Microdiscectomy allows for minimally invasive removal of intervertebral disc hernia in the course of acute sciatica syndrome. The cutting performed during microdiscectomy is much smaller than in the case of classic open surgery. Disc hernia removal is performed with special miniature neurosurgical instruments. Besides endoscopic discectomy, microdiscectomy is another method that saves paraspinal tissues and enables a quicker return to daily activity.
Indications for microdiscectomy
Indications for microdiscectomy include symptoms pointing to constriction of the nerve root by the protruding nucleus pulposus:
- occurrence of limb paresis and/or urinary incontinence (indication for urgent treatment),
- no improvement after analgesic, anti-inflammatory, and rehabilitation treatment – if the pain and/or sensory disturbances persist and negatively affect the patient's quality of life.
The physician also takes into account the result of the magnetic resonance of the spine and its correlation with clinical symptoms.
Course of the surgery
The surgery is performed under general anaesthesia. The patient is placed in a lying position on the stomach. During the surgery, it is necessary to use an X-ray preview (fluoroscopy) in order to precisely localise the level of the intervertebral disc hernia. The surgeon performs a small incision (3-4 cm) in the lumbar region of the patient’s back. The spinal muscles and the ligamenta flava are stratified and pulled aside to expose the nerve roots. The surgeon may cut the arches of the vertebrae, but not in every case is this necessary. Modern miniature neurosurgical instruments, together with devices enlarging the view of the structures in the surgical field enable an accurate visualization of the part of the nucleus pulposus that constricts the nerve root. The nerve structures are decompressed. If necessary, the surgeon can remove exostoses (osteophytes) and/or widen the intervertebral foramen through which the nerve roots leave the spinal cavity. After making sure that the nerve root environment is free from structural conflicts, the wound is sewn up with sutures and provided with a drain to evacuate the blood from the surgical field. By evacuating the hematoma, the wound heals faster and pain is reduced. The drain is removed 1-2 days after surgery and the sutures 7 days after surgery. If absorbable sutures are used, they do not need to be removed as they are resorbed in the tissues.
After a microdiscectomy
The patient may start to get up and walk on the same day or the next day after surgery. Verticalisation is only allowed with the consent of the surgeon. Usually, the patient is discharged from the hospital on the second or third day after the surgery, upon confirmation of their good general and neurological condition.
During the wound healing period, positions and movements causing pain in the operated area should be avoided. Occasionally, the physician may recommend taking antibiotics to prevent infections. The patient should participate in the rehabilitation process, which will enable him/her to safely return to their daily activities. Activities contraindicated within 6-8 weeks after surgery are those related to bending, sudden rotational movements of the torso, lifting, and running. The moment of proper return to work and normal activity is determined together with the physiotherapist and the attending physician.
Advantages of microdiscectomy
Advantages of microdiscectomy include:
- the possibility of complete and precise removal of the intervertebral disc hernia,
- minimally invasive surgical access – minor interference in the skeletal and joint system of the spine,
- a better cosmetic effect of the treatment in comparison to the classic open surgery,
- early verticalisation and quick return to work (with appropriate rehabilitation).
FAQ
- What happens during microdiscectomy?
Microdiscectomy is a minimally invasive method of treatment of intervertebral disc hernia. The surgeon performs a small incision of the body covering (3-4 cm). Then, he tilts the soft tissues of the spine aside so as to gain convenient access to the nerve root constricted by the nucleus pulposus. Thanks to the use of miniature instruments and devices enlarging the area of the surgical field, the nucleus pulposus can be precisely removed from the place where it presses on the nerve structures. At the same time, intraoperative tissue injury is much less extensive than in the case of traditional surgical access. An advantage of microdiscectomy is the small interference in the spine structures, which gives a better cosmetic effect, the possibility of early verticalisation and shortening the period of convalescence.
- When can I walk after a microdiscectomy?
Getting up and walking is only allowed with the consent of the surgeon. Usually, verticalisation takes place on the same day or on the second day after surgery. The patient is discharged from the hospital after an examination confirming their good general and neurological condition.
