When a Microdiscectomy Fails: Causes and Solutions
A microdiscectomy is a common surgical procedure used to relieve pain from a herniated disc pressing on a nerve. While the majority of patients experience significant relief, some find the surgery does not provide the expected results. Understanding the reasons behind a failed microdiscectomy is crucial for patients and healthcare providers looking for solutions. In this article, you will learn why a microdiscectomy might not work, exploring various factors that can contribute to unsuccessful outcomes.
The Basics of Microdiscectomy
A microdiscectomy is a minimally invasive surgical procedure that aims to relieve pressure on spinal nerves by removing the portion of a herniated disc that is causing compression. It is typically performed on patients experiencing persistent sciatica or radiculopathy that has not responded to conservative treatments.
Common Causes of Microdiscectomy Failure
- Incorrect diagnosis – One of the primary reasons for microdiscectomy failure is an incorrect initial diagnosis. In some cases, the herniated disc identified on imaging may not be the actual source of the patient’s pain. This misdiagnosis can lead to unnecessary surgery that fails to address the root cause of the problem.
- Incomplete decompression – During the procedure, if the surgeon fails to remove enough of the herniated disc material, it can result in inadequate decompression of the affected nerve root. This incomplete removal may lead to persistent symptoms and a perception that the surgery has failed.
- Recurrent disc herniation – Even after a successful microdiscectomy, there is a risk of recurrent disc herniation at the same level. This complication can occur in 3 percent to 15 percent of cases within 10 years of the initial surgery. Recurrent herniation may necessitate revision surgery and contribute to failed back surgery syndrome.
- Surgical complications – While rare, surgical complications can occur during or after a microdiscectomy, potentially leading to poor outcomes. These complications may include:
- Nerve root injury (reported in some studies)
- Durotomy (incidental injury to the dura or postoperative CSF leak)
- Wound complications (such as infection or poor healing)
- Postoperative hematoma
- Scar tissue formation – Following surgery, scar tissue can form around the operated area. In some cases, this scar tissue may compress nearby nerves, leading to persistent or new pain. This condition, known as epidural fibrosis, can be challenging to treat and may contribute to failed back surgery syndrome.
- Preexisting spinal conditions – Patients with preexisting spinal conditions, such as spinal stenosis or degenerative disc disease at other levels, may continue to experience pain even after a successful microdiscectomy. These underlying issues can mask the benefits of the surgery and contribute to perceived failure.
Patient-Related Factors
- Unrealistic expectations – Some patients may have unrealistic expectations about the outcome of their microdiscectomies. While the procedure can be highly effective for relieving leg pain (sciatica), it may not completely eliminate back pain. Patients who expect complete resolution of all symptoms may perceive the surgery as unsuccessful.
- Poor candidate selection – Not all patients with herniated discs are ideal candidates for microdiscectomy. Factors such as obesity, smoking, and certain medical conditions can increase the risk of complications and poor outcomes. Proper patient selection is crucial for achieving optimal results.
- Inadequate postoperative care – Following a microdiscectomy, the patient needs to adhere to postoperative care instructions, including activity restrictions and physical therapy. Failure to comply with these guidelines can lead to complications or delayed recovery, potentially contributing to perceived surgical failure.
Long-Term Outcomes and Recovery Challenges
- Persistent weakness – While the majority of patients with preoperative muscle weakness recover within a year after microdiscectomy, some may experience persistent deficits. A study found that patients with severe paresis at baseline had a four times higher risk of non-recovery. This lingering weakness can impact overall satisfaction with the surgical outcome.
- Chronic pain development – In some cases, patients may develop chronic pain syndromes following microdiscectomy. This can be due to various factors, including central sensitization or the development of complex regional pain syndrome. These conditions can be challenging to treat and may contribute to the perception of surgical failure.
- Functional status and quality of life – Research has shown that a small percentage of patients (around 4 percent) may experience a worsening of functional status and health-related quality of life after microdiscectomy. Interestingly, patients with better preoperative functional status were at higher risk for deterioration, possibly due to having less room for improvement.
Enhancing Microdiscectomy Outcomes
To maximize the chances of a successful microdiscectomy, consider the following strategies:
- Seek multiple opinions – Consult with several spine specialists to ensure an accurate diagnosis and appropriate treatment plan.
- Choose an experienced surgeon – Select a surgeon with extensive experience in performing microdiscectomies to minimize the risk of complications.
- Follow postoperative instructions – Adhere strictly to your surgeon’s guidelines for recovery, including activity restrictions and physical therapy.
- Manage expectations – Discuss realistic outcomes with your surgeon and understand that some residual symptoms may persist.
- Address underlying health issues – Work on improving overall health, including weight management and smoking cessation, to optimize surgical outcomes.
- Consider conservative treatments – Exhaust nonsurgical options before opting for microdiscectomy, as many herniated discs can resolve with conservative management.
While microdiscectomy is generally an effective procedure for treating herniated discs, various factors can contribute to unsuccessful outcomes. Understanding these potential pitfalls can help patients and healthcare providers make informed decisions and take steps to improve the chances of surgical success. If you are considering a microdiscectomy, discuss these factors with your spine specialist to determine if it is the right option for your specific condition.
Remember, even in cases where a microdiscectomy does not provide the expected relief, there are often alternative treatments or revision options available. Always work closely with your healthcare team to explore all possibilities for managing your spinal condition and enhancing your quality of life.
Although microdiscectomy surgery is a common and generally quite 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 experience 70 percent of all reherniations after surgery. A new treatment, Barricaid, which is a bone-anchored device proven to reduce reherniations, was specifically designed to close the large hole often left in the spinal disc after discectomy. In a large-scale study, Barricaid was proven 95 percent effective in a study of over 500 patients. This means 95 percent of Barricaid patients did not undergo a reoperation due to reherniation in the 2-year study timeframe.
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.