Lumbar Microdiscectomy

Learning about the spine can help you understand how herniated discs occur and how to avoid the condition. The bones (vertebrae) that make up the spinal column in the back consist of discs that act as cushions or shock absorbers for the spinal bones. These small, round, pillow-like structures have a tough outer layer called the annulus surrounding the nucleus.

A herniated disc (also called bulged, slipped or ruptured disc) is a fragment of the disc nucleus that ruptures into the spinal canal through a tear in the annulus. It can occur in any part of the spine but is more common in the lumbar spine or lower back. When there is a herniated disc in the lumbar spine, the displaced herniated fragment presses on the spinal nerves, often producing pain, numbness and weakness in one or both legs, which may be severe. If the herniated disc is not pressing on a nerve, the patient may experience a low backache or no pain.

Natural, age-related wear and tear (degeneration) on the spine or a single excessive strain or injury, such as a fall, are the most common causes of herniated discs. However, the following factors may increase a person's risk of a herniated disc:

• Men between 20 and 50 are more likely to have herniated discs.
• Using the back muscles instead of the legs to lift heavy objects, or twisting the body while lifting, can cause a herniated disc.
• Excess weight can put pressure on the discs in the lower back.
• Repetitive activities, such as constant lifting, pulling, bending or twisting, strain the spine and make it vulnerable to injury.
• Sitting for extended periods while driving and the car engine's vibration can stress the spine and discs.
• A sedentary lifestyle can weaken the backbones and cause many medical conditions, such as herniated discs.
• Smoking lessens the oxygen supply to the disc and causes rapid spine degeneration.

Most people with a herniated lumbar disc feel much better over several days to weeks of nonsurgical treatments. Typically, patients completely recover in three to four months. However, there is a small percentage of patients with a herniated lumbar disc who require surgery to treat painful symptoms, such as:

• Muscle weakness
• Difficulty walking
• Loss of bladder or bowel control

When initial conservative treatment options for a herniated disc, such as physical therapy and medications, fail to reduce the symptoms or remove the pain, a neurosurgeon may recommend a lumbar microdiscectomy.

What Is Lumbar Microdiscectomy Surgery?

A discectomy is the most common procedure to remove herniated discs in the lumbar region. In a discectomy procedure, neurosurgeons make a small incision over the affected area of the spine, then use special instruments to gently pull the nerve away to expose the ruptured disc and remove just enough of the disc to release the pressure on the spinal nerves caused by a bulging or slipped disc. Neurosurgeons close the incision with stitches or surgical tapes to complete the operation.

In a lumbar microdiscectomy surgery, neurosurgeons operate through a small incision at the level of the herniated disc through a microscope.

How Lumbar Microdiscectomy Surgery Is Performed

Neurosurgeons perform lumbar microdiscectomy surgery in a hospital or outpatient surgical center. The procedure is performed under general anesthesia (the patient is asleep and pain-free) or spinal anesthesia (the patient is injected with anesthesia to numb the spine). The operation goes as follows:

• The neurosurgeon makes a small incision about 1 to 1.5 inches, or 2.5 to 3.8 centimeters, on a patient's back, moving the back muscles away from the spine. The neurosurgeon uses a special microscope to view the bulging disc and nerves during surgery.
• Once the neurosurgeon locates the nerve root, it is gently pulled away to expose the affected discs.
• The neurosurgeon then removes the injured disc tissue and pieces of the disc.
• The back muscles are put back in place, and the neurosurgeon closes the surgical site with stitches or staples.

After the procedure, the spinal nerve has the space it needs inside the spinal column, so any pain caused by the pinched nerve should stop.

How Long Does a Lumbar Microdiscectomy Take?

A lumbar microdiscectomy takes about one to two hours

What To Expect After Lumbar Microdiscectomy Surgery?

Most can expect to get up, walk around when the anesthesia wears off, and leave the hospital the same day of the surgery or within 24 hours. Patients will likely have to meet with a physical and occupational therapist before going home for instructions on reducing bending, lifting and twisting while moving around.

If you have recently undergone a lumbar microdiscectomy surgery, you must get a recommendation from your treating physician for exercises to improve the strength and flexibility of the muscles around your spine and prevent future back problems.

Refrain from driving and sitting for a prolonged period, lifting heavy objects and bending over right after surgery. You may also have to reduce your workload or take some time off while recovering.

How Long Does It Take To Recover From A Lumbar Microdiscectomy?

Full microdiscectomy recovery typically takes about six weeks. With combined surgical treatment and rehabilitation, there is up to 20-25% chance that the affected disc will rupture or herniate again in your lifetime. Overall, lumbar microdiscectomy surgery has an outstanding track record for relieving pain from herniated disc symptoms. Although lumbar discectomy is a safe procedure, like any surgery, it comes with potential risks, such as nerve injury, infection or need for further surgery. Be sure to discuss the risks and benefits of the procedure with your doctor before making a decision.