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Microdiskectomy

Alternative Names

Definition

Spinal microdiskectomy is surgery to remove disk fragments from a herniated disk, usually in the lower back (lumbar area).

Unlike lumbar spine surgery that requires a surgical cut about 2 to 5 inches long, microdiskectomy is less invasive, and done using a very small surgical cut about about 1 to 1 ½ inches long.

Description

Microdiskectomy is done in a hospital or outpatient surgical center while you are under local anesthesia (awake but pain-free) or general anesthesia (asleep and pain-free).

A special high-powered microscope magnifies the affected disk(s) and nerves, and guides the doctor during surgery.

The surgeon makes a small cut on your back and moves the back muscles away from the spine. After identifying and moving the nerve root, the surgeon removes the injured disk tissue and fragments. The back muscles are placed back into the normal position, and the wound is closed with stitches or staples.

Why the Procedure is Performed

Spinal microdiskectomy is done to relieve nerve pain and pressure. It may be performed in patients with the following conditions:

• Cauda equina syndrome
• Herniated lumbar disk
• Leg pain or weakness (sciatica) caused by a herniated disk

It's important to note that patients with low back pain are usually treated conservatively before surgery is considered. Traction, anti-inflammatory medications, physical therapy, and exercise are often prescribed. Over time, many of the symptoms of low back pain will improve without surgery.

Risks

Risks include:

• Dural tears (tears to the tissue called the dura mater, which covers the spinal cord and spinal nerves)
• Nerve root damage
• Reherniation of the same disk

Because of the small surgical cut, the doctor may miss some disk fragments. This could result in persistent pain.

Outlook (Prognosis)

Most patients have pain relief and improved function after surgery, and numbness and tingling gets better.

Recovery

You will be encouraged to get up and walk around as soon as your anesthesia wears off. Most patients are released the day of surgery.

Most patients typically are able to go back to normal activities shortly after surgery. However, you should avoid sitting for prolonged periods or lifting heavy objects. When lifting anything, be sure to lift with your knees instead of bending over. This is necessary to avoid further injury

If you work in an office, youâ??ll most likely be able to return to work within 2 to 4 weeks. But if your job is more physically demanding, you may have to wait for up to 3 months.

Your doctor may recommend an exercise or physical therapy program to speed your recovery.

References

Deen HG, Fenton DS, Lamer TJ. Minimally invasive procedures for disorders of the lumbar spine. Mayo Clin Proc. 2003 Oct;78(10):1249-56. Review.

Koebbe CJ. Lumbar Microdiscectomy: A Historical Perspective and Current Technical Considerations. Neurosurg Focus 13 (2): Article 3, 2002.

Chou R, Qaseem A, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-491.

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