Microdiscectomy for Lumbar Disc Herniation
The microdiscectomy surgical procedure is a very common and safe procedure used to treat symptoms of sciatica due to a lumbar disc herniation, or disc prolapse. Microdiscectomy relieves the symptoms of sciatica in over 90% of patients. The procedure itself takes approximately one hour to perform. The expected time in hospital is one to two days.
For information about microdiscectomy, risks of surgery and other treatment options, watch Dr Oehme's Youtube videos below.
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The word Microdiscectomy stands for:
- Micro – meaning that the operating microscope is used. "Micro" also means “small.” With minimally invasive techniques this is a procedure performed through a very small or "micro" incision.
- Discectomy – meaning removal of the herniated intervertebral disc material. Most of the disc is left intact with only the part of the disc which has herniated and pressing on the nerve being removed.
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The microdiscectomy procedure is performed under general anaesthesia and is very well tolerated by most patients. A small incision, only 2 to 3 cm long, is made in the lower part of the back in the midline, at the level where the disc prolapse has occurred. The incision provides an excellent cosmetic result and is rarely noticed once the wound has healed.
X-ray is used to accurately localise the correct level. The most commonly affected levels are L4-5 and L5-S1, however, other levels of the lumbar spine may also be affected by disc herniations. Sometimes more than one level may need to be treated by performing a microdiscectomy at multiple levels. |
Image demonstrating removal of herniated disc material from an inflammed and compressed nerve.
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Using minimally invasive techniques, the lamina on the side of the disc prolapse is exposed by retracting the spinal muscle. The lamina is a ring of bone at the back of the spine that forms a protective roof over the nerves. A small window is made in the lamina, called a laminotomy, to expose the underlying ligament. This ligament is then removed to expose the compressed nerve root. It is the nerve root compression that causes the severe leg pain or sciatica. The goal of the surgery is to relieve this pressure on the nerve. For more information about spine anatomy see our spine and disc anatomy page.
Once the nerve is exposed, the nerve is gently retracted to expose the herniated disc. The part of the disc, which has prolapsed out and is pressing on the nerve, is then removed with the aid of microsurgical instruments. The removal of the pressure on the nerve improves leg pain symptoms almost immediately.
The amount of disc removed is variable in each patient. Usually only disc which has prolapsed is removed and the majority of the intervertebral disc is left intact. This reduces the chances of developing long term postoperative back pain. There is a 5 -10% chance of having a recurrent disc prolapse, or another disc herniation, as most of the disc is left intact.
Once the disc prolapse is removed and the nerve decompressed, the wound is closed with dissolvable sutures that do not need to be removed. Patient's are able to walk immediately postoperatively. Most patients' experience almost complete relief of their sciatica pain immediately after surgery. It is common to still have some residual numbness or tingling which slowly improves with time. Weakness in the legs or feets, which has been present for more than 24 hours, may not improve. Therefore, if you develop weakness it is important for the disc prolapse to be treated urgently.
The microdiscetomy procedure, although not designed to help with back pain, may give some relief of back pain symptoms once the inflamed nerve is decompressed, and patients can walk without pain.
For the most part, microdiscectomy surgery is very safe surgery, however, there are some small risks. For more information about the risks of microdiscectomy surgery please sees the information below in the risks of microdiscectomy section. For more information about the surgery itself watch the following video.
Once the nerve is exposed, the nerve is gently retracted to expose the herniated disc. The part of the disc, which has prolapsed out and is pressing on the nerve, is then removed with the aid of microsurgical instruments. The removal of the pressure on the nerve improves leg pain symptoms almost immediately.
The amount of disc removed is variable in each patient. Usually only disc which has prolapsed is removed and the majority of the intervertebral disc is left intact. This reduces the chances of developing long term postoperative back pain. There is a 5 -10% chance of having a recurrent disc prolapse, or another disc herniation, as most of the disc is left intact.
