Lumbar Microdiscectomy is a common surgical procedure for disc prolapse in your lower back. Traditionally this would mean long incision, longer recovery period and painful rehabilitation.
Advantages of minimally invasive surgery (MIS) for lumbar microdiscectomy are decreased muscle and soft tissue disruption, total length of stay and decreased post-operative pain. The procedure is called microdiscectomy because an operating microscope is used to perform the surgery.
All the structures including the prolapsed disc, spinal cord and spinal nerves are can be seen very clearly in greater detail. Therefore the chances of injury to the nerve or recurrence of disc prolapse are very minimal.
What is Lumbar Disc prolapse (Lumbar Disc Herniation)?
Lumbar disc prolapse and Lumbar Disc herniation both mean the same thing. The soft cushions between the bones of your spine called ‘discs’ bulges out and presses on the spinal nerve that comes out of your spinal-cord. It traps the spinal nerve (pinched nerve) and any movement causes severe back pain with leg pain called ‘sciatica’.
What are my treatment options before Lumbar Microdiscectomy?
1) Physiotherapy Sessions
Your Spine surgeon initially recommends gentle physiotherapy sessions that will stretch your back muscles that is very sore. This is because that they have gone into ‘spasm’. These sessions helps to stretch the muscles and nerves around the Disc prolapse. This improves the “Core Stability” for your lower back. Your muscles around the spine gets strengthened and your posture becomes pain-free.
2) Spine Steroid Injections
For some patients, physiotherapy rehabilitation improves back and leg pain only for a brief period. They still seem to have the back and leg pain that cannot be managed by medication is either. This means that the irritation of the spinal nerve is worse than expected. A mixture of a local anaesthetic and steroid will be required to reduce the pain and inflammation. These injections are called Spinal Nerve Root Injections.
At what stage is Lumbar Microdiscectomy recommended?
Lumbar discectomy (microdiscectomy) surgery is recommended for patients who have back pain and leg pain for at least six weeks. Such patient do not find any pain relief or improvement in their everyday function with conservative treatment like physiotherapy, NSAID’s (non-steroidal anti-inflammatory drugs).
However, it is important to note that after three to six months, the results of microdiscectomy surgery is not quite as favorable. This is because the spinal nerve undergoes internal changes due to the prolonged , inflammation, irritation and pressure on it from the disc.
If the pain is worsening and prevents you from your activities of daily living, then it is not advisable to postpone surgery for a prolonged period of time (more than three to six months).
What happens during Lumbar Discectomy?
Before the Procedure:
You’ll be required to come to the hospital the night before so that we can perform simple blood tests, check your temperature and blood pressure. This ensures that you are safe and healthy for the Microdiscectomy procedure. You’re also be seen by an experienced Consultant anaesthetist to assess you for general anaesthesia during the procedure. He will also review your medication and advice on the time of fasting for the Lumbar Microdiscectomy. Your spine surgeon and his team will make sure that you have all the necessary information before the procedure.
Most probably you will be advised to:
1) Bring are your medications including the prescription
2) Stop all tablets that causes your blood to become thin
3) Have a blood test to check your fitness for the procedure
During the Procedure:
You will be brought to the anaesthetic room and the Consultant Anaesthetist and his team will make sure that you are very relaxed before the procedure. You will gradually drift off to sleep. We will gently turn you over so that you lie flat on your tummy.
The Spine surgeon makes a small incision in the middle of your back. With the use of a microscope he gains access to the spinal canal and removes just the portion of the disc that actually presses on the nerve that causes your back and leg pain.
The Surgical injection is closed with absorbable sutures with a small dressing. The benefits of the microscopic lumbar discectomy include limited muscle dissection, good clarity and detail of the anatomy that ensures safety of the procedure. The pain and the risk of complication is much reduced and there is very little discomfort during recovery.
After the Procedure:
After the procedure your Consultant anaesthetist will arrange transfer from the operating theatre into the recovery room. After you are fully awake, you will be then transferred to your room. Later in the day, the physiotherapist and the spinal specialist nurse will help you to sit up in bed. On the following day, you will be made to take a few steps and walk if comfortable.
