Microdiscectomy has revolutionized the treatment of herniated discs, offering patients a minimally invasive alternative to traditional open back surgery. This surgical technique has gained popularity due to its precision, effectiveness, and shorter recovery times. In this comprehensive guide, you will learn about the surgical approach in microdiscectomy, including details about the procedure, its benefits, and what patients can expect.
Microdiscectomy Explained
A microdiscectomy is a type of spine surgery aimed at removing part of a herniated disc that is pressing on a spinal nerve. This compression causes pain, weakness, and numbness, often radiating down the leg (a condition known as sciatica). Microdiscectomy offers a faster recovery and smaller incisions compared to traditional open discectomy.
This minimally invasive technique uses specialized instruments and a microscope or magnifying lens to remove the portion of the disc that is compressing the nerve, alleviating pain and other symptoms associated with nerve compression. The procedure is typically performed under general anesthesia and is commonly recommended when nonsurgical treatments fail to provide relief.
Indications for Microdiscectomy
Microdiscectomy is typically recommended when conservative treatments such as physical therapy, medications, or spinal injections have failed to provide adequate relief from symptoms caused by a herniated disc. Common indications include:
- Persistent leg pain (sciatica) lasting more than 6–12 weeks
- Neurological deficits such as weakness or numbness in the leg
- Difficulty walking or standing due to nerve root compression
- Cauda equina syndrome (a rare but serious condition requiring immediate intervention)
It is important to note that not all patients with herniated discs require surgery. A thorough evaluation by a spine specialist is necessary to determine if microdiscectomy is the appropriate treatment option.
Preoperative Preparation
Before having microdiscectomy surgery, patients typically undergo several steps to ensure they are suitable candidates for the procedure and to optimize surgical outcomes:
- Medical evaluation – This involves a comprehensive medical assessment, including a review of the patient’s medical history, physical examination, and necessary diagnostic tests.
- Imaging studies – MRI or CT scans are performed to confirm the diagnosis and precisely locate the herniated disc.
- Preoperative instructions – Patients receive guidelines on medication management, fasting requirements, and other preparations for surgery.
The Surgical Approach to Microdiscectomy
Anesthesia and Positioning
The procedure is usually performed under general anesthesia. Once anesthetized, the patient is positioned prone (face down) on the operating table, often with specialized supports to reduce pressure on the abdomen and chest. Proper positioning is crucial to ensure access to the spine while minimizing complications such as nerve injury or pressure ulcers.
Incision and Access to the Spine
The surgeon makes a small incision, usually around 1 to 1.5 inches, directly over the affected vertebrae. Then the surgeon uses a special retractor to gently move aside muscles and soft tissues, creating a corridor to the spine.
Use of a Surgical Microscope
One of the hallmarks of microdiscectomy is the use of a surgical microscope, which provides a magnified view of the affected area. This allows the surgeon to operate with great precision, minimizing damage to the surrounding tissues. The small incision and microscope guidance are key aspects that differentiate microdiscectomy from open discectomy.
Removal of the Herniated Disc Material
Once access to the spine is achieved, the surgeon carefully removes the portion of the disc that is pressing on the nerve root. Only the herniated portion is removed, leaving the rest of the disc intact. In some cases, a small portion of the lamina (a part of the vertebral bone) may also be removed to create more space for the nerve.
Closing the Incision
After removing the herniated disc material, the surgeon ensures there is no remaining compression on the nerve. The incision is then closed with sutures or staples. The entire procedure typically takes about one to two hours, depending on the complexity of the case.
Advancements in Microdiscectomy Techniques
Recent years have seen several advancements in microdiscectomy techniques aimed at further improving outcomes and reducing invasiveness.
Endoscopic Microdiscectomy
This technique uses an endoscope (a thin, flexible tube with a camera) inserted through an even smaller incision. It allows for exceptional visualization while further minimizing tissue disruption.
Tubular Microdiscectomy
A series of progressively larger dilators are used to create a surgical corridor through which a tubular retractor is placed. This technique potentially reduces muscle damage compared to traditional approaches.
Recovery after Microdiscectomy
Immediate Postoperative Care
After microdiscectomy surgery, patients are monitored in recovery rooms and are usually discharged the same day or after one night in the hospital. Most patients are encouraged to walk within a few hours of the procedure, which can prevent complications like blood clots. Pain management typically includes over-the-counter medications or short-term prescription pain relief.
Postoperative Rehabilitation
Physical therapy is often recommended a few weeks after surgery to strengthen the muscles around the spine and increase flexibility. Patients are advised to avoid heavy lifting, twisting, or bending for several weeks, as these movements can put strain on the healing spine.
Long-Term Outlook
The majority of patients experience significant improvement in symptoms such as leg pain, numbness, and weakness. However, some may continue to experience residual back pain, especially if there was preexisting degeneration of the spine. The microdiscectomy recovery process is generally faster than traditional open spine surgery, and full recovery typically occurs within three months.
Risks and Complications
As with any surgical procedure, microdiscectomy carries potential risks, though complications are uncommon. Some possible risks include:
- Infection – Though rare, infection at the surgical site is a potential complication.
- Nerve damage – There is a small risk of damage to the nerve root during surgery, which could result in worsening symptoms or new neurological deficits.
- Reherniation – In some cases, the disc can herniate again, requiring additional surgery.
- Blood clots – There is a small risk of developing blood clots, especially in the legs, after surgery. Walking soon after the procedure reduces this risk.
Microdiscectomy represents a significant advancement in the treatment of herniated discs, offering a minimally invasive approach that balances effectiveness with reduced tissue trauma. The surgical approach in microdiscectomy, characterized by its use of magnification and specialized instruments, allows for precise decompression of affected nerve roots while preserving spinal stability.
As with any surgical procedure, the decision to undergo microdiscectomy should be made after careful consideration of all treatment options and in consultation with a qualified spine specialist. For many patients suffering from persistent symptoms due to herniated discs, microdiscectomy offers a path to relief and improved quality of life.
Although microdiscectomy surgery is a common and generally quite successful procedure, patients with a larger hole in the outer ring of the disc have a significantly higher risk of herniation following surgery. This risk is doubled if there is a large hole in the outer ring of the disc. Fortunately, there is a new treatment specifically designed to close the large holes that are often left in spinal discs after discectomy surgery. Barricaid is a bone-anchored device proven to reduce reherniations, and 95 percent of Barricaid patients did not undergo a reoperation due to reherniation in a 2-year study timeframe. This treatment is performed 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.
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