Overview And Indications
Microdiscectomy, also called Microlumbar Discectomy (MLD), is performed for patients with a painful lumbar herniated disc. Microdiscectomy is a very common, if not the most common, surgery performed by spine surgeons. The operation consists of removing a portion of the intervertebral disc, the herniated or protruding portion that is compressing the traversing spinal nerve root. Years ago, most spine surgeons would remove a herniated disc using a rather large surgical incision and surgical exposure without the use of a microscope or telescopic glasses, which would often involve a long hospital stay and prolonged recovery period. Today, many surgeons use a microscopic surgical approach with a small, minimally-invasive, poke-hole incision to remove the disc herniation, allowing for a more rapid recovery.
A disc ruptures when there is a tear in the outer lining (annulus) of the disc. When a tear in the annulus occurs, a fragment of disc material may protrude and pinch surrounding nerves. When a nerve is compressed it can cause symptoms such as extremity pain, numbness, weakness, electrical sensations, and bowel and bladder incontinence. If symptoms are not relieved with conservative treatments, a patient may be a candidate for surgical removal of the herniated disc fragment.
Microendoscopic discectomy is performed by making a small incision in the patient's back and inserting a small endoscopic probe between the vertebrae and into the herniated disc space. A small camera is placed through the probe enabling the surgeon to view the operation on a TV screen in the operating room. Small surgical devices are placed through the probe to remove bone and herniated disc fragments.
The procedure usually takes about one hour; the patient is often able to return home on the same day. It is normal for a patient to experience postoperative pain, such as back pain, spasms, and lower extremity symptoms. These symptoms will usually improve as the nerve heals and inflammation of the nerve decreases. Patients are given pain medications during the healing process.
Patients are generally not required or recommended to wear a back brace after surgery. Occasionally, patients may be issued a small, soft lumbar corset that can provide additional lumbar support in the early postoperative period, if necessary.
The wound area can be left open to air. No bandages are required. Small surgical tapes affixing the suture should be left in place. The area should be kept clean and dry.
Patients can shower immediately after surgery, but should cover the incision area with a small bandage and tape, and try to avoid water hitting directly over the surgical area. After the shower, patients should remove the bandage, and dry off the surgical area. Small surgical tapes affixing the suture should be left in place. Patients should not take a bath until the wound has completely healed, which is usually around 2 weeks after surgery.
Patients may begin driving when the pain level has decreased to a mild level, which usually is between 2-10 days after surgery. Patients should not drive while taking pain medicines (narcotics). When driving for the first time after surgery, patients should make it a short drive only and have someone come with them, in case the pain flares up and they need help driving back home. After patients feel comfortable with a short drive, they can begin driving longer distances alone.
Return to Work and Sports
Patients may return to light work duties as early as 1-2 weeks after surgery, depending on when the surgical pain has subsided. Patients may return to heavy work and sports as early as 4-6 weeks after surgery, if the surgical pain has subsided and the back strength has returned appropriately with physical therapy.
Doctor's Visits and Follow-Up
Patients will return for a follow-up visit to see Spine Surgeon approximately 6-10 days after surgery. The incision will be inspected and one stitch will be removed. Patients will be given a prescription to begin physical therapy for back exercises, to start 3-4 weeks after the surgery. Medications will be refilled if necessary.
Results and Outcome Studies
The results of microdiscectomy surgery in the treatment of a painful, herniated disc are generally excellent. Numerous research studies in medical journals demonstrate greater than 90-96% good or excellent results from microdiscectomy surgery. Most patients are noted to have a rapid improvement of their pain and return to normal function.
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