A microdiscectomy is a surgical procedure performed to relieve the symptoms of a herniated spinal disc, also known as a herniated or slipped disc. The main goal of a microdiscectomy is to remove the herniated portion of the disc that is compressing the nerves. By doing so, the pressure on the affected nerves is reduced, alleviating the associated symptoms. Unlike traditional open surgery, a microdiscectomy is a minimally invasive procedure, meaning it requires smaller incisions and causes less disruption to surrounding tissues.
Compared to traditional open back surgery, microdiscectomy requires smaller incisions, resulting in less tissue disruption, reduced scarring, and potentially faster recovery times. Most patients experience relief from symptoms within a few weeks and can gradually resume their regular activities under the guidance of their healthcare provider.
What is a microdiscectomy?
Microdiscectomy is a surgical procedure performed to relieve symptoms associated with a herniated or slipped disc in the spine. Also known as microdecompression or microdecompression discectomy, it is a minimally invasive technique that aims to alleviate pain, numbness, and weakness caused by the compression of spinal nerves.
During a microdiscectomy, a neurosurgeon or orthopedic surgeon uses specialized surgical instruments and a high-powered microscope to access the affected area of the spine. The procedure involves making a small incision, typically less than one inch, through which the surgeon creates a narrow pathway to remove the damaged herniated disc.
Which conditions are treated with a microdiscectomy ?
Microdiscectomy is primarily used to treat specific conditions related to herniated or slipped discs in the spine. These conditions cause compression of spinal nerves, leading to symptoms such as pain, numbness, tingling, and weakness in the back and legs. Examples include:
- Herniated disc: A herniated disc occurs when the soft inner material of the disc bulges out through a tear in the outer layer. This can put pressure on nearby nerves and cause pain, numbness, or weakness in the legs or arms.
- Degenerative disc disease: As we age, the discs in our spine can become worn and damaged, leading to chronic pain and stiffness.
A discectomy is typically performed when non-surgical treatments such as physical therapy, medications, or epidural injections have not been effective in relieving the symptoms caused by the herniated disc.
However, in some cases, surgery may be recommended right away if the patient is experiencing symptoms of spinal cord compression.
What happens during the procedure?
A microdiscectomy involves the removal of a small portion of the damaged or bulging disc material that is pressing on the spinal nerves and causing pain, numbness, or weakness. Here’s what happens during a microdiscectomy in more detail:
- Anesthesia: Before the surgery begins, the patient is placed under general anesthesia, which ensures that they are completely asleep and do not feel any pain during the procedure.
- Patient Positioning: The patient is positioned face down on the operating table to provide access to the back of the spine.
- Incision: The surgeon makes a small incision, typically less than an inch in length, over the area of the spine where the affected disc is located. The incision is made in the midline of the back.
- Soft Tissue Dissection: The surgeon carefully moves the muscles and soft tissues aside to expose the bony arch of the vertebra, known as the lamina.
- Lamina Removal (Partial Laminectomy): In some cases, a partial laminectomy may be performed. This involves removing a small part of the lamina to access the spinal canal and the herniated disc.
- Nerve Root Identification: The surgeon gently identifies the nerve root or roots that are being compressed by the herniated disc. Special surgical instruments, including a microscope or surgical loupes, are used to enhance visibility during this step.
- Discectomy: With the nerve root identified and safely moved aside, the surgeon then removes the protruding or herniated portion of the disc using microsurgical tools. This is the main part of the procedure, as it aims to relieve pressure on the nerve root.
- Disc Inspection and Closure: The surgeon thoroughly inspects the area to ensure that all herniated disc material has been removed. If any additional disc fragments are found, they are also carefully extracted. Once the surgeon is satisfied with the removal, the incision is closed using sutures or surgical staples.
- Recovery and Observation: After the surgery is completed, the patient is taken to the recovery room, where they are closely monitored as they wake up from anesthesia. Vital signs are checked regularly, and pain management is initiated if needed.
- Post-Operative Care: Depending on the surgeon’s recommendation and the patient’s condition, they may be discharged on the same day or kept overnight for observation. Post-operative instructions, including wound care, activity restrictions, and pain management, are provided to the patient.
What is the recovery time?
After the surgery, patients can often return home on the same day or with an overnight hospital stay. In the first few days, they may experience some discomfort around the incision site, but pain medication helps manage it. During the first week, strenuous activities should be avoided to promote proper healing. By the end of the first month, most patients experience significant improvement in symptoms and can resume light activities. Over six weeks, more activities can be introduced, and after three months, many patients return to most regular activities.
What are the risks of microdiscectomy?
While microdiscectomy is generally considered a safe and effective procedure, like any surgical intervention, it carries some inherent risks. Some potential risks and complications of microdiscectomy may include:
- Infection: Any surgical procedure carries a risk of infection. While strict sterile techniques are followed during surgery, there is still a possibility of developing an infection at the surgical site. Infections may require antibiotics and additional medical attention to resolve.
- Nerve Damage: Despite the surgeon’s utmost care, there is a risk of unintentional damage to nearby nerves during the procedure. Nerve damage could lead to new or worsened neurological symptoms, such as weakness, numbness, or tingling.
- Dural Tear: The dura mater is the protective covering of the spinal cord and nerve roots. During surgery, a tear in the dura can occur, leading to cerebrospinal fluid leakage and increasing the risk of infection. In such cases, the surgeon may perform a repair to close the tear.
- Bleeding: Excessive bleeding during or after the surgery can occur.
- Anesthesia Complications: General anesthesia carries its own risks, including adverse reactions to medications, breathing difficulties, or allergic reactions.
What are the benefits of microdiscectomy over traditional/open discectomy?
- Faster Recovery: Due to the smaller incisions and reduced tissue trauma, microdiscectomy generally leads to a faster recovery compared to open discectomy. Patients often experience less post-operative pain, require shorter hospital stays, and can resume normal activities and work sooner.
- Reduced Blood Loss: Microdiscectomy typically involves less blood loss during the surgery compared to open discectomy. This reduces the need for blood transfusions and decreases the risk of complications associated with excessive bleeding.
- Preservation of Spinal Stability: Microdiscectomy allows for targeted removal of the herniated disc material, focusing solely on the affected area. It minimizes disruption to the surrounding spinal structures, such as ligaments and bones, preserving spinal stability and reducing the risk of long-term complications.
- Lower Risk of Infection: The smaller incisions and reduced tissue trauma associated with microdiscectomy generally result in a lower risk of surgical site infections compared to open discectomy. Smaller incisions are easier to keep clean, reducing the exposure to potential contaminants.
- Reduced Scarring: The smaller incisions used in microdiscectomy result in less noticeable scarring compared to the larger incisions required for open discectomy. This cosmetic advantage can be particularly appealing to patients concerned about visible surgical scars.
How effective is microdiscectomy?
Microdiscectomy has a generally high success rate, with one large long-term study showing 84% of individuals who undergo the procedure report good or excellent outcomes (Dorhmann 2015).
Microdiscectomy is a highly effective and minimally invasive surgical procedure used to treat herniated or slipped discs in the spine. Compared to traditional open discectomy, microdiscectomy offers faster recovery times, reduced tissue disruption, and minimal scarring. Microdiscectomy has proven to be an excellent option for patients seeking relief from disc-related symptoms. However, the decision to undergo microdiscectomy should be made after careful evaluation and consultation with a qualified healthcare professional.