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What Conditions Indicate a Microdiscectomy May Be Appropriate?


12.19 - What-Is-the-Criteria-for-a-Microdiscectomy

Surgery for a herniated spinal disc is seldom absolutely necessary. If conservative treatments are not providing sufficient relief, you may be ready to consider a microdiscectomy rather than a traditional discectomy, which is a more invasive version of the same procedure. While there are many benefits to having microdiscectomy surgery, it is just as important to make sure you meet the established criteria first. This article explains some of the most important criteria for microdiscectomy surgery.

Single-Level Herniation

First, you will need to have spinal disc herniation at a single level. Since a microdiscectomy is a minimally invasive procedure, it is easier to access the affected disc when it is at a single level rather than multiple levels. Incisions are small in microdiscectomy surgery, so accessing a spinal disc that is at another level can present some challenges.

Nerve Root Compression

Some people have herniated spinal discs without even knowing it due to the lack of pain experienced. If you are considering
herniated disc surgery such as a microdiscectomy, this will not be the case. However, your discomfort needs to be related to the compression or irritation of a nearby spinal nerve root in order for surgery to be a consideration. There is a difference between nerve root compression and discomfort resulting from inflammation or muscle spasms that sometimes occur when a spinal disc is out of place or herniated. A microdiscectomy is a decompression procedure, so there must be a nerve root that needs to be decompressed.

Failed Conservative Treatments

Unless symptoms are severe or potentially life-threatening, there is not an urgent need to have a
microdiscectomy. Patients are expected to try conservative or nonsurgical treatments for several months before a microdiscectomy is considered. This list typically includes:

• Physical therapy
• Massage therapy
• Hot and cold applications
• Medication

If you prefer to hold off on surgery, you may also wish to give alternative treatments a try before discussing surgery. This is not a requirement, but it is certainly worth considering. And if you still fail to respond well to additional treatments such as chiropractic care or acupuncture, surgery can be discussed again.

Overall Health and Wellbeing

At the very least, any underlying health issues must be under control. This is especially true if you have a condition that can affect circulation and the ability to properly heal and recover. Simply having diabetes or chronic high blood pressure does not necessarily mean you cannot have a microdiscectomy. It just means you will need to discuss your condition with your doctor and spine surgeon. Doing so allows proper precautions to be taken during the procedure. It is equally vital to mention medications you take that may cause clotting.

Realistic Expectations

It is important to know what you want to achieve with surgery for a herniated spinal disc. Patients tend to respond better to surgery when their expectations are realistic. For example, if you are hoping to run marathons at a competitive level, realize your overall recovery and return to a more active lifestyle is going to be a more gradual process.

If you have a herniated disc that is not responding to conservative treatment, microdiscectomy surgery may be discussed and potentially recommended. Although this is generally a very successful procedure, having a large hole in the outer ring of the disc more than doubles the risk of needing another operation. A new treatment, Barricaid, is a bone-anchored device that closes this hole, 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 microdiscectomy—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, ask your doctor or contact us at 844-288-7474.

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