Once the Consultant spinal surgeon and his team are satisfied with your progress you will be discharged with a clear set of instructions to follow. You will be expected to stay in hospital for a period of 1 to 2 days.
After Discharge from Hospital:
After discharge from the hospital you will be given a discharge summary and a booklet. This will contain all the details of:
1) Lumbar Microdiscectomy procedure
2) How to look after the wound
3) Time to remove sutures
4) Exercises after Surgery
5) Driving – when and how to drive
6) Return to Work – when and how to return to your work
What should I do at home after Microdiscectomy?
The spine surgeon and his team will expect you to have had a good rest. This will allow the soft tissues enough time to heal after disc prolapse surgery. This will reduce complications like infection and bleeding. You can gradually increase your daily activities with support during the first few days. Please follow the physiotherapist advice on how to sit, stand and get on and off the bed. You’ll be required to take your medications for the first few weeks so that you’ll be able to mobilise without any pain.
What should I avoid after Microdiscectomy?
Once home, you should avoid these activities for atleast 4 weeks:
- Sitting for long periods
- Lifting heavy weights
- Leaning forward
- Bending forward
- Sudden jerky movements
- All sports including running
What do I need to be careful about after Microdiscectomy Surgery?
Please make sure that your Microdiscectomy surgical wound does not get wet or soiled when you wash and clean in the first 14 days. This is necessary for the skin and tissues to heal well. It also prevents infection. You must change your dressings every other day.
Do not bend or lift until the spine surgeon advises you to do so. Continue physiotherapy exercises and this will increase the tone and strength of your back muscles for faster recovery back to normal from disc prolapse surgery.
Get in touch if there are any concerns.
Follow up appointment after Microdiscectomy
My secretary will arrange a follow-up appointment in about two weeks’ time for a review with me. I will look at the wound and remove any stitches and make sure it is healed well. You will then be able to wash the wound.
The physiotherapist will educate you on gentle stretching, strengthening, and conditioning exercises for your back. You can walk as much as you can but sit for short periods only for the next 4 weeks. Usually patients require a sick note for 6 weeks for work. Full recovery takes 6-8 weeks.
How much does a Microdiscectomy cost in the UK?
In the UK the cost varies the cost for microdiscectomy surgery for self funding patients varies from £6000-£7000. The cost is different depending on the location in the UK. In London, we have the best spine specialists who can deal with all types of spine problems and are well known and internationally recognised.
For further details visit www.patient.co.uk
Is Microdiscectomy worth?
Certainly. I had a great experience with it. My discectomy was a success. The pain relief is instant. The prolapsed disc is shaved off from the spinal nerve. There is no further reason for the nerve irritation that has caused you a lot of back and leg pain. Please take care of the wound. Once the wound is healed well, in about 6-8 weeks (2 months) you will gradually return to normal function.
You must consider if your:
- Pain becomes unbearable
- Legs are numb and weak
- Activities are restricted
- Quality of life is poor
- Bladder and Bowel control is unreliable
What are the risks and complications of discectomy?
There are risks and complications associated with any surgery. For Microdiscectomy there are:
Superficial wound infections may occur in up to 4 out of 100 cases. These are treated with a course of Oral antibiotics. Deep wound infections may occur in fewer than 1 out of 100 cases. These do not respond to antibiotics alone and sometimes patients require surgery to clean out the infected tissue.
Patients at risk are those who have:
- Impaired immune systems
- Your Medical condition that need steroid treatment
This is most common if you are taking tablets to ‘thin your blood’ like aspirin, warfarin, rivaroxaban or clopidogrel. As the blood is too thin to clot and stop bleeding, there is an increased chance of bleeding into the wound. Medications like non-steroidal anti-inflammatories (NSAIDs) also increases the risk of bleeding. Please make sure that you inform the consultant or his team if you’re taking these tablets. You will need to stop taking these tablets before your procedure as they increase the risk of bleeding.
Damage to Nerve Root:
This occurs in less than 1 out of 100 cases of Microdiscectomy, but is much more common in repeat surgeries where injury can occur in up to 10 out of 100 cases. This is because the scar tissue from previous surgery looks exactly like a spinal nerve. Therefore the risk of nerve injury is very high. In a Nerve injury, there will be tingling, numbness, weakness or hypersensitivity of the skin over your leg.
