Lumbar Disc Microsurgery
A lumbar disc microsurgery is a small surgery performed using a microscope, used to remove a piece of a herniated disc that is pushing on a nerve root and causing hip or leg pain. Only the herniated piece of the disc is removed and the remainder of the disc is preserved.
There are some extreme circumstances, such as loss of bowel and bladder function, when immediate surgery is necessary. However, most disc ruptures resolve gradually without surgical intervention. The most common reason to have surgery is to alleviate pain that has not resolved within several months. Many people would like to be more active than their pain allows and this usually persuades them to have surgery.
If your pain is mild or moderately tolerable we do not recommend you proceed with surgery. We also feel that numbness, tingling, or the loss of a reflex is not sufficient to indicate surgery is absolutely necessary.
Muscle weakness, especially if worsening, is a good reason to consider operative intervention.
Microdiscectomy is quite effective in relieving pain in the buttocks area or pain that travels down the leg. However, it is less effective in relieving back pain.
After general anesthesia, patients are carefully placed on a frame and secured in a prone position. X-ray imaging is used to localize the proper level for surgery and an approximately one-inch incision is made over the disc. The muscles on one side of the spine are pushed to the side and a microscope is brought in to help remove soft tissue above the nerve. The nerve and disc are identified and then the herniated portion of the disc is removed.
The most common complication is the re-herniation of the disc. There is about a 10% chance of disc re-herniation, with or without surgery, in the first five years after discectomy. The chances are highest in the first two months after surgery. Spinal fluid leaks occur in about 1-2% of patients who have never had prior surgery and up to 10% of patients who have had prior surgery. Spinal fluid leaks can be repaired but can require hospitalization and bed rest to allow time to heal.
Nerve injury resulting in weakness in part of the leg or foot occurs in less than 0.5% of cases. Infection occurs in about 1% of cases. Wrong-level surgery can occur but chances of this are minimized by the use of live x-ray during the surgery to locate the proper disc.
A lumbar disc microsurgery is about 90% successful in relieving pain in the buttocks and leg. Pain relief is typically quite rapid, although init may take six to eight weeks for the nerve to calm down in specific instances. If a nerve has been pinched for a long time, the success rate is rarely 100% as there is usually some residual mild tingling, weakness, or pain, all of which are fairly tolerable.
Our overall advice for this type of surgery is the same for any other spine surgery, which is to live with the pain you are experiencing if you can. This operation may be right for you if the pain or weakness is making life very uncomfortable and is not improving.