The spine is comprised of vertebrae (bones) and discs. The function of the intervertebral discs is to provide cushion for the vertebrae and to create space for the nerves to exit from the spinal canal to the right and left side. A disc herniation occurs when the soft inner portion of the disc (nucleus pulposus) ruptures out of the disc. When a portion of the soft, spongy disc protrudes in the lumbar spine, the disc material can put pressure on the exiting nerve root causing a constellation of symptoms. These symptoms usually include shooting or burning pain, numbness, or tingling down one leg or the other (also called radiculopathy or sciatica), and is sometimes accompanied by lower back pain.
The initial treatment of a lumbar disc herniation is conservative therapies, including a short period of rest followed by physical therapy. Anti-inflammatory medications are usually incorporated early in the treatment plan to help calm the irritation of the nerve caused by the herniated disc. Steroids can also be injected directly around the irritated nerve to help with inflammation as well. An estimated 90% of lumbar disc herniations will resolve without surgical management in 90 days.
If symptoms worsen or persist despite conservative therapies, surgery may be indicated. The surgery performed for lumber disc herniation is a microdiscectomy. A microdiscectomy relieves the pressure on a spinal nerve root by removing the portion of the disc putting pressure on the nerve, ultimately causing the pain. Minimally invasive microdiscectomy uses a very small incision with a microscope to remove the disc, rather than the traditional ‘open’ surgical technique that requires a larger incision.
Benefits Minimally Invasive Microdiscectomy
- There is less postoperative pain and faster recovery after the procedure than there is with a standard open discectomy. Patients often wake up from surgery with immediate relief of symptoms and discharge home the same day of surgery.
- There are fewer wound complications and less blood loss in comparison to standard open discectomy. The incision used in minimally invasive microdiscectomy is < 1 inch in length, allowing for minimal tissue disruption.
- There is less infection risk than traditional open back surgery.
Patients who would benefit from Minimally Invasive Microdiscectomy
- Patients with lumbar disc herniation who have symptoms that persist despite conservative therapies will benefit from minimally invasive microdiscectomy
- Patients with foot drop due to disc herniation
- Patients with worsening or unimproved lower extremity weakness due to disc herniation
Procedure
“Minimally-invasive” means the procedure is performed through a small incision that is less than 1 inch in length. Using fluoroscopic guidance, an 18 mm tube is then inserted to the level of the disc herniation. While visualizing the herniation through a microscope, small instruments are used to remove the offending piece of disc. The majority (healthy portion) of the disc is left alone.
The skin is then closed using dissolvable sutures and a shower-proof dressing is placed over the incision.
The procedure usually takes about an hour, but this varies depending on the patient.
Risks associated with Minimally Invasive Microdiscectomy
The risk of a complication after having minimally invasive microdiscectomy is generally low. However, as with any surgery, there are some things to be aware of before deciding to proceed with surgery.
The risks of minimally invasive microdiscectomy include:
- Reherniation of the disc can occur after the initial discectomy surgery is performed. Recurrent back pain or leg pain in the same pattern that occurred prior to the discectomy might indicate that the disc has herniated again.
- There is a small risk of nerve damage and the affected nerve may not function correctly. This could result in radiating leg pain, numbness, or tingling.
- Infection is a risk with any surgery. Given the small incision size and the short amount of time it takes to perform the operation, risk of infection is minimal. Antibiotics will be administered during the surgery to prevent infection. You will be given instructions on how to keep your incision clean and allow it to heal properly. Smoking increases your risk of post-operative infection.
- Microdiscectomy does not always result in complete recovery from pain or other bothersome symptoms. Usually, any persisting symptoms after surgery are temporary, but occasionally, surgery does not fully relieve the patient’s symptoms.
- Dural tear is a complication in which there is a small hole in the protective tissue that contains the spinal nerves and spinal fluid.
Dr. Wheeler will go over all risks with you during your office visit and answer any questions you may have.
