Microdiscectomy, also called Microlumbar Discectomy, is performed for patients with a painful lumbar herniated disc. Microdiscectomy is surgery performed by very few trained spine surgeons. The operation consists of removing a portion of the intervertebral disc, the herniated or protruding portion that is compressing the traversing spinal nerve root. Years ago, most spine surgeons would remove a herniated disc using a rather large surgical incision and surgical exposure without the use of a microscope or telescopic glasses, which would often involve a long hospital stay and prolonged recovery period. Today, many surgeons use a microscopic surgical approach with a small incision to remove the disc herniation, allowing for a more rapid recovery.
Patient comes with complains of :
- Pain the the back and extremity, usually the back of the leg
- Pain and limitation of raising the leg with the patient lying on his back
- Numbness and Loss of sensation in the leg which aggravates on walking for short distance
- Mild Weakness in specific muscle groups in the leg
- X rays – shows decrease in disc space
- MRI – shows herniation of the disc and compression of unilateral or bilateral nerve roots at the involved level of the spine.
Fortunately the vast majority of individuals spontaneously recover from their first episode of sciatica. Bed rest for a day or two may be helpful. Surgery is indicated in patients who continue to have severe pain for more than few weeks, significant weakness & numbness and patients who do not respond to conservative management.
The aim of operation is decompression of the nerve root. Under general anesthesia a 1 inch incision is made in the low back overlying the nerve root with help c-arm imaging. Using the operative microscope a small crescent of bone is removed from the spine, exposing the nerve root and herniated disc material (laminotomy). The disc material compressing the nerve root is removed along with loose disc fragments and nerve root is freed completely.
Decompressing the nerve root relieves the sciatic pain in the leg and back pain as well. The surgical procedure takes around one hour. Most individuals can return home the same day of surgery and return to normal or light limited activities within a day or two. Athletic activities can be resumed in 3 months. There is virtually no blood loss and no support corset is prescribed. More than 90% of patients experience total or near total pain relief, usually within a day or two of operation.
Spine and trauma Surgery
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