You would only consider surgery if you’re NOT getting better with the other therapies that are mentioned in my blog. If you are having persistent intractable pain, weakness, numbness and dysfunction then you and your surgeon might consider doing this surgery.
Microdiscectomy in my experience is best entertained when your symptoms are primarily related to leg pain or sciatica pain. If your biggest problem is low back pain, then you may have a bulging disk but that bulging disk will typically cause pain in the back and not just the leg. A herniated disk, when it’s pushing on a nerve, is really a secondary problem as it is a nerve impingement. This procedure is geared at reducing the compression, taking away the compression off of the nerve that is irritated, so you cannot expect this surgery is going to fix or heal your disk. It is not intended to do that and you should not expect that it will.
Microdiscectomy surgery is common. It usually takes 45 minutes to an hour and is performed in an outpatient setting. There is a little incision that is made in the back which is closed with a thin layer of skin glue and patients go home a few hours after surgery. They can also get in the shower the same day and their primary therapy after surgery is just walking.
There are restrictions with regard to how much patients can lift, bend and twist after surgery. This is to allow the muscles to heal so there is little risk of putting any pressure on the disk architecture which would cause another herniation and would likely preclude the patient from being a candidate for disk replacement surgery if that was needed in the future.
During surgery, a tiny incision is made in the back and I work through a small, minimally invasive tubular retractor that is about the diameter of a dime (18 mm), we use a microscope and try not to disrupt the soft tissue. That tube is placed over the spine right where the nerve is and we use x-rated guide placement of that tube and then through that tube and using the microscope and some special instruments, some bone is shaved off the spine, giving access to the nerve. Once the nerve is found, it is gently teased over and underneath where the herniating disk is found. When we find that disk, a small incision is made in a layer of tissue that is containing it and then that disk has a chance to come out with a little bit of help from the surgeon. Sometimes it comes out in one large piece, sometimes it comes out as little pieces.
After the herniation is removed, the nerve is no longer compressed so the surgeon will then go and look around for any other soft fragments within the disk space that are free-floating and ready to follow at another time. What we don’t want to happen is to have a disk reherniation as that is really one of the most discomforting, tragic things that happens with this surgery and it can happen up to 10% of the time. After the surgery, you might be doing well and then in delayed fashion, you could push out more disk because the disk is weak now and there is a risk for more to come out.
Microdiscectomy is geared at fixing a secondary problem for the herniation and not meant to just fix back pain, although you may have back pain from your nerve compression and disk degeneration that’s occurred by the herniation.
When the disk herniation is removed, you will feel an improvement in your leg pain and you may also have significant Improvement in your lower back symptoms. However, you shouldn’t expect that it will go away completely and you should also understand that the failure internally to the disk hasn’t changed; it is still a fractured disk so the problem is still there. In other words, this is not a fix for your disk, it’s a fix for your nerve.
Although there are risks associated with the surgery, this is quite a common procedure and with a good surgeon, you can expect to not have any major complications. Reherniation is probably the most concerning aspect of this surgery and there is one technique that is rarely performed called an annular closure.
Annular closure
The annulus is the outer layer of the disk where the tear in the disk occurs and it holds the disk into place. Once the disk has herniated, that area has torn and if your surgeon is capable and experienced, he or she can suture that closed and that can help reduce the risk of a reherniation. This process can be performed through the same minimally-invasive incision and although it takes a bit of experience to know how to do it safely, it does reduce the risk of reherniation. Additionally, this annular closure can be performed with some stem cell type of procedure to facilitate healing of the annulus at the same time.
