|
Microdiscectomy surgical procedure
A microdiscectomy is performed through a small (1 inch to 1 1/2 inch)
incision in the midline of the back.
-
First, the back muscles (erector spinae) are lifted off
the bony arch (lamina) of the spine. Since these back
muscles run vertically, they can be moved out of the way
rather than cut.
-
The surgeon is then able to enter the spine by
removing a membrane over the nerve roots (ligamentum
flavum), and uses either operating glasses or an operating
microscope to visualize the nerve root.
-
Often, a small portion of the
inside facet joint is removed both to facilitate access to
the nerve root and to
relieve pressure over the nerve.
-
The nerve root is then
moved to the side and the disc material is removed from under
the nerve root.
Microdiscectomy risks and complications
As with any form of spine
surgery, there are several risks and complications that are associated
with a microdiscectomy procedure. Complications are quite rare
in this procedure, but possibilities include:
-
Dural tear (cerebrospinal fluid leak). This occurs in
1% to 2% of these surgeries. It does not change the
results of surgery, but post-operatively the patient
may be asked to lay recumbent for one to two days to allow
the leak to seal.
-
Nerve root damage (1in 1,000)
-
Bowel/bladder incontinence (extremely rare)
-
Infection (1%)
-
Recurrent disc herniations (5-10%)
Postoperative Care
Follow-up care for a microdiscectomy usually includes
a combination of the following:
-
Pain management. Immediate
post-operative pain can be managed with a combination of
non-steroidal anti-inflammatory drugs (ibuprofen such as Advil,
Nuprin, or Motrin; or naproxen such as Naprosyn or Aleve)
and a mild pain pill such as Darvocet or Vicodin.
As the discomfort subsides (usually about 1 to 2 weeks) the
patient can move toward substituting Tylenol
for the narcotic pain medications. Ice may also be applied to
the back to decrease pain within the first
48 hours after surgery.
-
Stretching program. Most surgeons feel that to minimize
tethering of the nerve root by scar tissue, gentle
stretching exercises should be done in the
early postoperative period. Scar tissue in and of itself is not
painful, but if it tethers the nerve root short
as the patient heals this can result in chronic pain. The stretching
should be done about 5 to 6 times a day for 6 to 12 weeks, since
this is the time period in which the scarring occurs. It is generally
advisable to do the stretching exercises frequently and gently.
Stretching too hard may result in pain, and one should only take
the stretch to the point of pain to avoid inflaming the nerve.
If a patient feels too much pain after surgery to do any stretching,
it would be wise to wait until he or she is more
comfortable.
-
Back strengthening exercises. After the soft tissue has
healed (usually 2 to 3 weeks after surgery), it is
important to start back strengthening exercises.There
are a wide variety of possible exercises to achieve the desired
results, and it is important to choose exercises that are safe
and well tolerated so that they will be done on a regular basis.
About 15 minutes of appropriate stretching and strengthening
exercises per day is advisable for the first one to three months.
-
Early return to activity. Early mobilization may help
patients heal sooner, as the pre-operative pain has
usually caused patients to limit their motion,
and limited motion is a common cause of pain. Walking is very
gentle on the back, and a postoperative walking
program with a goal of walking about 3 miles a day is
advisable. Return to work is based on how quickly
the patient feels better and on what type of work the
patient does.
|
