Microdiscectomy: Causes, Symptoms and Recovery

Microdiscectomy, also known as microdecompression or cervical microdiscectomy, is one of the most commonly performed spine surgeries. This procedure is particularly preferred for patients with a lumbar herniated disc. The primary goal of a microdiscectomy is to relieve pressure on a spinal nerve root by removing the material causing the pain.

Traditionally, this was achieved through an open technique called lumbardiscectomy surgery, which involved making a large incision and cutting some of the back muscles, leading to a slow and painful recovery. However, modern advancements have led to the development of microdiscectomy, which achieves the same goal with a smaller incision and minimal injury to the back muscles. Consequently, recovery is quicker and less painful.

During a microdiscectomy, a special microscope is used to view the disc and nerves. This magnified view allows the surgeon to make a smaller incision, causing less damage to the surrounding tissues.

Here are some of the signs and symptoms before microdiscectomy:

Pain radiating down one or both legs
Feeling of Numbness or tingling in one or both legs
Muscle weakness in the leg(s)
Pain in the back or buttocks
Bowel or bladder incontinence

Before undergoing a microdiscectomy, several diagnostic tests and evaluations are typically conducted to confirm the diagnosis of a herniated disc and determine the best treatment course. Here are the common steps and tests involved in the diagnostic process:

Medical History and Physical Examination

Medical History: The doctor will ask about symptoms, their duration, and how they affect daily activities. They will also inquire about any previous injuries, medical conditions, and treatments attempted.

Physical Examination: The doctor will perform a physical exam to assess nerve function, muscle strength, reflexes, and pain response. This may include specific tests such as the straight leg raise test to identify nerve root irritation.

Diagnostic Imaging Tests are:

Magnetic Resonance Imaging (MRI): An MRI is the most common imaging test used to diagnose herniated discs. It provides detailed images of the spine, including the discs and nerve roots.

Computed Tomography (CT) Scan: A CT scan may be used if an MRI is not possible. It provides detailed cross-sectional images of the spine.

X-rays: While X-rays do not show herniated discs, they can help rule out other conditions, such as fractures, tumors, or spinal alignment issues.

Myelogram: Involves injecting contrast dye into the spinal canal followed by a CT scan. It can highlight pressure on the spinal cord or nerves.

Electromyography (EMG) and Nerve Conduction Studies (NCS): This pressure causes the nerves to send pain signals to the brain, which interprets the pain as originating in the legs.

The microdiscectomy begins with the administration of general anesthesia, ensuring the patient is unconscious and unable to feel anything during the surgery. Preoperative intravenous antibiotics are given to reduce the risk of infection.

The procedure is performed with the patient lying face down on a special operating table with padding for comfort. The surgical area is cleansed with a sterile solution. A small incision, about one to two centimeters long, is made over the herniated disc area. Special retractors and a lighted operating microscope are used to provide the surgeon with a clear view of the spine, minimizing or avoiding the need to cut adjacent muscles and tissues.

Before removing the herniated disc, a small piece of bone called the lamina is removed from the affected vertebra in a process called a laminotomy. This allows the surgeon to fully visualize the herniated disc. Small scissor-like tools and grasping instruments are then used to remove the protruding disc material.

Finally, the incision area is irrigated with sterile water containing antibiotics, and the deep fascial and subcutaneous layers are closed with sutures. The skin is sealed with special surgical glue, eliminating the need for bandages.

Microdiscectomy has a relatively short recovery time compared to other invasive procedures. Generally, patients can expect to leave the hospital within 24 hours after surgery. Before discharge, patients are often advised to meet with a physical therapist. The therapist will provide instructions on how to minimize twisting and bending of the back and may recommend exercises to improve the strength and flexibility of the muscles around the spine.

Patients should avoid driving, sitting for prolonged periods, lifting heavy objects, and bending over immediately after the surgery. While normal activities can generally be resumed after two weeks, patients are advised to refrain from lifting heavy objects for at least four weeks post-surgery. Full recovery from a microdiscectomy procedure typically takes between four to six weeks.