What is lumbar microdiscectomy?

Lumbar = lower back

Micro = means small

Disc = intervertebral disc/cushion between the bones

-ectomy = to remove

Lumbar microdiscectomy = a procedure that involves removal of a small portion of the intervertebral disc (the bulging/herniated portion) that is compressing the spinal nerves and/or spinal cord in the low back.

 

The Procedure

Anesthesia & Induction

  • Your anesthesiologist will talk to you about the specifics of his/her plan for the procedure. You will find out what medications and what type of anesthesia will be used to keep you pain free and comfortable throughout the operation.
  • In general, most patients will undergo general anesthesia during spine procedures meaning you will be asleep and wont remember or feel any pain during the procedure itself. Patients may have pain upon waking up from anesthesia, but this will be managed with intravenous and oral pain medications.
    • After a breathing tube is placed and you are fully asleep, you will be positioned on the operating room table.
    • Surgery will not begin until you are asleep and given pain medications so that you don’t feel any pain during the procedure.
  • A skin incision is made on lower aspect of your back.
    • After dissecting through the skin, Dr. Webb will carefully peel off the muscles overlying your spine using special instruments. These muscles will be held apart with the use of special tools, called retractors.

Performing the Decompression

  • Before removing the diseased and herniated disc, Dr. Webb will confirm that he is operating at the correct level by taking an x-ray while you are asleep. 
    • When the level is confirmed, Dr. Webb will then begin the decompression (removing the areas of compression from your spinal cord) portion of the procedure.
    • Dr. Webb will then carefully remove bone in order to get to the spine using special instruments.
    • The disc that is pressing on your spinal cord/nerves will be removed with the use of special instruments and tools. He will also remove any additional surrounding structures which may be pressing on your spinal cord, such as bone spurs and/or excess ligaments.
    • Dr. Webb will then ensure that your spinal cord and nerves are free from compression.

Closure

  • The retractors that held the muscles apart will now be removed and will be allowed to fall back into their normal position.
  • Dr. Webb uses absorbable sutures to close your wound. These sutures do not typically need to be removed and will absorb on their own.
  • Sometimes, a special tube called a drain will be used. This is to collect any blood or fluids that can collect after surgery. This drain will be removed before you leave the hospital, usually the next day after surgery.

Frequently asked questions

What can I expect after surgery?

After surgery you will be transferred to the recovery room, also called the PACU (post anesthesia care unit). After you have awaken from the anesthesia, you will then be transferred to your hospital room. This is typically when your family members can visit you.

Either the same day or the following morning after surgery, a physical and/or occupational therapist will begin your therapy. During your hospital stay, you will be given medications to help with pain and IV antibiotics to minimize the risk of infection. Most patients go home the same day of surgery but some patients may spend 1-2 nights in the hospital and are discharged home after:

  1. You are tolerating a diet
  2. Your pain is controlled
  3. After you have worked with and passed physical therapy.

Walking after surgery is highly encouraged, even the same day of surgery!

What kind of recovery can you expect after surgery?

Recovery from a lumbar microdiscectomy surgery generally takes 8-12 weeks, but patients continue to heal for up to a year after surgery.

When can I return to work and/or activities?

Walking is highly encouraged, immediately after surgery and throughout your postoperative period. Most patients can return to a light desk job or household activities by 2-3 weeks after surgery. Patients with jobs that require heavy lifting, strenuous labor, or high impact activities such as running, biking, skiing, sports will not be allowed to return until Dr. Webb clears you, usually around 6-8 weeks.

When will my back and/or leg pain go away?

Short answer: depends on how long your nerves have been compressed. If you can imagine putting your elbow on a hard surface for a long time, what happens? Your fingers start to go to sleep. Why? Because the nerves to these fingers is compressed, is asleep, and is irritable. Once you realize this, you pick up your elbow (to remove the pressure off of the nerve) and shake your fingers until they wake up. This is a similar concept in spine surgery where depending on how long your nerves and spinal cord have been compressed, will determine how long it takes for the nerve to wake up after the surgery. If you have had compression of your nerves and spinal cord for months to years, then it may take some time before the nerve recovers and wakes up (if it recovers at all). Most patients, however, wake up from surgery with leg pain relief meaning that the debilitating leg pain they had before surgery went away, but may have some back pain and spasms from the surgical incision itself. This pain will be controlled with oral/IV pain medications and antispasm medications throughout your hospital stay.

What complications should I be aware of?

Inadequate relief of symptoms

  • Dr. Webb is very particular about making sure we target the right level of your spine that may be causing your symptoms.
  • Inadequate relief of symptoms after surgery could be due to a number of things including: multiple levels that are degenerated or worn out that will not be addressed in surgery, surgery done on the wrong level, or advanced and severe spinal cord compression that may be irreversible.
  • Injections are confirmatory and are very predictive of how well you will do with surgery. These spinal injections, usually done before surgery in the conservative treatment period, are essential in determining which level of your spine is the cause of your symptoms.
  • Just because you have multiple degenerated areas of your spine according to your imaging studies (MRI, X-ray, etc.), does not mean every level needs an operation.

Reherniation

  • Most studies show a 10-15% reherniation risk meaning that after your surgery, you are at risk for your disc herniation recurring.
  • Studies have also looked various variable to determine whether things like early return to activities or wearing a brace after surgery increases this risk.

Nerve damage, causing leg weakness or pain

  • There are small nerves that control the muscles in your legs and foot that are close to where Dr. Webb will be working.  
  • Dr. Webb carefully works around these nerves and ensures they are not damaged during surgery.
  • If these nerves become irritated during surgery (sometimes just by touching or moving them), these nerves may cause pain for weeks to months after surgery until the nerve recovers. During this time, Dr. Webb may prescribe you nerve medication or steroids to help calm the inflammation down.

Dural tear

  • The dura is the outer layer of the spinal cord. Sometimes, this layer can be especially thin in certain patients and very friable. During surgery, if there is a small tear in this layer, Dr. Webb will attempt to repair it. This is a not a very common complication, but definitely one that needs to be known.
  • Sometimes after a dural tear is repaired, Dr. Webb may ask that you lay flat for 24 hours after surgery. This is done to give the repair time to heal and to ensure his repair does not come apart.
  • Fortunately, multiple studies have shown that having a dural tear repair does not affect your outcome from surgery.

Infection

  • Very low risk (<1%) but this risk is increased if you are overweight, immunosuppressed, on chronic steroids, or diabetic.
  • Antibiotics will be given before surgery starts and also given for 24 hours after surgery while you are in the hospital to decrease the risk of infection.

Bleeding

  • Very low risk, but increased if you are taking blood thinners, fish oil, herbal medications or have a clotting disorder.
  • These medications will need to be stopped before surgery.
  • Sometimes, a special tube called a drain will be placed during surgery. This tube is to collect any blood or fluids that can collect after surgery. This drain will be removed before you leave the hospital, usually the next day after surgery.

Spinal cord or Nerve damage

  • Very low risk
  • A neuromonitoring technician is a professional trained in the monitoring of your nerves and spinal cord.
  • This person (along with a Neurologist) is part of the team that will be taking care of you during surgery and will help Dr. Webb monitor your nerves and spinal cord throughout the procedure.
  • You will be able to meet this person the morning of surgery and ask any questions about their role in your care.
  • Generally, after you are asleep from anesthesia, this technician will place small wires on your legs and arms so that the nerves and spinal cord and be monitored during surgery.
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Lumbar Microdiscectomy