Lumbar Discectomy

What is Lumbar Microdiscectomy?

Lumbar microdiscectomy is a surgical procedure that is used to treat a herniated or slipped disc in the lower back. The procedure involves the removal of a small portion of the affected disc, which puts pressure on the nerves in the spinal cord and causes pain, numbness, or weakness in the lower back, buttocks, legs, or feet.

Why is it done?

It is done for lumbar disc prolapse.
Spinal discs act as cushions between the vertebrae of the spine, enabling flexibility and movement of the spine.
Lumbar disc prolapse is when a spinal disc's inner soft gel-like material protrudes through a tear in its outer layer. This condition is also referred to as a slipped disc or herniated disc.

Disc prolapse can exert pressure on nerves or the spinal cord located in the vicinity, resulting in discomfort, tingling, and/or reduced strength in the back, buttocks, legs, or feet. The severity of the symptoms varies depending on the prolapse's size and location, ranging from moderate to severe.

Surgery is not necessary for most individuals with lumbar disc prolapse, as many people tend to recover naturally within 6-12 weeks. In some cases, image-guided steroid injections can help reduce disc swelling and nerve compression. About 6 out of 10 patients improve spontaneously after six weeks, and 7-8 out of 10 patients feel better within three months. Generally, most people with leg symptoms will eventually recover. Surgery is usually only considered if the pain is severe and has not responded to strong pain relief, except in cases with signs of nerve damage.

It is important to strike a balance between waiting for natural recovery and waiting too long, which may prolong suffering, pain, or compromise nerve function, such as weakness, numbness, or painful recovery. In rare cases, compression of the nerves controlling the bladder, bowel, and sexual function, known as cauda equina syndrome (CES), may require immediate surgical intervention. Fortunately, immediate spinal surgery is only necessary in a few cases.

What happens during the procedure?

Before the procedure, the patient will typically undergo a thorough evaluation by the surgeon to determine the underlying cause of their pain and whether a lumbar discectomy is an appropriate treatment option. This will also include an anaesthetic assessment for fitness for surgery.

The surgery is usually performed under general anaesthesia, and the patient lies face down on the operating table.

The surgeon makes a small incision, typically less than one inch, in the lower back over the affected disc's area.

The surgeon then uses a microscope/ surgical loupes and specialized instruments to remove the portion of the disc that is compressing the spinal nerves. Magnification has its advantages like enhanced visualisation, improved precision, reduced trauma, and quicker recovery (reduced trauma and small incisions)

The procedure typically takes 1-2 hours, depending on the extent of the herniation and the case's complexity.

Lumbar microdiscectomy is generally considered a safe and effective procedure.

Typically, approximately 85-90% of patients experience good relief from leg pain after disc surgery, which may take several weeks to take effect.

Spinal surgery is not a complete solution and cannot prevent further degeneration of the disc. Its goal is to significantly relieve leg symptoms and improve the patient's condition. However, in some cases, numbness or weakness may persist even after a technically successful operation. It should be noted that the surgery is not aimed at relieving back pain, and its success rate in this regard is less reliable.

What happens after the procedure?

After the procedure, the patient is taken to a recovery room, where they are monitored briefly before discharge. Patients can usually return home on the same day or the day after the surgery.

If necessary, physical therapy is typically initiated after the surgery to enhance the patient's strength and flexibility.

What are the potential side effects of the procedure?

As with any form of surgery, there are risks associated with it. These are nerve root damage, dural tear, recurrence, bleeding, infection, and ongoing pain.
These risks and benefits will be discussed in detail during the consent process.

What are the benefits of microdiscectomy?

  • Low complication rate
  • Quick recovery
  • Small incision
  • Reduced muscle and soft tissue trauma

Please follow the BASS (British Association of Spinal Surgeons) website for more information.

Learn about spinal conditions addressed by Lumbar Discectomy:

Lumbar Disc Prolapse: Understand the mechanism and consequences of a prolapsed disc in the lumbar region.