Lumbar Microdiscectomy: A Minimally Invasive Solution for Disc Herniation
Lumbar microdiscectomy is a cutting-edge surgical procedure aimed at providing relief to patients suffering from debilitating back and leg pain caused by disc herniation. At The Spine MDT, our collaborative approach led by a spine surgeon and partnered with osteopaths, physiotherapists, and chiropractors ensures that we offer the least invasive solutions for optimal long-lasting results. In this blog post, we will delve into what a lumbar microdiscectomy entails and how it is carried out.
Lumbar microdiscectomy is a surgical procedure meticulously crafted to alleviate the tormenting symptoms stemming from herniated discs within the lower back. A herniated disc emerges when the inner nucleus of a spinal disc ruptures through the outer layer, impinging on neighbouring nerves, thereby triggering an array of discomforts including pain, numbness, and weakness coursing through the lower back and legs.
The Procedure: Carrying Out a Lumbar Microdiscectomy:
Intricately engineered with minimally invasive techniques, lumbar microdiscectomy has emerged as a beacon of hope for individuals yearning for effective relief coupled with a swifter recovery. Here is a comprehensive overview of the surgical procedure:
1. Incision:A minute incision, often measuring 2cm, is meticulously crafted over the afflicted region of the spine in the midline of the lower back.
2. Visualization:Employing a specialized microscope or endoscope, the surgical area is illuminated and magnified, and a small window is created at the back of the spine furnishing the surgeon with a crystal-clear view of the herniated disc and its neighbouring structures.
3. Discectomy:The surgeon embarks on a precise and delicate removal of a small portion of the herniated disc. This tactical manoeuvre is pivotal in alleviating the nerve compression and ushering in relief by mitigating pain and restoring the normal function of the nerve.
4. Closure:The wound is meticulously sutured in layers with absorbable sutures that do not need to be removed. A waterproof dressing is dressing is then applied. The inherently minimally invasive nature of the procedure ensures minimal tissue damage, ushering in a swifter recovery with less scarring.
Benefits of the procedure (from British Association of Spine Surgeons):
70-75% of patients experience a significant improvement in leg pain.
20-25% may be better but still have persistent leg pain
5% may have no benefit at all
1% may be worse in terms of pain.
Risks of the procedure:
As with any surgical intervention, potential risks exist but are rare overall. These include:
1. Paralysis.The risk of paralysis, which means loss of use of the legs, loss of sensation and loss of control of bowels and bladder is very low. Probably occurring less than one per 300 operations to about one per 1000 from historic data sets. We believe this to be less since the use of microscopes. It can be due to a haemorrhage forming immediately after the operation compressing the nerves or direct damage to the nerves. This is extremely rare, when carried out under the microscope. It is extremely rare for this to be permanent, and every effort is made to reverse the situation, including further surgery.
2. Infection:Around 2%. Most resolve with antibiotic treatment but some deeper infections (less than 1% of cases) may require a further procedure to “wash” the infected area.
3. Spinal fluid (CSF) leak. An accidental tear to the lining of the nerves containing the spinal fluid occurs in about 2-3% of cases. Most of the time this can be repaired during the surgery without any consequences. Occasionally further surgery may be required to repair the tear.
4. Damage to major blood vessels at the front of the spine causing life-threatening haemorrhage is also extremely rare at one in 10,000 cases from historic data.
5. Recurrence:This occurs in approximately 5% of cases when further disc material at the same level tears away and herniates enough to compress the nerves. A set of exercises and stretches are given to all of our patients, which can help prevent this.
Alternative treatments:
As most people with sciatica will improve within a few weeks we normally advise treatments that our physiotherapists, osteopaths or chiropractors can offer in the first few weeks of symptoms. However this is determined following a thorough assessment with a spine surgeon to specifically look for any neurological deficits. Whilst a study demonstrated similar results with conservative management to surgery up to 2 years later, it is quite clear that surgery leads to a faster improvement of symptoms.
A recent study (The NERVES trial) showed similar results with a targeted injection to the spine (x-ray guided transforaminal epidural nerve block). Again a thorough assessment of you and review of the MRI scan by a spine surgeon is advised before considering this as an alternative.
Our Multi-Disciplinary Team approach to spine care:
At The Spine MDT, our multidisciplinary team, synergizing the expertise of spine surgeons and allied professionals, collectively navigates the treatment trajectory. Lumbar microdiscectomy emerges as a viable option when non-surgical interventions have been exhaustively explored and the patient's quality of life is egregiously compromised. Our driving force lies in meticulously tailoring treatment plans to ensure optimal outcomes while prioritizing minimal disruptions to your daily routine.
Lumbar microdiscectomy offers an effective solution for individuals with herniated discs. Our collaborative approach at The Spine MDT ensures personalized care and the least invasive treatment options for optimal, long-lasting results.
