What Position Is the Patient in for a Microdiscectomy?

Microdiscectomy is a minimally invasive surgical procedure used to treat herniated discs in the spine. This operation aims to relieve pressure on spinal nerves by removing the portion of the disc causing the problem. While the surgical technique itself is crucial, the positioning of the patient during the procedure plays a vital role in its success. In this comprehensive guide, you will learn about the standard patient position for microdiscectomy, why it is important, and how it impacts the surgery and recovery process.

Importance of Proper Positioning

The correct positioning of the patient during microdiscectomy is crucial for several reasons:

• Surgical access and visibility – Proper positioning ensures the surgeon has clear access to the surgical site. This is essential for performing the delicate work of removing disc material without damaging surrounding tissues.
• Spinal alignment – Maintaining proper spinal alignment during the procedure ensures the surgeon can accurately identify and treat the affected disc level.
• Patient safety – Correct positioning can prevent complications such as pressure sores, nerve compression, and respiratory issues during the surgery.
• Anesthesia management – The prone position can affect cardiovascular and respiratory function. Proper positioning helps anesthesiologists manage these aspects more effectively.
• Surgical efficiency – When the patient is positioned correctly, the surgeon can work more efficiently, potentially reducing operating time and associated risks.

The Standard Position: Prone

The most common position for a microdiscectomy is the prone position. Here is what you need to know about this positioning technique:

What is the prone position?

The prone position involves the patient lying face down on the operating table. This orientation provides the surgeon with optimal access to the spine, particularly the lower back area, where most herniated discs occur.

Why is the prone position preferred?

Surgeons prefer the prone position for several reasons:

• It allows for better visualization of the surgical site
• It provides easier access to the affected disc
• It helps patients maintain proper spinal alignment during the procedure
• It minimizes the risk of certain complications

How is the patient positioned?

Positioning a patient for microdiscectomy involves several steps:

• The patient lies face down on a specialized operating table
• The abdomen is supported to prevent excessive lordosis (curvature) of the spine
• The head is turned to one side and supported to ensure proper breathing
• Arms are usually positioned at the sides or on armboards
• Padding is placed under pressure points to prevent nerve compression

Variations in Positioning

While the prone position is standard, there are some variations depending on the specific case and surgeon preference:

Wilson Frame

Some surgeons use a Wilson frame, which is a special positioning device that flexes the patient’s spine. This can open up the spaces between vertebrae, making it easier to access the herniated disc.

Knee-Chest Position

In some cases, particularly for upper lumbar disc herniations, the knee-chest position may be used. This involves the patient kneeling on the operating table with his or her chest resting on supports. This position can provide better access to higher levels of the spine.

Lateral Position

Rarely, a lateral (side-lying) position may be used, especially if the patient has respiratory issues that make prone positioning risky. However, this is not common for routine microdiscectomy procedures.

Challenges and Considerations

While the prone position is generally safe and effective for microdiscectomy, there are some challenges and considerations:

• Pressure points – Care must be taken to pad all pressure points to prevent nerve compression or skin damage during the procedure.
• Respiratory considerations – The prone position can make breathing more difficult for some patients. Anesthesiologists must monitor and manage this carefully.
• Cardiovascular effects – Lying prone can affect blood flow and cardiac function. This is particularly important for patients with preexisting heart conditions.
• Neck and shoulder strain – Improper head positioning can lead to neck and shoulder pain postoperatively. Careful attention to head and neck alignment is crucial.
• Gender-specific considerations – For female patients, special care must be taken to position the breasts comfortably and avoid excessive pressure.

Preparing for the Procedure

If you are scheduled for a microdiscectomy, here is what you can expect regarding positioning:

• Preoperative discussion – Your surgeon will discuss the positioning with you before the procedure. This is a good time to mention any concerns or preexisting conditions that might affect your positioning.
• Anesthesia – You will be under general anesthesia when positioned, so you will not feel any discomfort during the process.
• Postoperative effects – You may experience some stiffness or soreness from the positioning after the surgery. This is normal and usually resolves quickly.

By ensuring optimal positioning, surgeons can perform microdiscectomies with greater precision and efficiency, leading to better outcomes and faster recovery times for patients suffering from herniated discs.

Understanding the importance of patient positioning can help you feel more prepared and confident as you approach your microdiscectomy procedure. Remember, your surgical team has extensive experience in positioning patients safely and effectively. Do not hesitate to discuss any concerns you may have about positioning with your surgeon or anesthesiologist before the 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 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.