If your doctor has recommended a microdiscectomy to relieve your herniated disc pain, you might be wondering about various aspects of the procedure, including something as fundamental as what position you will be in during surgery. Understanding the surgical process can ease anxiety and prepare you for what lies ahead. In this comprehensive guide, we take a closer look at patient positioning during microdiscectomy surgery, exploring why specific positions are used, how they contribute to surgical success, and what this means for your recovery.
What Is Microdiscectomy Surgery?
Before diving into positioning details, it is helpful to understand what a microdiscectomy entails. This minimally invasive spinal procedure is designed to remove a portion of a herniated disc that is pressing on a nerve root or the spinal cord. The surgery typically addresses conditions causing sciatica, leg pain, numbness, or weakness that has not responded to conservative treatments.
The procedure uses specialized microscopes and small instruments through a one- to two-inch incision, allowing surgeons to access the affected disc while minimizing damage to surrounding tissues. The success of this delicate operation depends significantly on optimal patient positioning.
The Standard Position: Prone Positioning
During a microdiscectomy, you will be positioned lying face down on your stomach. This is called the prone position, and it is the standard positioning for nearly all lumbar spine surgeries, including microdiscectomy procedures.
The prone position is not chosen arbitrarily. It offers several critical advantages for spinal surgery:
- Optimal spinal access - When you are lying face down, your back naturally becomes the highest point of your body, giving surgeons direct, unobstructed access to the spine. This positioning allows the surgical team to work with gravity rather than against it, providing the clearest view of the surgical site.
- Natural spine alignment - The prone position maintains the spine’s natural curvature while still allowing surgeons to access the posterior (back) elements of the vertebrae. This is crucial, since microdiscectomy approaches the herniated disc from the back of the spine.
- Improved visualization - Face-down positioning minimizes blood pooling at the surgical site, which could otherwise obscure the surgeon’s view. Better visualization leads to more precise disc removal and reduces the risk of complications.
- Reduced bleeding - The prone position decreases venous pressure in the spine, which can reduce bleeding during surgery. Less bleeding means better visibility and a safer procedure overall.
Special Positioning Equipment and Support
You will not simply be lying flat on a standard operating table. Surgical teams use specialized equipment to ensure your safety and optimize the surgical approach:
The Wilson frame or chest rolls
Most commonly, patients are positioned on what is called a Wilson frame or supported by chest rolls. These devices support the chest and pelvis while allowing the abdomen to hang freely. This positioning is crucial because it:
- Reduces pressure on the abdomen
- Decreases pressure on the vena cava (the large vein returning blood to the heart)
- Minimizes bleeding from epidural veins
- Opens up the space between vertebrae, making disc access easier
Protective padding
Your surgical team will carefully pad pressure points throughout your body, including:
- Face and forehead (often with a special headrest that protects your eyes and allows you to breathe)
- Chest and shoulders
- Elbows and arms
- Knees and ankles
- Any other areas in contact with the table
This padding prevents nerve compression, skin breakdown, and discomfort during the procedure, which typically lasts one to two hours.
Arm positioning
Your arms are typically positioned either alongside your body or extended forward above your head in a “Superman” position, depending on the surgeon’s preference and your body type. The position chosen ensures your shoulders remain relaxed and no nerves are compressed.
The Positioning Process: What to Expect
Understanding the positioning process can reduce anxiety about your surgery day:
Before positioning
You will be brought into the operating room while awake and transferred to the operating table. The anesthesiologist will then administer general anesthesia, putting you completely to sleep. You will not be aware of the positioning process or remember anything about it.
During positioning
Once you are fully anesthetized, the surgical team carefully turns you from your back onto your stomach. This is done with multiple team members supporting your body to ensure your spine remains stable and aligned. The entire process is methodical and safe, with special attention paid to protecting your airway, intravenous lines, and monitoring equipment.
Final adjustments
After you are positioned face down, the team makes final adjustments to ensure optimal positioning. They will check that all padding is properly placed, your breathing is not restricted, and the surgical site is appropriately exposed. The operating table itself may be adjusted or flexed to provide the best possible access to your spine.
When Alternative Positions May Be Used
While prone positioning is standard for microdiscectomy, there are rare circumstances when alternative positions might be considered:
Kneeling position
Some surgeons occasionally use a kneeling position, where patients are positioned on their knees with their chests supported. This is less common but can be beneficial for certain body types or specific levels of disc herniation.
Lateral position
In very rare cases involving unusual anatomical considerations or when a microdiscectomy is combined with other procedures, a side-lying (lateral) position might be used. However, this is extremely uncommon for standard microdiscectomy procedures.
Position-Related Safety Measures
Your surgical team takes numerous precautions to ensure positioning does not cause complications:
- Frequent monitoring - Throughout surgery, your vital signs, breathing, and circulation are continuously monitored. Any positioning-related issues will be immediately identified and corrected.
- Eye protection - Special care is taken to protect your eyes from pressure, which could otherwise cause vision problems. Many facilities use special foam headrests with cutouts for eyes and face.
- Nerve monitoring - In some cases, intraoperative nerve monitoring is used to ensure positioning and surgical work are not affecting nerve function.
Recovery Considerations Related to Positioning
While you will not remember being in the prone position, you may experience some minor effects afterward:
- Facial swelling - Mild facial swelling or puffiness is common after being face down for an extended period but typically resolves within 24 to 48 hours.
- Sore pressure points - Despite careful padding, you may feel some soreness in areas that were in contact with the support frame, particularly your chest or hips.
- Grogginess - The combination of anesthesia and being in one position for the procedure may leave you feeling temporarily groggy or stiff.
These effects are normal, temporary, and generally mild compared to the relief most patients experience from addressing their herniated discs.
Proper positioning enables surgeons to perform microdiscectomies more accurately and efficiently, which contributes to better results and quicker healing for patients with herniated discs.
Knowing how patient positioning works can ease your mind as you prepare for your microdiscectomy. Your surgical team is highly skilled at positioning patients both safely and effectively. Make sure to ask your surgeon or anesthesiologist about any positioning-related concerns before your procedure.
Even though microdiscectomy surgery is a common and generally quite successful procedure, a hole is frequently left in the outer wall of the disc. In fact, patients with these large holes in their discs are more than twice as likely to reherniate. Reherniations often require additional back surgery procedures or even fusions. 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 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.
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