Hi, my name is Dr. John Shim and I want to discuss lumbar microdiscectomy. By now you've already tried non-surgical treatments and have decided to move forward with the operation. Lumbar microdiscectomy surgery is offered because your pain patterns and physical examination matches the findings on your diagnostic studies. Let me show you a typical lumbar MRI of a disc herniation. This is a sagittal view, it is a side view of your back. For most patients there are some normal disc levels but the offending disc shows a mass pushing backwards on the spinal SAC with potential to irritate specific nerves. The axial view or the cross-sectional view will provide another angle to visualize the offending disc. For some patients there may be also associated bone spurs that contribute to the nerve irritation and a surgeon must anticipate removal of some of these bone spurs to maximize a chance of a good outcome. Of course I'm simplifying the procedure. For the surgeon there are many nuances that need to be considered. Experience helps when planning the operation, still the exposure is relatively the same. An incision is made just off the mid line. Care is taken to preserve the posterior spinous ligament and minimize the stripping of the multifidus muscle attachments. For the average-sized person the incision is less than 1.5 inches but may be larger if more than one disc removal is required. Muscles are generally retracted to allow visualization of the bony covering or lamina and the ligaments that cover over the spinal canal. Magnification is used to better visualize the anatomy thus micro. Depending on the level some of the bone will need to be removed to allow access. Tools including burrs, Kerrison punches and curettes aid in the removal of the covering bone and ligament. The nerve sac is then identified and protected. The nerve sac and thereby nerves are then gently swept off the offending disc herniation and the disc herniation is removed and the nerve is now free of pressure. Associated bone spurs may also need to be removed. The wound is then closed. For the properly selected patients without any other medical issues the success rate of improvement is greater than 90 percent. For the vast majority of patients they can resume normal activities within a few months. Most patients now have the operation performed on an outpatient basis. This is the basic anatomy of the lumbar microdiscectomy operation. You should discuss your individual concerns with your surgeon. This is Dr. John Shim and I hope this video helped you understand the micro lumbar discectomy surgery.
What exactly is Microdiscectomy? In the simplest terms, it means removal of disc material that is pinching a nerve, using small incisions and with magnification. In the United States, there is an average of 300,000 discectomy type surgeries performed per year.
For the vast majority of patients, the reason for microdisectomy is PAIN, despite treatments such as medications, physical therapy, chiropractic care, and/or injections. While some patients have such pain that they pursue surgery immediately, the recommended time for non-surgical treatments is 6 weeks – 3 months. While a good percentage of the non-surgically treated patients improve, those that have definite physical examination evidence of a pinched nerve, and a corresponding finding on diagnostic studies such as a MRI can benefit from the procedure.
In general, the patient will have a small incision ( less than 2 inches) made to the back. the corresponding back bones are properly identified by x-ray guidance, and the area of the pinched nerve by a ruptured disk is localized. Usually a small piece of the bone may be removed to allow entry into the spinal canal. Magnification is used to assist in visualization of the nerves and disk material. The nerves are identified, and gently deviated away from the pinched nerve material. Then, with use of instruments such as surgical tweezers, the disk material is removed away from the nerve.
In the properly selected patient, who has failed non-surgical care, there is a predicted greater than 90% improvement rate. Since 2010, the surgery is most often performed as an outpatient procedure.
The post operative rehabilitation is usually focused on maintaining core strength and flexibility. For some patients, the nerve pinching has caused specific muscle atrophy, and additional focus may be on those muscles. By 6 weeks, most can return back to all activities. Traditionally, patients are cautioned against heavy weight lifting, and repetitive bending during those 6 weeks. Some research suggests fit individuals can return back to all activities. We have certainly seen NFL athletes return back to the highest level after this procedure.
If you think you need microdisectomy, please discuss this with your physician.
- Daly CD, Lim KZ, Lewis J, Saber K, Molla M, Bar-Zeev N, Goldschlager T. Lumbar microdiscectomy and post-operative activity restrictions: a protocol for a single blinded randomised controlled trial. BMC Musculoskelet Disord. 2017 Jul 20;18(1):312. PubMed PMID: 28728580
- Ahuja N, Sharma H. Lumbar microdiscectomy as a day-case procedure: Scope for improvement? Surgeon. 2017 May 15; PubMed PMID: 28522270