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. 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