Microdiscectomy is a form of spinal decompression surgery that’s sometimes used to treat nerve compression caused by a herniated or or prolapsed ruptured disc, to alleviate symptoms such as sciatica pain (felt in the buttocks and down the leg), as well as reduced sensation, numbness and weakness in the affected leg and/or foot. A microdiscectomy involves removing a section of the damaged disc and is essentially the same as a discectomy, except that minimally invasive techniques and microscopic tools are used such as a high-powered microscope. Surgery can potentially be carried out on any part of the spine but is most commonly performed on discs within the lumbar region (lower back).
When is a microdiscectomy performed?
Surgery is generally always a last resort. Herniated or ‘slipped’ discs are relatively common and it can take many months to fully recover, but only very few cases will require surgery. So, when is surgery deemed suitable? Firstly, relevant tests, including MRI scans, will need to have sufficiently indicated that a disc is causing the symptoms. Secondly, conservative treatments, such as physiotherapy, pain management medication and injections, should be tried first and given a fair chance. If these aren’t effective, or symptoms become chronic or continue to worsen and are significantly impacting quality of life, surgery may be explored. However, there are also occasions when microdiscectomy surgery is performed as an emergency procedure. In very rare cases, spinal nerve compression can result in ‘red flag’ symptoms associated with a condition called cauda equine syndrome, including numbness in the genitals, groin and saddle area, reduction or loss of bladder and bowel control, or a sudden inability to pass urine. This needs to be treated promptly, or permanent damage can occur.
What does microdiscectomy surgery involve?
Microdiscectomy surgery is carried out under general anaesthetic, which means you’re asleep during the procedure. A small incision will be made near the site of the disc, and the surgeon will carefully move the surrounding muscles and nerves aside. Complex Spine London’s surgeons are specialists in the latest minimally-invasive techniques, so great care is taken to ensure minimal impact on surrounding muscles. The surgeon will remove a segment of the damaged disc, as required, relieving the nerve compression, before restoring any muscles that were moved or cut, and closing the incision with stitches or staples.
Are there any risks?
All surgery carries a degree of risk, including the risk of bleeding, blood clots and infection. With spinal surgery, there are also additional risks, such as nerve damage, a dural tear (when a small tear occurs in the dura – the watertight sac that surrounds the spinal cord) and leakage of cerebrospinal fluid (CSF). Tears can usually be detected and repaired quickly, although there is a chance you may need to stay in hospital a little longer and in a small number of cases, further surgery may be required. While risks are generally low, it’s important to be fully informed. Your surgeon will discuss these with you during your consultation and answer any questions you might have.
What is the recovery process and success rate of microdiscectomy surgery?
Microdiscectomy surgery is generally very successful in reducing symptoms such as sciatica pain, numbness and sometimes associated weakness. However, success rates may vary depending on the severity of nerve compression and how long the symptoms have been going on for. Your surgeon will be able to discuss this with you beforehand. During the initial recovery phase, wound care and avoiding infection are key. Most people are able to go home the next day – your surgeon and nurses will explain how to manage your aftercare once you’ve left hospital. You’ll need some time off work (most people are able to resume work after 4 weeks) and to avoid things like heavy lifting and strenuous exercise for a while. However, keeping mobile is very important – it’s likely you’ll be advised to get up and move around regularly and take short walks. This helps in avoiding blood clots, as well as restoring muscle strength and mobility. Follow-up appointments will be arranged to check your wound is healing well and assess recovery progress. Your surgeon and physiotherapist will be able to advise on when and how to begin increasing your activity levels again and returning to more strenuous exercise. There’s lots of evidence that people who engage well with a suitable physiotherapy or fitness rehab regime, and maintain a fit and active lifestyle, tend to have better long-term outcomes and a lower chance of suffering a relapse or further problems.
[answerpacktv video="/what-is-a-discectomy" header-link="/video/#!/dr-syed-aftab-s-videos" header-only="yes" single-view-mode="yes" show-summary="yes" landing-page-header-title="Information Videos" landing-page-header-text="Browse through our playlists of frequently asked questions on a range of spinal conditions"]
The London Independent Hospital 1 Beaumont Square, London E1 4NL