Could Microdiscectomy Surgery Affect Your Spine’s Long-Term Stability?

Microdiscectomy is one of the most common surgical procedures performed to relieve pain caused by herniated discs in the lumbar spine. While it offers significant relief for many patients, especially those suffering from sciatica and nerve compression, concerns about potential complications naturally arise. One question that frequently emerges is whether this surgical intervention might compromise spinal stability. In this article, we take a closer look at the relationship between microdiscectomy and spinal instability, examining the evidence, risk factors, and what patients can expect from this procedure.

What Is Microdiscectomy Surgery?

Microdiscectomy is a minimally invasive surgical procedure designed to remove a portion of a herniated disc that is pressing on a spinal nerve root. During the procedure, the surgeon makes a small incision and uses specialized instruments and a microscope to access the affected disc. The goal is to remove only the problematic disc material while preserving as much of the surrounding structures as possible, including the facet joints, ligaments, and bone.

The procedure typically takes one to two hours and is performed under general anesthesia. Most patients experience significant relief from leg pain and other symptoms related to nerve compression, with many returning to normal activities within a few weeks to months.

What Is Spinal Instability?

Spinal instability refers to abnormal movement between vertebrae that can lead to pain, nerve compression, and progressive deformity. A stable spine maintains proper alignment during movement and adequately protects the spinal cord and nerve roots. Instability occurs when the spine’s structural integrity is compromised, allowing excessive motion that can damage neural structures or cause mechanical pain.

Key stabilizing structures of the spine include the intervertebral discs, facet joints, ligaments, and surrounding musculature. When these components are damaged or altered, the risk of instability increases.

Microdiscectomy and Instability

Standard microdiscectomy, when performed correctly, rarely causes clinically significant spinal instability. Research and clinical experience over several decades have demonstrated this procedure is generally safe from a structural stability perspective.

The key factor is the preservation of critical stabilizing structures during surgery. Microdiscectomy is specifically designed to be conservative, removing only the herniated disc fragment that is causing symptoms while leaving the majority of the disc, facet joints, and supporting ligaments intact. This targeted approach minimizes disruption to the spine’s structural integrity.

Research Evidence

Multiple studies have examined the relationship between microdiscectomy and postoperative spinal stability. The consensus among spine surgeons and researchers is that microdiscectomy alone does not typically produce spinal instability when appropriate surgical techniques are employed.

A significant body of research indicates that postoperative instability is rare following standard microdiscectomy. Long-term follow-up studies have shown that most patients maintain stable spinal alignment years after the procedure. When instability does occur, it is often related to preexisting degenerative changes rather than the surgery itself.

The amount of disc material removed during surgery appears to be less important for stability than the preservation of other structures, particularly the facet joints. These posterior spinal elements play a crucial role in preventing excessive motion and rotation between vertebrae.

Risk Factors for Post-Surgical Instability

While microdiscectomy itself is unlikely to cause instability, certain factors may increase this risk:

• Preexisting degenerative disease - Patients with advanced degenerative disc disease, significant facet joint arthritis, or preoperative spondylolisthesis may be at higher risk for developing or worsening instability after any disc surgery.
• Extent of surgical decompression - If a more aggressive decompression is required, involving significant removal of facet joints or lamina, the risk of instability increases. However, this would typically be classified as a laminectomy or decompression procedure rather than a standard microdiscectomy.
• Multiple-level surgery - Undergoing microdiscectomy at multiple spinal levels may theoretically increase instability risk, though this remains relatively uncommon with proper patient selection.
• Biomechanical factors - Individual variations in spinal anatomy, bone quality, and ligamentous laxity can influence postoperative stability.

When Fusion Might Be Necessary

In some cases, spine surgeons may recommend spinal fusion in conjunction with or instead of microdiscectomy. This is typically considered when there is preexisting instability, significant degenerative disease, or substantial bone removal is necessary for adequate decompression.

Fusion involves joining two or more vertebrae together to eliminate motion at that segment, which by definition prevents instability. However, fusion is a more extensive procedure with longer recovery times and its own set of potential complications.

Preventing Instability after Microdiscectomy

Patients can take several steps to minimize any risk of developing instability following microdiscectomy:

• Proper rehabilitation - This is essential. Working with a physical therapist to strengthen core muscles provides dynamic stability to the spine, compensating for any structural changes from surgery or underlying degeneration.
• Following postoperative restrictions - This is crucial during the initial healing period. Surgeons typically advise patients to avoid heavy lifting, excessive bending, and high-impact activities for several weeks after surgery.
• Maintaining a healthy weight - This reduces mechanical stress on the spine and decreases the risk of progressive degeneration that could lead to instability.

The Bottom Line

Standard microdiscectomy, when performed with appropriate surgical techniques and patient selection, does not typically cause spinal instability. The procedure is designed to be minimally invasive and structurally conservative, preserving the key elements that maintain spinal stability.

Patients considering microdiscectomy should discuss their individual risk factors with their spine surgeons. For most people with herniated discs and without preexisting instability or advanced degeneration, microdiscectomy offers an excellent balance of symptom relief with minimal structural risk.

If you have concerns about spinal stability or are considering microdiscectomy, a thorough evaluation by a qualified spine specialist can help you determine the most appropriate treatment approach for your specific condition.

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 risk of reherniation, was specifically designed to close the large hole often left in the spinal disc after discectomy. 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 directly.

For full benefit/risk information, please visit: https://www.barricaid.com/instructions.