Microdiscectomy

The spine is made up of small bony segments called vertebrae. These vertebrae are categorized into cervical or neck vertebrae, thoracic or upper back vertebrae, lumbar or lower back vertebrae and the sacrum within the pelvis. A cylindrical bundle of nerve fibres called the spinal cord passes through the entire vertebral column and branches out to the various parts of our body. Cushioning discs present between the vertebrae act as shock absorbers that redistribute the forces acting on your vertebrae when you walk, run, bend, or twist. These intervertebral discs are made up of two types of cartilage: inner pulpy cartilage known as the nucleus pulposus which is surrounded by concentric layers of fibrous cartilage known as the annulus fibrosis. When the cartilage in the centre of the disc protrudes through small tears in the outer hard covering of the disc, adjacent nerves passing through the spinal cord can become compressed or pinched, causing severe pain. This is known as disc herniation. Microdiscectomy, also called micro decompression, is a minimally invasive spinal surgery where your surgeon removes a part of the herniated disc to relieve pressure on the spinal nerves.

Disease Overview: Disc Herniation

As you age, gradual wear and tear occur to the spinal discs causing them to lose water content. This makes them more susceptible to rupturing or tearing. Any heavy lifting or minor trauma can cause disc herniation. Most disc herniation occurs in the lumbar spine, causing debilitating pain in your buttocks, thigh, and calf areas and is referred to as sciatica. Herniated discs in the cervical spine can cause pain in the shoulders and arms. Other symptoms associated with a herniated disc include numbness and tingling or weakness in the region served by the pinched nerve.

Indications

Symptoms of a disc herniation including sciatica pain can be alleviated by surgically releasing the compressed spinal nerves through microdiscectomy.

Surgical Procedure

Microdiscectomy is usually performed under general anaesthesia. You will lie on your stomach for the procedure. A small incision around 1 to 1½-inches will be made directly over the affected disc, usually in the midline of your lower back, which is identified by X-ray imaging. The back muscles are retracted and your surgeon will use a microscope with light to visualize the herniated disc during the procedure. A small bony segment protecting the compressed nerve may be removed. Using a scissor-like tool, the damaged herniated tissue will be excised and the pressure on the compressed nerve is relieved. After this, the incision is closed with sutures. You may be discharged the same day or the next morning.

Post-Operative Care and Recovery

Following the procedure, you will be prescribed pain medications to relieve immediate postoperative pain.

  • Cold packs may be applied as instructed for pain relief.
  • Avoid driving, lifting heavy objects, prolonged sitting and bending over immediately after your surgery.
  • Your physical therapist will educate you on gentle stretching, strengthening, and conditioning exercises to be performed during the postoperative period.
  • You can slowly begin lifting weights and performing strenuous physical activities and exercises two to four weeks after your surgery. Complete recovery usually takes about six weeks.

Risks and complications

Some of the potential risks associated with microdiscectomy include:

  • Bleeding
  • Infection
  • Nerve root damage
  • Recurrent disc herniation

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