Microdiscectomy, sometimes called microdecompression, is minimally invasive surgical procedure performed on patients who have a protrusion (herniation) of the disc. The main goal of microdiscectomy is to relieve pressure from the nerves in order to alleviate it back pain. However, as in other minimally invasive procedures, surgeons use special visualization instruments that allow them to make very small incisions. The results can be faster and less painful recovery.
If the patient’s leg pain due to disc herniation will get better, it will usually be within about six to twelve weeks, from the onset of pain. As long as the pain is bearable and the patient can function adequately, it is advisable to postpone the operation for a short period of time in order to see if the pain would be solved only by non-surgical treatment. If the pain in the legs is severe, it is reasonable to consider surgery earlier. If, despite non-surgical treatment, the patient suffers from so much severe pain that it is difficult to perform daily activities, surgery may be considered before six weeks time.
These are the most common indications for surgery:
- Leg pain for at least six weeks
- MRI scan or other findings showing disc protrusion
- Leg pain (sciatica) is the main symptom of the patient, not just lower back pain
- Non-surgical methods such as oral steroids, NSAIDs and physical therapy have not provided sufficient pain relief
The procedure is usually performed under general anesthesia. These are the three ways microdiscectomy is performed:
- Mini-open approach: This is similar to an open discectomy, but your surgeon uses an advanced technology to examine the spine through smaller incisions.
- Tubular method: Your surgeon inserts a tube through a small incision. This tube is gently pushed through the back muscles until it reaches the spine, and then is inserted through the expanding tubes, one around the other. These tubes gradually open (or expand) the area where the operation will be performed.Then your surgeon uses specially designed instruments to remove parts of the disc through this pipe.
- Endoscopic: This involves inserting a small video camera (called an endoscope) through a tube so that the surgeon can see the spine and remove the disc material with a miniature instruments.
As with any form of spinal surgery, there are several risks and complications with microdiscectomy. Dural tear (leakage of cerebrospinal fluid) occurs in about 1% to 7% of microdiscectomy operations. The leak does not change the results of the surgery, but the patient may be asked to lie down for one to two days longer.
Other risks and complications include the following:
- Nerve root damage
- Intestinal / bladder incontinence
- Pain that continues after surgery
Recovery time is shorter than other, more invasive procedures. Most people can expect that they will be able to leave the hospital within 24 hours of surgery. For the first week or two you may need to reduce your workload or be absent from work while you recover. The good news is that many patients feel significantly less pain after microdiscectomy and can quickly return to their own normal life, mostly in less than 2 weeks. However, your doctor will advise you on this how quickly you can get back to exercise and other daily activities.
Successful microdiscectomy should achieve what traditional open surgery achieves -but with faster and less painful recovery.