Once spinal surgery meant for large incisions, longer recovery time, and even painful rehabilitation. However, surgical techniques have advanced with time and improved procedures in various aspects. Microdiscectomy also called micro lumbar discectomy(MLD) is one such amazing procedure advanced with time. It is a minimally invasive surgical procedure performed for patients suffering from the herniated lumbar disc. Often this is performed by an orthopaedic spine surgeon in which a portion of the herniated disc might be removed to relieve pressure on the nerves in the spinal column.
What Is Microscopic Lumbar Discectomy Surgery?
Micro lumbar discectomy is a surgical procedure performed on patients with a painful lumbar herniated disc popularly known as “ruptured” or “slipped” disc. A herniated disc happens when the nucleus pulposus of the vertebral disc protrudes out through the ligaments surrounding the disc. It creates extra pressure on the nerve roots resulting in severe back pain.
In such conditions, micro lumbar discectomy or microdiscectomy is performed, a procedure in which a small incision is made and the involved vertebral bone is exposed. Then a microscope with a light and camera is used to improve lighting and vision during the surgery, making the surgical procedure more precise and accurate. Some specially designed small surgical devices are used during microscopic discectomy to remove fragments of a herniated disc carefully. This microscope provides a magnified view with special lighting that allows a spine surgeon to make only a smaller incision which results in less damage to surrounding tissue.
How A Microscopic Lumbar Discectomy Surgery Is Performed?
The surgery is done under general anaesthesia. Some preoperative antibiotics are given and the patient is positioned on a radiolucent table in the prone position. The surgical region is cleaned by a special solution and the process is called preparation and draping. The entire surgical team wears sterile surgical attire to maintain a bacteria-free environment. A smaller longitudinal incision of around 2cm long is made in the lower back at the site of the herniated disc. Special retractors and a microscope are used. It helps the spine surgeon by providing a clear visual of the herniated disc. Same is sometimes accomplished by tubular retractors and endoscopes. This is known as a microendoscopic procedure .
The bone spurs and the lamina are removed by inserting the special surgical tools and this approach is referred to as a laminectomy. It provides a clear path to access the herniated disc by gently retracting the nerves. Finally, the pieces of a herniated disc are dissected and removed carefully. After that, the incision is closed with sutures. If absorbable stitches are used, they dissolve in the body on their own.
Typically after lumbar discectomy, patients are discharged on the same day or the next day. Before discharging, physical therapists work with them to provide some instructions and techniques of getting in and out of bed and walking independently. Usually in almost 99% of cases with micro lumbar discectomy patients are made to walk within a few hours after surgery. As the incisions are small, small bandages are affixed over the sutures and patients are advised to keep the surgical site clean and dry. Routine activities of daily living are encouraged. Activities like driving and prolonged sitting will need a few weeks’ time before resumption.
Patients should not miss the follow-up visit that maybe around 12-14 days after surgery. In the visit, the incision will be inspected and provides a prescription to begin physical therapies and back exercises for 3-4 weeks post-surgery.
Patients are insisted to avoid bending, twisting and lifting weights for the first few weeks after surgery in order to avoid a strain injury or recurrent disc injury. Patients should avoid sitting more time in the same position in the first few weeks after surgery, they should stretch or walk because movement plays a dominant role after surgery. Getting up and walking around in the early postoperative period helps to lower the risk of scar tissue formation. Patients can do light work after 1 or 2 weeks post-surgery. Patients might return to sports or other heavy work 2 to 3 months following surgery .
Why It Is Done
Micro lumbar discectomy surgery is usually done to reduce pain caused due to herniated disc and also helps to regain the lost movement and functions. Surgery is recommended when a person suffering from intense leg pain, numbness, or weakness and the symptoms do not get better even after nonsurgical treatment. Surgery is mandatory if the patient has severe nerve compression like cauda equina syndrome. It may result in loss of bowel movements or bladder control and numbness or tingling in the buttocks, genital area and legs.
Benefits Of Microlumbar Discectomy
Experts evaluated and stated that the outcome of micro lumbar discectomy surgery is the best of all surgery in terms of safety and efficiency of the technique.
The potential benefits of microdiscectomy surgery include:
- Reduction of pain
- Smaller incision
- Less blood loss
- Less muscle and local damage
- Better cosmetic appearance
- Less operative time
- Faster recovery after surgery
The results of micro lumbar discectomy surgery for a herniated disc are generally excellent. Many research studies demonstrate that greater than 90-96% of the surgical results are good or excellent after microdiscectomy surgery. Most patients stated that they have rapid relief from pain and returned to their normal functions. When an experienced spine surgeon like Dr Surya Prakash performs the surgery, the results will be more precise.