What Do They Remove in a Microdiscectomy?

A microdiscectomy is a common surgical procedure performed to relieve pain and discomfort caused by a herniated disc pressing on a spinal nerve. While the procedure is minimally invasive, many patients wonder what exactly is removed during the surgery and how it impacts long-term spinal health. Understanding the specifics of a microdiscectomy can help you prepare for the surgery and manage expectations during the recovery process. In this article, you will learn about the intricacies of microdiscectomy, focusing on what is removed during the surgery and why.

Microdiscectomy Defined

A microdiscectomy, also known as microdecompression spine surgery, is a minimally invasive surgical procedure performed to relieve pressure on a spinal nerve root caused by a herniated disc. The term “micro” refers to the use of a microscope or other magnifying device, which allows the surgeon to operate through a small incision with enhanced precision.

This procedure is typically recommended for patients experiencing persistent leg pain, numbness, or weakness caused by a herniated disc in the lumbar (lower) spine. It is often considered when conservative treatments such as physical therapy, medications, and epidural steroid injections have failed to provide adequate relief.

The Anatomy of a Herniated Disc

To understand what is removed during a microdiscectomy, it is crucial to grasp the anatomy of a herniated disc:

• Spinal discs – These are cushion-like structures located between the vertebrae in the spine. They act as shock absorbers and allow for flexibility in the spine.
• Disc structure – Each disc consists of two main parts:

• The annulus fibrosus – A tough, fibrous outer ring
• The nucleus pulposus – A soft, gel-like center
• Herniation – A disc herniation occurs when the nucleus pulposus pushes through a tear in the annulus fibrosus, potentially pressing on nearby nerves and causing pain, numbness, or weakness.

What Is Removed in a Microdiscectomy?

Now that we understand the basic anatomy, we will explore what a surgeon actually removes during a microdiscectomy:

• Herniated disc material – The primary goal of a microdiscectomy is to remove the portion of the herniated disc that is pressing on the nerve root. This typically involves:
  • Extracting the extruded nucleus pulposus – The surgeon carefully removes the gel-like material that has pushed through the annulus fibrosus and is compressing the nerve.
  • Clearing loose disc fragments – Any loose pieces of disc material in the surrounding area are also removed to prevent future irritation.

It is important to note that only the herniated portion of the disc is removed, not the entire disc. The aim is to preserve as much of the healthy disc as possible to maintain spine stability and function.

• Bone spurs – In some cases, bone spurs (osteophytes) may have formed near the herniated disc, contributing to nerve compression. If these are present, the surgeon may remove the bony overgrowths to further decompress the affected nerve.
• Ligamentum flavum (partial removal) – The ligamentum flavum is a ligament that runs along the back of the spinal canal. In some cases, a small portion of this ligament may be removed to gain better access to the herniated disc material and further decompress the nerve root.
• Lamina – In certain situations, the surgeon may need to remove a small portion of the lamina, which is part of the vertebral arch. This procedure, called a laminectomy, can provide better access to the herniated disc and compressed nerve.

What Stays Intact during a Microdiscectomy?

Understanding what remains in place is just as important as knowing what is removed:

• Spinal stability structures – The majority of the disc, including most of the annulus fibrosus, remains intact. This helps maintain spinal stability.
• Vertebrae – The bony structures of the spine are not removed or significantly altered.
• Facet joints – These joints, which provide stability and allow for spine movement, are preserved.
• Spinal cord and nerve roots – Great care is taken to protect these vital structures throughout the procedure.

The Microdiscectomy Procedure: Step by Step

To better understand the removal process, it can be helpful to walk through the typical steps of a microdiscectomy:

• Anesthesia – The patient is given general anesthesia or, in some cases, local anesthesia with sedation.
• Incision – A small incision (usually about 1–1.5 inches) is made over the affected area of the spine.
• Muscle retraction – The back muscles are carefully moved aside to access the spine.
• Visualization – A microscope or other magnifying device is used to provide a clear enlarged view of the surgical area.
• Lamina access – If necessary, a small portion of the lamina may be removed (laminectomy) to access the herniated disc.
• Nerve root retraction – The affected nerve root is gently moved aside to expose the herniated disc material.
• Disc removal – The herniated portion of the disc and any loose fragments are carefully removed using specialized surgical instruments.
• Final inspection – The surgeon ensures all pressure has been relieved from the nerve root.
• Closure – The incision is closed with sutures or surgical glue.

Benefits of Targeted Removal

The precise and targeted removal of herniated disc material in a microdiscectomy offers several benefits:

• Immediate nerve decompression – By removing the offending disc material, pressure on the nerve root is immediately relieved, often resulting in rapid pain relief.
• Minimally invasive – The small incision and targeted approach result in less tissue damage, faster recovery, and reduced risk of complications compared to traditional open surgery.
• Preservation of spinal stability – By removing only the herniated portion of the disc, the procedure maintains overall spine stability and function.
• Long-term relief – Many patients experience long-lasting relief from leg pain and associated symptoms following a successful microdiscectomy.

Potential Risks and Considerations

While microdiscectomy is generally considered safe and effective, it is important to be aware of potential risks:

• Incomplete disc removal – In some cases, not all of the herniated material may be removed, potentially leading to persistent symptoms.
• Recurrent herniation – There is a small risk the disc may herniate again at the same level.
• Nerve root damage – Although rare, there is a risk of injury to the nerve root during the procedure.
• Infection – As with any surgery, there is a risk of infection, although it is relatively low in microdiscectomy.
• Spinal fluid leak – In rare cases, the dural sac containing spinal fluid may be accidentally punctured.

Recovery and Outlook

Recovery from a microdiscectomy is typically faster than traditional open spine surgery. Depending on the doctor’s recommendation, most patients can return home the same day or after an overnight stay in the hospital. Physical therapy usually begins within a few weeks after surgery to strengthen the back muscles and increase flexibility.

The majority of patients experience significant improvement in leg pain and other symptoms immediately after surgery. However, it may take several weeks for numbness and weakness to fully resolve. Complete recovery and return to normal activities often occur within 6–8 weeks, although this can vary depending on the individual and his or her specific situation.

Microdiscectomy is a precise and effective surgical procedure for treating herniated discs in the spine. By selectively removing the herniated portion of the disc and any loose fragments, surgeons can relieve pressure on compressed nerve roots, often resulting in significant and rapid pain relief. The minimally invasive nature of the procedure, combined with the preservation of spinal structures, allows for faster recovery and a quicker return to normal activities for many patients.

If you are considering a microdiscectomy, it is crucial to have a thorough discussion with your spine specialist about the specifics of your condition, the details of the procedure, and what you can expect in terms of recovery and outcomes. With proper patient selection and skilled surgical technique, microdiscectomy can be a life-changing procedure for those suffering from persistent pain due to herniated discs.

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 reinjure themselves by having what is known as a reherniation. These reherniations often require additional 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 microdiscectomy 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 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 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.