• First, the back muscles (erector spinae) are lifted off the bony arch (lamina) of the spine. Since these back muscles run vertically, they can be moved out of the way rather than cut.
• The surgeon is then able to enter the spine by removing a membrane over the nerve roots (ligamentum flavum), and uses either operating glasses or an operating microscope to visualize the nerve root.
• Often, a small portion of the inside facet joint is removed both to facilitate access to the nerve root and to relieve pressure over the nerve.
• The nerve root is then moved to the side and the disc material is removed from under the nerve root.

Microdiscectomy risks and complications
As with any form of spine surgery, there are several risks and complications that are associated with a microdiscectomy procedure. Complications are quite rare in this procedure, but possibilities include:

• Dural tear (cerebrospinal fluid leak). This occurs in 1% to 2% of these surgeries. It does not change the results of surgery, but post-operatively the patient may be asked to lay recumbent for one to two days to allow the leak to seal.
• Nerve root damage (1in 1,000)
• Bowel/bladder incontinence (extremely rare)
• Infection (1%)
• Recurrent disc herniations (5-10%)

• Lumbar microdecompression (microdiscectomy) spine surgery animation • Postoperative care for lumbar microdiscectomy surgery • Pain management after microdiscectomy surgery • Back strengthening exercises after microdiscectomy surgery

Postoperative Care
Follow-up care for a microdiscectomy usually includes a combination of the following:

• Pain management. Immediate post-operative pain can be managed with a combination of non-steroidal anti-inflammatory drugs (ibuprofen such as Advil, Nuprin, or Motrin; or naproxen such as Naprosyn or Aleve) and a mild pain pill such as Darvocet or Vicodin. As the discomfort subsides (usually about 1 to 2 weeks) the patient can move toward substituting Tylenol for the narcotic pain medications. Ice may also be applied to the back to decrease pain within the first 48 hours after surgery.
• Stretching program. Most surgeons feel that to minimize tethering of the nerve root by scar tissue, gentle stretching exercises should be done in the early postoperative period. Scar tissue in and of itself is not painful, but if it tethers the nerve root short as the patient heals this can result in chronic pain. The stretching should be done about 5 to 6 times a day for 6 to 12 weeks, since this is the time period in which the scarring occurs. It is generally advisable to do the stretching exercises frequently and gently. Stretching too hard may result in pain, and one should only take the stretch to the point of pain to avoid inflaming the nerve. If a patient feels too much pain after surgery to do any stretching, it would be wise to wait until he or she is more comfortable.
• Back strengthening exercises. After the soft tissue has healed (usually 2 to 3 weeks after surgery), it is important to start back strengthening exercises.There are a wide variety of possible exercises to achieve the desired results, and it is important to choose exercises that are safe and well tolerated so that they will be done on a regular basis. About 15 minutes of appropriate stretching and strengthening exercises per day is advisable for the first one to three months.
• Early return to activity. Early mobilization may help patients heal sooner, as the pre-operative pain has usually caused patients to limit their motion, and limited motion is a common cause of pain. Walking is very gentle on the back, and a postoperative walking program with a goal of walking about 3 miles a day is advisable. Return to work is based on how quickly the patient feels better and on what type of work the patient does.