Once the disc prolapse is removed and the nerve decompressed, the wound is closed with dissolvable sutures that do not need to be removed. Patient's are able to walk immediately postoperatively. Most patients' experience almost complete relief of their sciatica pain immediately after surgery. It is common to still have some residual numbness or tingling which slowly improves with time. Weakness in the legs or feets, which has been present for more than 24 hours, may not improve. Therefore, if you develop weakness it is important for the disc prolapse to be treated urgently.
The microdiscetomy procedure, although not designed to help with back pain, may give some relief of back pain symptoms once the inflamed nerve is decompressed, and patients can walk without pain.
For the most part, microdiscectomy surgery is very safe surgery, however, there are some small risks. For more information about the risks of microdiscectomy surgery please sees the information below in the risks of microdiscectomy section. For more information about the surgery itself watch the following video.
Video - Microdiscectomy Surgery
It is important to remember most disc prolapses can be treated conservatively. Approximately 80% to 90% of disc prolapses will improve with time and not require surgery. For more information about non-oprerative treatment options see our sciatica and disc herniation page. Immediate indications for performing a microdiscectomy surgery include disc prolapses which cause:
1. Severe intractable pain not managed by with high doses of analgesia.
2. Weakness in the legs or feet – for example foot drop.
3. Cauda equina syndrome causing bowel and bladder disc function.
If none of the above symptoms are present, then it is acceptable to see if the sciatica pain settles over a period of approximately four to six weeks. An epidural or nerve root injection may also be helpful to try and settle the sciatica pain by reducing the inflammation in the nerve root.
If symptoms have worsened or not improved after six weeks of non-operative treatments then it is generally recommended to perform a microdiscectomy surgery.
Patients typically spend one to two days in hospital. Sometimes the surgery can be performed as a day case. Following surgery walking is encouraged. Rehabilitation is generally not needed. Patients are advised to take things relatively easily for the first four weeks after surgery. Although patient's can walk and lift objects up to 5 kilograms, heavy lifting or prolonged bending is generally avoided. Patients can drive after one to two weeks. Pain relief in the postoperative period is easily controlled with oral pain medications.
Once the wound has healed after, usually after 7 days, hydrotherapy can be commenced. Physiotherapy can be started after 3-4 weeks.
For recurrent disc prolapses, if it is only the first recurrence then it is advisable to perform a redo microdiscectomy surgery. Following multiple recurrent disc prolapses then often a lumbar spinal fusion surgery is indicated to prevent further disc prolapses occurring. Please see our spinal fusion surgery page for more information.
Dr Oehme will advise if microdiscectomy surgery is appropriate for your condition. For more information or to arrange a time to discuss surgery with Dr Oehme contact his rooms on [email protected] or 1800 DO SPINE (1800 367 746).
1. Severe intractable pain not managed by with high doses of analgesia.
2. Weakness in the legs or feet – for example foot drop.
3. Cauda equina syndrome causing bowel and bladder disc function.
If none of the above symptoms are present, then it is acceptable to see if the sciatica pain settles over a period of approximately four to six weeks. An epidural or nerve root injection may also be helpful to try and settle the sciatica pain by reducing the inflammation in the nerve root.
If symptoms have worsened or not improved after six weeks of non-operative treatments then it is generally recommended to perform a microdiscectomy surgery.
Patients typically spend one to two days in hospital. Sometimes the surgery can be performed as a day case. Following surgery walking is encouraged. Rehabilitation is generally not needed. Patients are advised to take things relatively easily for the first four weeks after surgery. Although patient's can walk and lift objects up to 5 kilograms, heavy lifting or prolonged bending is generally avoided. Patients can drive after one to two weeks. Pain relief in the postoperative period is easily controlled with oral pain medications.
Once the wound has healed after, usually after 7 days, hydrotherapy can be commenced. Physiotherapy can be started after 3-4 weeks.
For recurrent disc prolapses, if it is only the first recurrence then it is advisable to perform a redo microdiscectomy surgery. Following multiple recurrent disc prolapses then often a lumbar spinal fusion surgery is indicated to prevent further disc prolapses occurring. Please see our spinal fusion surgery page for more information.
