization may help patients heal sooner, as the pre-operative pain has
usually caused patients to limit their motion, and limited motion is a
common cause of pain. Walking is very gentle on the back, and a
postoperative walking program with a goal of walking about 3 miles a day is
advisable. Return to work is based on how quickly the patient feels better
and on what type of work the patient does.
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