Microdiscectomy Surgery

Microdiscectomy Surgery

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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.  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.

Citations

  • 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

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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