Dr Oehme will advise if microdiscectomy surgery is appropriate for your condition. For more information or to arrange a time to discuss surgery with Dr Oehme contact his rooms on [email protected] or 1800 DO SPINE (1800 367 746).
Risks of Microdiscectomy
More than 90% of patients undergoing microdiscectomy for disc herniation have good-to-excellent outcomes. This operation is extremely effective at improving the symptoms of leg pain. Most microdiscectomy surgeries can be performed safely without any complications. However, like any surgical procedure there are risks associated with both the anaesthetic and the procedure itself.
Risks of Anaesthesia
Risks of anaesthesia will be discussed with you by your anaesthetist prior to surgery. It is important that you inform us of your correct age and any past medical problems, as this can influence the risk of anaesthesia. Risks include:
General Risks of Spine Surgery
Although spine surgery is generally safe, there are some risks whenever operations on the spine are performed. These include:
Specific Risks of Microdiscectomy
The specific risks will be discussed in detail prior to your surgery but may include:
Risks of Anaesthesia
Risks of anaesthesia will be discussed with you by your anaesthetist prior to surgery. It is important that you inform us of your correct age and any past medical problems, as this can influence the risk of anaesthesia. Risks include:
- Heart problems, such as heart attack (AMI) or arrhythmia
- Lung problems, such as infection (pneumonia) or blood clots
- Urinary tract infection
- Deep Venous Thrombosis (DVT)
- Eye or visual problems
- Pressure wounds
- Stroke
- Small risk of significant life-threatening event
General Risks of Spine Surgery
Although spine surgery is generally safe, there are some risks whenever operations on the spine are performed. These include:
- Infection 1-2%
- Bleeding. This can occur at the time of surgery and may necessitate a blood transfusion. It can also occur at some time after surgery. Rarely another operation is required to drain the bloodclot and stop the bleeding.
- Spine fluid leak (CSF leak)
- Small risk of significant neurological injury causing paralysis
- Chronic pain
Specific Risks of Microdiscectomy
The specific risks will be discussed in detail prior to your surgery but may include:
- Pain in the lower back
- Nerve injury causing pain, numbness, weakness in the legs
- Nerve injury causing bowel or bladder problems
- Progressive deformity of the lumbar spine - kyphosis or spondylolisthesis
- Requirement for fusion at later stage
- Persistant symptoms
- Recurrence of disc herniation. Usually, only the part of the disc that has prolapsed, or is loose, is removed during microdiscectomy surgery. There is a lot more disc which remains behind. It is possible for some of this remaining disc to also herniate at some stage in the future, which is termed recurrent disc prolapse. The reported rates of recurrent disc herniation range from 5 – 15%.
Post-Operative Care and Instructions
Postoperative Care Following Lumbar Microdiscectomy
The following information is provided to assist and maximise your recovery following microdiscectomy surgery.
If you have any questions or concerns not outlined below, please contact Dr Oehme’s rooms on 1800 367 746 (1800 DO SPINE), or [email protected], for further information.
The information provided below is general information for patients following microdiscectomy. Dr Oehme will explain any additional instructions which may be specific to you, or your operation, during your admission.
General Advise
Microdiscectomy is a procedure performed to alleviate symptoms from a herniated lumbar disc. It is usually performed to relieve symptoms such as sciatica (leg pain), pins and needles, numbness or weakness in the leg or foot.
How much pain relief you will receive, and how quickly it will occur after microdiscectomy surgery, is impossible to predict. Often patients will have immediate relief of their leg symptoms following the surgery. At other times, it may take weeks or months for symptoms to improve.
Some patients will have pain, numbness or weakness that does not completely improve and may be permanent. This is typically due to permanent nerve injury as a result of nerve compression from the disc herniation.
It is very common to have numbness and tingling in the leg and foot in the first few weeks after surgery. This slowly improves with time in most patients. If you have had no improvement in your leg pain symptoms following the surgery, it is important to relay this to Dr Oehme.
