Can a Microdiscectomy Eliminate Back Pain?
Back pain affects approximately 80 percent of adults at some point in their lives, and lumbar disc herniation is a significant cause of debilitating symptoms that can severely impact quality of life. For people who are suffering from persistent back and leg pain caused by herniated discs, microdiscectomy surgery is often considered as a potential solution. But does this procedure truly eliminate back pain? In this article, you will gain a nuanced understanding of what microdiscectomy can and cannot address as well as realistic expectations about outcomes.
What Is Microdiscectomy?
Microdiscectomy is a minimally invasive surgical procedure specifically designed to relieve pressure on neural structures caused by a herniated disc. Treatment with microdiscectomy involves the surgeon using specialized instruments and microscopic visualization to access and remove the portion of the disc that is compressing the nerve root while minimizing damage to surrounding tissues.
The procedure typically involves:
- A small incision (1–2 inches) in the midline of the lower back
- Gentle retraction of the muscles to access the spine
- Removal of a small portion of the lamina (the bony arch of the vertebra)
- Careful identification and protection of the affected nerve root
- Removal of the herniated disc material that is compressing the nerve
This targeted approach focuses specifically on addressing nerve compression rather than treating all potential sources of back pain, which is important when it comes to understanding expected outcomes.
The Primary Goal: Nerve Decompression vs. Back Pain Relief
To understand whether microdiscectomy gets rid of back pain, it is important to recognize that the procedure’s primary objective is to relieve nerve compression symptoms—particularly radiating leg pain (sciatica)—rather than back pain itself.
Research consistently shows microdiscectomy has a success rate of 85 to 95 percent for relieving sciatica. A 2020 randomized controlled trial published in the journal Spine found that patients who underwent microdiscectomy for lumbar disc herniation experienced significantly greater reduction in leg pain compared to those who received conservative treatment alone.
However, when it comes to back pain specifically, patients may experience:
- Variable results - Studies show more inconsistent outcomes for axial back pain compared to leg pain, with approximately 60–75 percent of patients reporting significant improvement in back pain following microdiscectomy.
- Dual pain mechanisms - Many patients with disc herniations experience both mechanical back pain and neurogenic pain. Microdiscectomy primarily addresses the neurogenic component by decompressing the nerve, but it may not fully resolve mechanical pain caused by disc degeneration, facet joint issues, or muscular problems.
When Is Microdiscectomy Most Effective for Back Pain?
Microdiscectomy is most likely to provide back pain relief under specific conditions:
Clear correlation between disc pathology and symptoms
Patients whose imaging studies show a direct correspondence between disc herniation and clinical symptoms tend to have better outcomes. A 2016 systematic review found that positive straight leg raise tests (indicating nerve compression) correlated with superior surgical outcomes.
Acute rather than chronic conditions
Those whose symptoms are shorter in duration (less than 6 months) generally experience better results than patients with longstanding back pain. A retrospective study of 108 patients found that symptom duration of less than 6 months was associated with a 78 percent success rate, compared to 56 percent in those with symptoms lasting longer than a year.
Minimal degenerative changes
Patients with isolated disc herniation who do not have significant degenerative disc disease or arthritis in their facet joints typically report better back pain outcomes. Thus, advanced degeneration at multiple levels may continue to generate pain even after successful decompression at one segment.
Recovery and Long-Term Outcomes
Understanding the recovery process and long-term outcomes provides further context for evaluating microdiscectomy surgery’s effectiveness against back pain.
Immediate postoperative period
Most patients experience immediate relief of leg pain following microdiscectomy, but back pain may persist or even temporarily increase during the initial recovery phase due to surgical trauma. This postoperative back pain typically resolves within several weeks as tissues heal.
Medium-term results
A prospective study following 200 microdiscectomy patients found that at the 2-year mark:
- 91 percent reported resolution of leg pain
- 75 percent reported significant improvement in back pain
- 84 percent had returned to previous occupational activities
Long-term outcomes
The long-term effectiveness of microdiscectomy for back pain shows more variability. A longitudinal study with 10-year follow-up revealed:
- 73 percent maintained good to excellent results for leg pain
- 68 percent maintained good to excellent results for back pain
- 17 percent required additional surgery at the same or adjacent level
This data suggests that while microdiscectomy provides lasting relief for many people, it does not guarantee permanent relief from back pain for all patients.
Limitations of Microdiscectomy for Back Pain Relief
Several factors limit microdiscectomy’s effectiveness as a comprehensive back pain solution:
Targeting only one specific cause of pain
Microdiscectomy addresses only one potential cause of back pain (herniated disc material compressing neural structures) while leaving other possible sources intact.
Recurrent disc herniation
Research indicates a reherniation rate of approximately 5–15 percent following microdiscectomy, which can lead to recurrent back and leg pain.
Adjacent segment degeneration
The biomechanical changes that occur following disc removal, even partial removal, may accelerate degenerative processes at neighboring spinal segments over time.
Underlying degenerative disc disease
If a patient’s pain stems primarily from degenerative disc disease rather than nerve compression, microdiscectomy alone may not provide significant relief.
Alternatives and Complementary Approaches
For comprehensive back pain management, microdiscectomy often works best as part of a multimodal approach:
Conservative treatment
Before considering microdiscectomy, most spine specialists recommend a trial of conservative management, including:
- Physical therapy focusing on core strengthening and proper biomechanics
- Anti-inflammatory medications
- Activity modification
- Epidural steroid injections
Many patients (approximately 60–80 percent) will experience natural improvement without surgery within a few months.
Postsurgical rehabilitation
Following microdiscectomy, targeted rehabilitation enhances outcomes by:
- Improving spinal stability through core strengthening
- Correcting movement patterns that may contribute to recurrent herniation
- Addressing myofascial pain components
- Providing education on ergonomics and injury prevention
A 2014 systematic review found that structured postoperative rehabilitation programs significantly improved functional outcomes and reduced recurrence rates compared to standard postoperative care.
Setting Realistic Expectations
Microdiscectomy is often an effective intervention for the right patient with the right diagnosis, but it is not a universal solution for all back pain. While microdiscectomy excels at relieving radicular leg pain, its effectiveness for axial back pain is more variable and depends heavily on patient selection and the presence of other underlying causes.
Patients considering microdiscectomy should:
- Maintain realistic expectations about potential back pain outcomes
- Understand the procedure may be most effective as part of a comprehensive treatment plan
- Recognize that lifestyle modifications and core strengthening remain essential even after successful surgery
For people with herniated discs that are causing both back and leg pain, microdiscectomy offers a valuable option with good evidence supporting its efficacy, particularly when conservative measures have failed. However, the decision to undergo surgery should always involve careful consideration under the guidance of a qualified spine specialist.
Although microdiscectomy surgery is generally a very successful procedure, patients with a larger hole in the outer ring of the disc have a significantly higher risk of reherniation following surgery. Often, the surgeon will not know the size of the hole until he or she begins surgery. A new treatment, Barricaid, which is a bone-anchored device proven to reduce reherniations, was specifically designed to close the large hole often left in the spinal disc after microdiscectomy. This treatment is done immediately following the microdiscectomy—during the same operation—and does not require any additional incisions or time in the hospital. In a large-scale study, 95 percent of Barricaid patients did not undergo a reoperation due to reherniation in the 2-year study timeframe.
If you have any questions about the Barricaid treatment or how to get access to Barricaid, ask your doctor or contact us today.
For full benefit/risk information, please visit: https://www.barricaid.com/instructions.
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