There is an outer lining that covers the nerve roots. This is called the Dura. During the procedure this outer lining is likely to be torn particularly, if the bone is stuck to the outer lining. As the bone is lifted off this outer lining of the nerve, it is accidently torn. This does not occur often but it is reported in fewer than 5 out of 100 cases.
Dural tears are more common where patient had previous surgery. The scar tissue from previous surgery looks exactly the same like that of the outer lining of the spinal nerve (dura). The Spine Surgeon takes special care in these situations. It is like driving through a rough weather. We do take extra care in rough weather. If a dural tear occurs, the dura is repaired with stitches, a patch or a special glue.
The spinal-cord is surrounded by a special type of brain fluid called the cerebral spinal fluid (CSF). It is in this fluid the brain and the spinal cord floats so that it is protected from the shocks and impacts of every day life. The spinal-cord is surrounded by a special type of brain fluid called the cerebral spinal fluid. It is in this fluid the brain and the spinal cord floats so that it is protected from the shocks and impacts from everyday life.
When the dura is torn, this CSF leaks out into the surrounding tissues. Some patients suffer from headaches but it settles with time. Rarely, the problems with leakage persists and the surgeon might have to return to theatre to repair the dural tear. This risk of a second operation is less than 0.05%.
Recurrent Sciatica is a condition where the back pain and leg pain returns after a period of complete pain relief following Microdiscectomy. This occurs when there is a further disc prolapse, excess scar tissue around the sciatic nerve and a lack of rehabilitation causing further irritation and inflammation of the sciatic nerve. It occurs in approximately 5 out of 100 cases at any time from a few days to several years later.
Problems with positioning during MIcrodiscectomy:
These are very rare and happens when patients lay on the operating table. The skin and soft tissue are put under pressure due to the lying in the same position. The nerves are also stretched. We make sure that special gel mattress is used on the operating table and all your pressure areas that are at risk are well padded up. Very rarely blindness is a risk.
You won’t be able to move as normally as you would have after a Microdiscectomy procedure. This causes the blood to stay in one place and not move around very much. Blood clots are formed in your legs and this causes the pain and swelling of the leg. This condition is called Deep Vein Thrombosis (DVT). The clot in the legs really might travel to the lungs are cutting off the blood supply to the portion of the lung. Although rare, if not treated this could be a fatal condition. It is reported in 1 out of 700 cases.
There are many ways to reduce the risk of blood clots:
- Get moving as soon as possible
- Physiotherapist will show you leg exercises
- Walk as much as possible
- Drink plenty of water
- Stop contraceptive pill (4 weeks before)
- Stop HRT tablets (4 weeks before)
Damage to Spinal Nerves:
This is called Cauda equina syndrome. This results in paralysis of the legs with loss of sensation and loss of control of bladder and bowel. After surgery, if there is a lot of bleeding into the spinal canal the blood will compress upon the nerves in the spinal canal. This is how Cauda equina syndrome develops. This condition is extremely rare and this is an emergency situation. It will require returning to theatre as soon as possible to wash out the blood from inside the canal.
Medical Complications like Heart Attack, Stroke, Medical or Anaesthetic problems (1 in 250,000 cases).
How long does it take to recover from a microdiscectomy surgery?
It usually takes about eight weeks to get back to normal activities stop. That will be a gradual improvement in function and strength. Your physiotherapist will help you to improve your muscle tone and mobility. I normally recommend my patients at least six weeks of time off work. Most of my patients get back to full activities at work in 8 weeks time. You will need to learn new ways to lift, bend and twist so that you do not put too much strain on your back and protect the Microdiscectomy.
What is the success rate of Microdiscectomy surgery?
Microdiscectomy has a very high success rate. About 90 to 95% of my patients in London improve their symptoms and get back to normal work in about 2 to 3 months time. However, there is a small recurrence rate of a further disc prolapse (5%) at some point in the future.
Success from Microdiscectomy surgery depends on program of stretching, strengthening and aerobic conditioning as recommended by your physiotherapist. It also means that you should restrict yourself from bending, lifting, twisting for the first six weeks following surgery.