It is very common to have back pain following microdiscectomy surgery. This is incisional and muscular pain and should slowly improve as the wound and muscles heal Any long-term chronic back pain you have had is unlikely to improve following microdiscectomy.
One of the biggest risks with microdiscectomy surgery (5-10% of patients) is recurrent disc prolapse (more disc herniating at some point in the future). Although this is not completely avoidable, it is important that you take things quietly for the first four to six weeks after surgery to minimise the chance of having a recurrent disc prolapse.
During Your Hospital Stay
Most patients are in hospital for one to two days following microdiscectomy surgery, after which they are usually discharged home. It is recommended that a family member or friend drive you home from hospital. Most patients do not require inpatient rehabilitation following microdiscectomy.
To minimise the chances of infection you will typically have 24 hours of antibiotics following the operation.
Post-operative pain is generally well controlled with oral pain medications. It is important you ask for more pain relief if you feel your pain is not under control.
You will have stockings on your legs to prevent clots in the legs developing (DVT). You will also have calf compression devices fitted until you are mobile. Most patient also receive medication (Clexane) to prevent blood clots from forming.
Dr Oehme will review you during your hospital stay after your operation. You will then have a follow up appointment approximately four weeks after your discharge from hospital. A physician will also visit you to manage your pain and control any medical problems you may have.
Guidelines for Activities
Most patients can begin mobilising the day of surgery, or early the following day. Unless you are specifically told to remain in bed you can mobilise as soon as you have recovered from the anaesthetic.
The nurses and physiotherapists will help you sit out of bed. You can then progress to walking around the ward. It is important that you get up and walk around to prevent blood clots from developing in your legs and to maximise your recovery.
Walking: It is important that you start on a daily walking programme. Walking is the best exercise following surgery. Aim to be walking at least five times daily and slowly increase the distance you walk each day. Start with walking a small distance and slowly increase the distance each day. Patients who walk more have a much better recovery in the longer term.
Running: You should avoid running or jogging until Dr Oehme sees you at your post-op review and gives approval for more vigorous activities. Usually jogging can be commenced at six weeks following surgery.
Rest: Rest is also important to allow for healing. It is important that you rest, especially in the first two weeks following surgery. It is best to rest in a lying down position.
Sitting: It is best to limit your sitting. Typically, sitting should be restricted to one hour at a time to minimise the chance of recurrent disc prolapse. It is best to lie or stand, rather than sit, for long periods during the first four weeks after your surgery. It is important to have breaks if you are sitting for long periods of time. For example, if you are sitting at a desk you should aim to stand up and take a short walk once every hour.
Posture: Maintain a good posture. Stand up straight with your shoulders back. A sit-to-stand desk may be a good option for you if you are required to work at a computer or desk.
Lifting: No heavy lifting should be performed in the immediate post-operative period. You should not lift anything heavier than 5 kilograms for four weeks following surgery. At your four-week review Dr Oehme will usually increase the lifting limit.
Bending and Twisting: Minimise bending and twisting. Although you can bend and twist to perform necessary activities, such as putting your shoes and socks on, it is best not to perform any repetitive lifting, manual labour, or unnecessary bending and twisting.
Wound Care
Unless advised otherwise, your sutures will be dissolvable and will not need to be removed.
It is important that you keep your wound dry for one week following the surgery. You will be provided with waterproof dressings. You are able to shower with this dressing on. Tt will need to be replaced following a shower, or when it is dirtied or soiled.
It is important not to have any restrictive clothing which is tight around the wound, or which rubs on the wound.
Any increasing wound pain or swelling, or any evidence of redness, heat, discharge, fluid leakage, wound breakdown or signs of infection, should be urgently reported to Dr Oehme's rooms or your local doctor.
After seven days, you can get the wound wet. It is best not to scrub or rub the wound in the shower. After two weeks, you are able to swim and get the wound completely immersed in water.
Medications
You will be discharged home on your normal medications and also some additional pain medications. Typically, after one week when your back pain is starting to settle, you can start to wean off your pain medications. It is important not to stop all the pain medications at once as this can lead to a recurrence of pain.
