Minimally Invasive Microdiscectomy
By M. Victor Silver, MD, FRCSC, FACS, FAANS
Overview and Indications
Microdiscectomy is performed for patients with a painful lumbar herniated disc often known as sciatica. Microdiscectomy is a very 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 spinal nerve root.
Today, many surgeons use a microscopic surgical approach with a small, minimally-invasive, one-inch incision to remove the disc herniation, allowing for a more rapid recovery with less blood loss, less pain and shorter hospital stay.
A 1-inch longitudinal incision is made in the midline of the low back, directly over the area of the herniated disc. Special retractors and an operating microscope are used to allow the surgeon to visualize the region of the spine, with minimal or no cutting of the adjacent muscles and soft-tissues.
A few millimeters of bone of the superior lamina may be removed to fully visualize the disc herniation. The nerve root and neurologic structures are protected, so that the herniated disc can be removed. Small dental-type instruments and biting/grasping instruments are used to remove the protruding disc material. All surrounding areas are also checked to ensure no additional disc fragments are remaining. The total surgery time is approximately 1 hour.
Most patients are able to go home the same day or early the next day after surgery. Patients are instructed to avoid bending at the waist, lifting (more than five pounds), and twisting in the early postoperative period (first 2-4 weeks) to avoid a strain injury or recurrent disc injury.
Patients should try to avoid sitting in the same position for more than 30-45 minutes in the first few weeks after surgery. After sitting for 30-45 minutes, patients should get up and stretch or walk for a little bit, then sit down again if desired.
Patients are generally not required or recommended to wear a back brace after surgery.
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 for 10 days. 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). 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.
Doctor’s Visits and Follow-Up
Patients will return for a follow-up visit to see Dr. Silver approximately 8-10 days after surgery. The incision will be inspected. 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 but can vary according to the degree and duration of compression of the spinal nerves which can lead to a permanent nerve damage. However, most patients are noted to have a rapid improvement of their pain and return to normal function.
Dr. Silver is a double-board certified Neurosurgeon by the American Board of Neurological Surgery and by the Royal College of Physicians and Surgeons of Canada. He graduated from one of the largest neurosurgical training centers in North America only to further specialize in the treatment of Spine Disorders. Learn more about Dr. Silver’s state-of-the-art office by visiting www.silverneurosurgery.com.