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A microdiscectomy is typically performed in the case of a
lumbar herniated disc. The center of the disc protrudes through
the outer ring (annulus) and subsequently puts pressure on a
nerve, causing pain to radiate down the patient’s leg and into the
foot. In this procedure, a small portion of the bone over the nerve
root and disc material from under the nerve root is removed to
relieve the pressure and provide room for the nerve to heal. A
microdiscectomy surgery is more effective for treating leg pain (radiculopathy)
than for lower back pain. The compression on the nerve root can
cause substantial leg pain, and while it may take weeks or months
for the nerve root to fully heal and for any numbness or weakness to
get better, patients normally feel relief from leg pain almost
immediately after a microdiscectomy surgery.
Who should have this surgery?
This procedure is usually recommended for patients who have
experienced leg pain for four to six weeks and who have tried
conservative treatment (such as oral steroids, epidural steroid
injections, NSAID’s, and physical therapy) without successfully
relieving the pain. However, it is not advisable to wait too long
before having this surgery, because the results are not as good if
the surgery is postponed more than three to six months. Besides
time, one needs to also factor in the level of the pain and the
amount of disability the patient is experiencing. If the symptoms
are mild, a longer course of conservative treatment may be
reasonable, whereas if the symptoms are severe more immediate
surgery is reasonable.
Microdiscectomy success rate
A recurrent disc herniation may occur directly after back surgery
or many years later, although they are most common in the first
three months after surgery. Recurrence rates after a patient has a
disc herniation are between 5 and 10%. If the disc does herniate
again, generally a revision microdiscectomy will be just as
successful as the first operation. However, after a recurrence, the
patient is at higher risk of further recurrences (15 to 20% chance).
If herniation continues to recur, a fusion procedure might be
considered.
Recurrent disc herniations are probably due to the fact that within
some disc spaces there are multiple fragments of disc that can come
out at a later date. Through a posterior microdiscectomy approach,
only about 5 to 7% of the disc space can be removed and most of the
disc space cannot be seen. Also, the hole in the disc space where
the herniation occurs (annulotomy) probably never closes because the
disc itself does not have a blood supply. Without a blood supply,
the area does not heal or scar over. There also is no way to
surgically repair the outer portion of the disc space (the annulus).
Usually, a microdiscectomy procedure is performed on an outpatient
basis (with no overnight stay in the hospital) or with a one night
stay in the hospital. Post-operatively, patients may return to a
normal level of daily activity quickly. The success rates for pain
relief are between 90 and 95%.
Following surgery
Some surgeons restrict a patient from bending, lifting, or twisting
for the first six weeks following surgery. However, since the
patient’s back is mechanically the same after a microdiscectomy, it
is also reasonable to return to a normal level of functioning
immediately following surgery. There have been reports in the
medical literature showing that immediate mobilization (return to
normal activity) does not lead to an increase in recurrent lumbar
herniated disc. Although a patient may be technically allowed to
resume their normal activities immediately, they should expect
reduced activities due to incisional discomfort for one to three
weeks.
Following a microdiscectomy surgery, a program of stretching,
strengthening, and aerobic conditioning is recommended to help
prevent recurrence of back pain or disc herniation.
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