Lumbar Microdiscectomy

A Microdiscectomy is a procedure done, under a surgical microscope, to remove a prolapsed disc fragment through a small incision in the back. Usually the entire disc is removed at that time to prevent further prolapse occurring.

The most common reason for this procedure is because you are suffering from Sciatica with or without leg numbness or weakness. If you are to have this surgery it usually means that the symptoms you are experiencing are significant and have not gone away with other therapies such as physiotherapy, rest, and anti-inflammatory medications. A Microdiscectomy is not usually performed for back pain alone as this generally does not improve with this type of procedure.

You will be admitted either the day before or the day of surgery, and you must be NPO from midnight the night before surgery. Generally you will be discharged about 3 days post-operatively and should at that time be able to perform most of your daily tasks such as showering and dressing.

In the operating room, you are given a general anaesthetic and then positioned face down on a special frame. A small incision is marked out with a special pen and the area is cleansed with antiseptic and you are covered with sterile drapes so that only the incision can be seen. A cut is made through the skin down to the spinous process. The muscle is moved out of the way from the field of view and held out of the way by a retractor. The level is checked with Xray. Using a special bone drill, the lamina and part of the facet joint may be removed to expose the dura and the compressed nerve. The nerve is then gently moved out of the way and the prolapse is removed. This gives more space to allow the removal of as much of the remaining disc as possible. From this approach it is difficult to remove all of the disc.

After this has been done, your doctor will make sure that all the bleeding has stopped and a small piece of fat is placed behind the nerve to act as a cushion. The layers are then all sewn back into their normal place and the skin is closed with a nylon removeable suture or with a dissolvable suture.

You will wake up in the recovery room and after about 1 hour you will be moved to your room. The nurses will be continually checking your vital signs and leg strength monitoring for any signs of complications. During the first night the nurse will wake you for these observations. You will be given injections for pain which will be discussed before surgery. Sometimes you will have difficulty urinating and will require a catheter. You will be encouraged to get up and walk a little. The next day the IV in your arm will be removed after your next walk adn then you will be given oral analgesia. You could go home on this day, or the next depending on your comfort level.

It is important after the surgery to walk as much as possible. Prolonged rest in bed can produce hip pain and blood clots in the legs. Sometmies a couple of days after the surgery the discomfort in the legs may return. This is caused by swelling and will usually settle down with NSAIDs. If you have removeable sutures they will be removed 7 to 10 days post-operatively.

On discharge you will be able to shower and dress. Post-operativly, if you experience any of the following you should notify your doctor immediately:

• Weakness in the legs
• Difficulty in urination
• Abdominal pain
• Increasing leg pain or numbness
• Fever
• Increasing back pain
• Swelling or infection in the incision

When you go home, you will be able to do most things. You should avoid any heavy lifting, twisting, or prolonged sitting. You will also not be able to drive for 3 to 6 weeks post-operatively. You will able to return to work in some cases between 4 to 6 weeks. It is very important to walk as much as is comfortable. The most common risk are:

• Infection which will be treated with antibiotics
• Damaging the nerves that are compressed
• Damage to the dural sac containing the nerves and producing a fluid leak. This will stop with bed rest.
• Post operative blood clot requiring drainage.
• Paraplegia with or without bladder/bowel function. (This is very rare)
• Clot in the legs. (This can travel to the lungs, although it is uncommon.)
• Complications not related directly to the procedure are:
  • Pneumonia
  • Heart Attack
  • Kidney/bladder infection