Can You Have a Third Microdiscectomy?

Is a Third Microdiscectomy Possible? Risks, Benefits, and Alternatives

Microdiscectomy is a common surgical procedure used to relieve nerve compression caused by a herniated disc. While the surgery can be highly effective, some patients may experience recurrent disc herniation, leading them to consider a second—or even a third—microdiscectomy. But is a third microdiscectomy a viable option? In this article, you will learn about the risks, benefits, and alternatives to repeated spine surgery.

Understanding Microdiscectomy and Recurrent Herniation

A microdiscectomy is a minimally invasive procedure designed to remove the portion of a herniated disc that is pressing on a nerve. The goal is to relieve pain, numbness, and weakness in the affected area. Patients often experience immediate relief from sciatica and other related symptoms post-surgery. However, even after successful surgery, some patients experience recurrent herniation at the same spinal level, requiring additional interventions. Recurrent disc herniation can occur in approximately 5–15 percent of patients following microdiscectomy. The chances of experiencing a second recurrence (after a second microdiscectomy) are even higher, leading to the complex decision of whether to proceed with a third surgery.

When a Third Microdiscectomy Is Considered

A third microdiscectomy is typically considered in patients who:

• Have experienced significant pain relief from previous surgeries but suffered another disc herniation
• Have no significant spinal instability or degenerative changes that would require a more extensive procedure, such as a spinal fusion
• Prefer a minimally invasive approach before considering fusion surgery

However, surgeons often evaluate several factors before recommending a third microdiscectomy, including the patient’s age, overall spine health, and the likelihood of long-term relief.

Risks of a Third Microdiscectomy

While a first microdiscectomy has a high success rate, repeat surgeries come with increased risks. Some of the potential complications include:

• Scar tissue formation - Each subsequent surgery increases the amount of scar tissue around the nerve, potentially leading to chronic pain or nerve irritation.
• Reduced success rates - The likelihood of achieving long-term pain relief decreases with each additional microdiscectomy.
• Spinal instability - Repeated disc removals can weaken the spine, increasing the risk of instability and the potential need for spinal fusion.
• Increased infection and bleeding risk - Any surgical procedure carries a risk of infection, bleeding, or complications related to anesthesia.

Benefits of a Third Microdiscectomy

Despite the risks, some patients may still benefit from a third microdiscectomy. Benefits include:

• Minimally invasive approach - Compared to spinal fusion, a microdiscectomy is a less invasive option that preserves more of the spine’s natural movement.
• Potential for pain relief - If the recurrent herniation is the primary source of pain, removing the offending disc material can provide symptom relief.
• Shorter recovery time - Microdiscectomy recovery time is typically shorter than that for fusion surgery, allowing patients to return to their daily activities sooner.

Alternatives to a Third Microdiscectomy

For patients hesitant about undergoing a third microdiscectomy, several alternative treatments exist:

• Physical therapy and rehabilitation - Targeted exercises can strengthen the muscles supporting the spine, increase flexibility, and reduce pain without the need for surgery.
• Pain management techniques - Epidural steroid injections, nerve blocks, or radiofrequency ablation can help patients manage pain without the risks of another surgery.
• Spinal fusion surgery - For those with recurrent herniations or spinal instability, spinal fusion surgery may provide long-term stability and pain relief.
• Artificial disc replacement - In select cases, replacing the damaged disc with an artificial one can enhance mobility and reduce the likelihood of future herniations.

Making an Informed Decision

Choosing whether to undergo a third microdiscectomy is a complex decision that should be made with the guidance of a spine specialist. Factors to consider include:

• Severity of symptoms - If pain is severe and significantly impacts daily life, another surgery may be necessary.
• Previous surgery outcomes - If previous surgeries provided pain relief before recurrence, a third microdiscectomy might be beneficial.
• Overall spine health - Patients with extensive degenerative disc disease may be better candidates for spinal fusion.

The decision to undergo a third microdiscectomy requires careful consideration and thorough discussion with healthcare providers. A complete medical evaluation and examination of individual patient factors are necessary to make the best decision.

Medical evaluation

A comprehensive medical evaluation should include:

• Advanced imaging studies
• Neurological examination
• Assessment of overall health and fitness for surgery
• Review of previous surgical outcomes
• Evaluation of current symptoms and their impact on quality of life

Patient factors

Individual patient characteristics that influence the decision include:

• Age and overall health
• Lifestyle and activity requirements
• Work demands
• Personal goals and expectations
• Willingness to pursue alternative treatments

While a third microdiscectomy is possible, it comes with increased risks and reduced success rates compared to the initial procedure. Patients should carefully weigh their options, explore conservative treatments, and consult with spine specialists to determine the best course of action. In some cases, alternatives such as spinal fusion or pain management techniques may offer a more sustainable solution for long-term relief.

Although microdiscectomy surgery is generally a very successful procedure, a hole is left in the outer wall of the disc. Patients with a large hole in the outer ring of the disc are more than twice as likely to reherniate after surgery. A new treatment, Barricaid, which is a bone-anchored device proven to reduce the likelihood of a reherniation, was specifically designed to close the large hole often left in the spinal disc after microdiscectomy. In a large-scale study, 95 percent of Barricaid patients did not undergo a reoperation due to reherniation in the 2-year study timeframe. This treatment is done immediately following the discectomy—during the same operation—and does not require any additional incisions or time in the hospital. 

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.