Microdiscetomy & Microdecompression
When a nerve root is compressed in the back, such as when you have a herniated lumbar disc, you can experience substantial leg pain. In some cases, this pain will subside as the nerve root heals. In other instances, surgery may be required to provide long lasting relief from the pain. This surgery is known as a microdiscectomy or microdecompression. It is most effective in cases of a herniated lumbar disc.
Who is a candidate for a microdiscectomy?
A compressed nerve root due to a disc herniation is not uncommon. In many cases, it will heal on its own in 6 to 12 weeks. As long as the pain isn’t debilitating, surgery is not recommended or required.
If the situation doesn’t get better after 12 weeks, your doctor will usually recommend non-surgical interventions to see if these will correct the problem. If they don’t, then surgery may be the best option.
If there is bowel/bladder incontinence or progressive neurological issues, immediate surgery may be necessary.
What is the procedure like?
In a microdiscectomy a small portion of the bone that covers the nerve root is removed. This gives the nerve root additional space to heal and relieves any pressure or compression on the root.
To conduct the microdiscectomy, your surgeon will make a small incision (about 1 to 1 ½ inches long) in the middle of the lower back. The back muscles are then moved out of the way so the bony arch of the spine (the lamina) can be accessed. Once a small membrane that covers the nerve root is removed, the surgeon takes out a small part of the inside facet joint. This provides greater access to the nerve root itself and relieves pressure on the nerve. The nerve is then lifted aside and the disc material creating the compression is removed.
Because the procedure does not affect any of the muscles, joints or ligaments, the structure of the lower spine is unaffected.
In about 6 to 12 weeks, the pain should be less intense. As long as the pain is tolerable, additional surgery is not required or usually recommended.
What can I expect after surgery?
Depending on your case, your surgeon may recommend that you not do a lot of bending, twisting of lifting for up to six weeks after your surgery. Your function should be improved immediately, but your body still needs time to heal from the surgery.
The success rate is between 90% and 95%. The other percentage of patients may experience a recurrence of the disc herniation at some point in the future. If it is going to reoccur, it typically does so in the first three months following surgery. A follow-up procedure known as a revision microdiscectomy may correct the problem, but the chances of recurrence increases to 15% to 20%.
What are the risks of a microdiscectomy?
As with any other type of spine surgery, there are some risks and complications that can occur. These include:
- A dural tear where the cerebrospinal fluid leaks. To correct this your doctor may recommend bed rest for a day or two to allow the leak to seal on its own.
- Bowel/bladder incontinence
- Damage to the nerve root
These complications are rare with a microdiscectomy.
Your doctor at the Celebration Health Spine Center will be happy to go over your options for addressing nerve root compression and answer your questions regarding courses of treatment.