A microdiscectomy is 85% – 95% successful in relieving pain down the leg(s).  Pain relief is typically quite rapid, although in specific instances, it may take six to eight weeks for the nerve to calm down. 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.

 

It is important to realize that a microdiscectomy is quite effective in relieving pain in the buttock(s) or leg(s); however, it is not particularly effective in relieving back pain.  Back pain is usually from the structures of the spine itself such as degenerative discs, arthritic facet joints, and muscle strains/spasms. Back pain is typically best treated with aggressive physical therapy. The primary reason to proceed with surgery is to relieve pain, numbness, and/or weakness in the buttock(s) or leg(s) sooner than would be accomplished without surgery.

Surgery is intended only to remove pressure from a pinched nerve.  When a disc ruptures, a hole is created in the outer ring.  This hole will typically heal with scar tissue.  The risk of re-herniation is 5-10%. However, not all patients will require revision surgery.

During surgery, you are carefully positioned on a padded frame in a flexed posture which allows the space between your vertebrae to be opened as widely as possible.  A small one-half inch incision is made on your back over the operative disc.  A guidewire is inserted through this incision and onto your spine. A series of dilators are placed over this guidewire so as to spread the muscle tissue rather than cut it. Once the largest dilator has been placed, a one inch diameter tube is inserted over the last dilator. The guidewire and dilators are then removed and the tube is attached to a clamp to secure it in place. Surgery is performed through this tube with the assistance of a microscope. A small amount of bone is trimmed from the lamina to create a space between the two vertebrae.  Since only a small amount of bone is removed, no instability results from this. A ligament (ligamentum flavum) between the vertebrae is removed in order to gain access to the disc. This ligament can be removed with no deleterious consequences. Utilizing a microscope, the nerve is visualized and then retracted towards the middle of the spine.  Any loose disc fragments are then removed taking any pressure off of your nerve(s).

Prior to surgery, the nurses and doctors at the surgery center will ask you questions regarding your medical history.  Please bring a list of medications that you are currently taking. You will wait in the holding area of the operating room for about 30 minutes prior to surgery.  This is where you will meet your anesthesiologist (doctor who will put you to sleep and monitor you during the procedure) and have your IV placed.

 

After surgery you will wake up in the recovery room where you will remain for about one hour. After surgery many patients will have significantly less leg pain, however, your back will be quite sore. Sometimes it can take 1-2 weeks for some patients to have significant relief of their leg symptoms if they had more severe nerve compression prior to surgery. Even though the size of the incision is small (~1/2 inch), pain should be expected as your muscles were slightly stretched for the procedure.  Appropriate medications are provided to reduce your pain. On most occasions this procedure is performed as an outpatient procedure.

 

We have found that there is a lower incidence of complications if you mobilize early. If you are discharged to home following your procedure, a period of light activity is recommended.  Extensive travel, frequent lifting, and repetitive bending are to be avoided until your pain subsides in 1-2 weeks.

 

Due to the combination of anesthesia and pain medication, you may feel nauseated and have difficulty urinating immediately after surgery.  Some patients require a catheter in their bladder to enable them to urinate. You may go home once your pain can be controlled on pills.

We generally advise people to take it easy for the first couple of days.  You will be able to take care of yourself, go up and down stairs, and move around based on your own comfort level.  For the first six weeks you should not put any unnecessary stress on your back. During the first few weeks following discharge, we encourage you to begin walking as tolerated.  You should walk slowly enough so pain does not flare up in your leg(s). The nerve is generally quite sensitive after surgery and intermittent leg pain similar to your pre-surgical pain is not uncommon. The pain should calm down quickly if you decrease your activity level.

 

At the six week mark, you may be enrolled in a structured physical therapy program to include core strengthening and neutral spine exercises. You will also be allowed to begin low impact aerobic activities (e.g., elliptical training, recumbent bicycling, swimming, etc…) at this time point. Three months after surgery, you can begin higher impact aerobic activities such as running, jumping, and non-contact sports. Six months after surgery, you will be free to participate in any physical activity (including contact sports and activities) without restriction.

Each situation is unique and should be discussed with your physician prior to surgery. In general, most patients return to work about one to two weeks after a microdiscectomy.

During the first four to six weeks after surgery the nerve tends to be very sensitive.  We do not recommend physical therapy in the beginning of your recovery cycle because it may cause the nerve root to flare up. Repetitive bending, twisting, and sitting are the most common causes of a disc re-herniation.  Therefore, we believe in preventing future problems by teaching you how to properly care for your back.  A back education program includes developing proper posture and body mechanics, a strengthening and stretching program, and an aerobic exercise program.  You should be aware that a long-term rehabilitation program is an important part of your overall recovery process.  Each physician will prescribe a rehabilitation program based on your specific needs.

Most people with disc herniations do not require surgery since over 90% of disc herniations resorb on their own. The most common reason to have surgery is to alleviate pain, which has not resolved within a reasonable time period (6-8 weeks). Many people would like to be more active than their pain allows and this often persuades them to have surgery. However, if your pain is tolerable, we do not recommend you proceed with surgery. We also feel that mild numbness/tingling, or the loss of a reflex is not sufficient to indicate surgery. If the weakness is profound or progressive, surgery is most likely indicated. We recommend you have surgery if your symptoms are disruptive to your quality of life and there is a specific anatomic lesion that can be corrected. However, if your symptoms are tolerable or we cannot find a specific structural problem causing your pain, surgery is not a good idea.  It is our role to define whether or not there is a structural lesion that can be corrected. However, only you can determine if the pain and discomfort you are experiencing is worth the risk of surgery.