Personal Story
Just recently I was given minimally invasive back surgery. The type of surgery I was given was a microdiscectomy at the L5-S1. Instead of a traditional discectomy where the entire disc is removed, only fragments of my disc were removed.
Studies have shown that a microdiscectomy allows for faster recovery times and less complications during surgery. In fact, after my surgery I immediately felt less sciatic pain.
Introduction
The purpose of a microdiscectomy is to remove the piece of the herniated disc that is pushing upon the sciatic nerve. The goal is that sciatic pain will be greatly relieved and have time to recover because it is no longer being pinched by the herniated disc material.
Leg pain, known as radiculopathy, is better treated with a microdiscectomy then actual lower back pain. Microdiscectomy’s therefore are more common for the lumbar spine; especially the L5-S1 which is the most common herniated disc.
The majority of patients, such as myself, have felt immediate pain relief after having a microdiscectomy. Sciatic pain for me is nearly nonexistent and I only have a very slight pain in the right side of my foot. However, this is normal because it takes time for the nerve root to heal fully. It could take up to a full 18 months to be fully recovered.
Microdiscectomy Procedure
The entire surgery is processed through a very small cut in the mid-line of the lower back. The size of the incision is usually between 1 to 1/2 inches. A nurse will shave your back before the surgery.
Luckily, our back muscles are built vertically across the back so muscle doesn’t need to be cut. The surgeon simply will simply move the muscles of the erector spine off to the side when performing the surgery.
By doing this, the surgeon has easier access to the spine. The ligamentum flavum, a membrane over the nerve roots, is then removed. The surgeon can now use a microscope or operating glasses to better visualize the nerve root.
A tiny part of the inner facet joint is displaced to allow entry to the nerve root and to relieve pressure on the root.
The nerve root is then gently moved to the side and the disc material is removed from under the nerve root.
One of the added benefits of a minimally invasive back surgery is the fact that since all the muscles, joints, and ligaments are left intact, the mechanical structure of a patients back is not changed. In my case, my upper body was a little crooked after surgery but went back to normal in a few days. I take it this was caused by weakness in one part of my lower back.
Who should get a Microdiscectomy
Generally, conservative treatments such as ice/heat, physical therapy, cortisone shots, are all done first to see if this helps the patient recover. Usually a herniated disc will heal on its own in six to twelve weeks. And if pain is tolerable surgery is also postponed to give the patient more time in conservative treatments.
Microdiscectomy’s are never a surgery to rush into unless the patient is having a loss of bladder control which is a great indicator of Cauda Equina Syndrome which is a medical emergency. If sciatic pain and leg pain do not get better with conservative treatments then minimally invasive back procedures should be looked into by the patient by a medical profession such as a neurosurgeon.
Some indicators for those who are considering this surgery are those who have:
- Suffered sciatic pain for at least six weeks
- Conservative treatments have failed to relieve pain
Unfortunately, delaying surgery could be harmful. After roughly three to six months the results of spine surgery tend to decline because the nerve has been compressed for a prolonged time. So its generally advisable to make haste and decide on the surgery quickly.
Normally for minimally invasive back surgeries, an overnight stay in the hospital is not required. Its usually performed on a outpatient basis with the worst case being a one day overnight stay. When I had my microdiscectomy, I was able to walk an hour after the surgery and leave. Though sitting is not to comfortable. The ride on the way home was painful.
Doctors such as the one I had for my surgery recommend the patient to not do any kind of lifting, twisting, or bending for the first couple of weeks after surgery. I was given four weeks off of work to allow for this. However, it can also be argued that since the patients back didn’t mechanically change then there should be no reason for this and an active lifestyle can be returned to rather quickly. My advice is to go by your gut feeling and return to your active lifestyle when you’re ready.
A few reports by medical sources have shown that there isn’t any real increase in recurrent lumbar herniated discs if you decide to not stay completely immobile.
Success rates for a Microdiscectomy
The success rate for microdiscectomy spine surgery is approximately 90% to 95%, although 5% to 10% of patients will develop a recurrent disc herniation at some point in the future.
Microdiscectomy’s have a really awesome success rate. 90% to 95% have no complications and immediate pain relief. However, the other 5% to 10% have permanent nerve damage and/or will develop a future herniated disc. This is caused by a fragment not being taken out. Or a spinal fusion will eventually have to be done for those individuals.
The majority of recurrent herniated discs happen within the first three months following surgery. If this does happen, then another microdiscectomy will be performed and it should be just as successful as the first one. However, this makes the patient more prone to these recurrent issues in the future. The chances rise to to 15% to 20% instead of the original 5% to 10%.
For those who are not relieved by a microdiscectomy, then there are other options to help these patients. A artificial disc replacement and a spinal fusion are viable options. These are usually only recommended to patients who have multiple herniated disc repetitions. A spinal fusion is then used to prevent these from happening again.
One of the disadvantages of a microdiscectomy is that only about 5% to 7% of the disc can be seen. So recurrent herniated discs have nothing to do with a patient returning to a active lifestyle more quickly. It has more to do with the fact that not all of the fragments were able to be removed. These fragments usually come out at a later date and surprise those who have had this surgery before. Remember, that the cartilage of your disc is still open since you had a herniated disc. Usually scar tissue will attempt to form over this.
This is because the hole that is left after a herniated disc does not receive a blood supply. Without this blood supply then a clot cannot form. The area never heals or scars over. And as far as the medical community is concerned, there is no real way to repair the outer portion of the disc (called the annulus).
Post-operative care for a microdiscectomy is important. A physical therapists should be able to help you out with a regimen of stretching, strengthening, and aerobic conditioning. This will help bring the lower back and legs back to there full strength before the patient was injured. This will also help prevent future recurrences of herniated discs.
Risks and Complications For a Microdiscectomy
Minimally invasive back surgery’s are not immune to complications and risks like any other surgeries. Here a list of common complications that could occur:
- There is a small chance (1% to 2%) of a dural tear. This is also known as cerebrospinal fluid leak. This fortunately doesn’t change the results of the surgery, however it keeps the patient immobile for one to two days while the back has time to let the leak seal up and stop leaking.
- Damage to the nerve root.
- Bladder and bowel control issues.
- Infection could occur.
Remember, complications for these surgeries are quite rare and when they do occur there isn’t too much of a problem for the doctor to correct the issue.
Conclusion
A minimally invasive back surgery is highly recommended because of a higher success rate compared to traditional discectomy’s, less chances of complications, and faster recovery times. I can personally attest to the success of a microdiscectomy because I am nearly fully recovered having been given one on September 30th of 2011. Check my blog towards recovery to keep up to date with my post-surgery.