Lyrica: If you are taking Lyrica it should be weaned off slowly and should not be ceased abruptly.
Anticoagulation (Blood thinners): Typically, blood thinning medication (Plavix, Warfarin, Pradaxa, Xarelto, others) can be re-commenced one week (7 days) following surgery. Dr Oehme will discuss this with you during your hospital stay.
If you have any side effects from your medications, you can contact Dr Oehme's rooms or the nurses at the hospital. It is important that you inform Dr Oehme's rooms about any allergies that you might have.
Sitting and Working at a Desk
Always try and maintain a good sitting posture. Sit in a straight back chair with armrests. Do not sit in a reclining chair for the first four to six weeks after the surgery. Do not sit for periods longer than one hour. It is best to lie or stand rather than sit for long periods during the first four weeks of your recovery. If you are working at a desk, keep your computer screen and the reading material at eye level. You should consider getting a sit to stand up desk.
Lifting
You should not lift anything heavier than 5 kilograms for the first four to six weeks after surgery. You should abide by safe lifting practices and keep the load close to your chest. If you do need to lift something heavy, bend you knees and keep your back straight and minimise twisting and lifting.
Driving
You can drive after one week following a microdiscectomy if you feel up to it. There is no legal restriction preventing you from driving. If you have weakness in the leg, this should be discussed with Dr Oehme and you should consider whether driving is appropriate for you. In addition, if you are still taking strong medications, such as narcotics, you should not drive.
Physiotherapy
Physiotherapy, or other allied health input, is usually not required for the first four to six weeks after surgery. Dr Oehme will discuss commencing physiotherapy at your postoperative review at four weeks.
You may have been given some gentle exercises by the physiotherapist in hospital that you are able to perform. Although you can do these gentle exercises, aggressive physiotherapy is not required for the first four to six weeks after surgery. It is best if you focus on a walking programme. Once Dr Oehme has seen at your postoperative review, he will give you clearance to pursue more aggressive physiotherapy or an outpatient rehabilitation programme.
Swimming and Hydrotherapy: Hydrotherapy and swimming can be commenced two weeks following the surgery as long as there have been no problems with wound healing.
Work:
Dr Oehme will discuss returning to work for you and this will depend on the job you perform. Typically, you will be off work for at least two weeks. If you perform a job involving manual labour or physical work, you may need to off work for up to four to six weeks.
Sports
Contact or competitive sports should not be played for three months following a microdiscectomy. Dr Oehme will discuss in detail about returning to sports at your four-week review.
Cleaning
Avoid vigorous cleaning and vacuuming until after your four-week review with Dr Oehme. Gardening or lawn mowing should also not be performed. Other jobs that require heavy lifting, or repetitive bending or twisting, should not be performed.
Bracing
You are not required to wear a brace following microdiscectomy surgery and Dr Oehme does not usually advise this.
Smoking, Alcohol and Illicit Drugs
Smoking, and excessive alcohol, will impede your recovery. If you smoke you will have a greater risk of poor wound healing, infection, complications in general, pneumonia, blood clots in the legs or lungs, all of which may necessitate further surgery.
Other Medical Symptoms
If you develop any of the following symptoms you should contact Dr Oehme’s rooms or your GP immediately:
- Temperature
- Increasing leg pain, numbness or leg weakness
- Urinary or faecal incontinence
- Wound infection or breakdown
- Leg swelling
- Cough or shortness of breath
- Feeling generally unwell
If you develop chest pain, palpitations, extreme SOB or collapse, you should call “000” or present to the emergency department of your local hospital for assessment.
Follow Up
Unless there are any problems or you are advised otherwise, you will have a follow up appointment approximately four weeks following your surgery. This is generally the only appointment that is required following successful microdiscectomy surgery.
You should visit your GP one week following the surgery so that they can check your wound and write prescriptions for any pain medications you may need. If your GP has any concerns they can contact Dr Oehme directly.
Final Note
Please contact Dr Oehme's rooms on 1800 367 746 or [email protected] if you have any further questions.