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Microscopic Lumbar Discectomy

The spine has three major components. Nerve roots and the spinal cord transmit information and command throughout the body. Surrounding them are the vertebrae, bones that encase and protect the nerves. Because these are arranged as a column of smaller bones, rather than as one long bone, the spine can move, bend, twist, and straighten. For this to work, though, there has to be some way to make sure bones don't grind against each other. Between each pair of vertebrae are the vertebral discs, which are made of softer tissue and act as cushions.

The section of the spine above the tailbone and below the ribs is called the lumbar spine. Sometimes, a lumbar disc will slip from its place in between two vertebrae, and when the disc presses against a nerve root, it causes pain, weakness, and numbness or tingling feelings. When a lumbar disc slips and the nerve pressure causes these symptoms in the legs, it is called sciatica.

One way to deal with this is to remove the portion of the disc that has bulged from in between the vertebrae. This is called a discectomy (“-ectomy” means "removal").

First, you are placed under general anesthesia. This means you're unconscious and won't feel or be aware of what's going on.

You will be lying face-down so the surgeon can operate from your back side.

The surgeon will make an incision in your lower back to access the disc that will have the tissue removed.

"Microscopic discectomy" means the surgeon will perform the operation using a tiny scope rather than open the surgery site and look at it directly.

Because the scope only needs a small incision, the surgical wound is much smaller.

With the scope connected to a monitor, the surgeon will use slim surgical instruments to cut away the portion of the disc that is protruding.

This relieves pressure on the nerves that are affected, and symptoms should go away relatively promptly.

Most patients see some benefit after lumbar discectomy. According to a study, up to three-quarters of patients said they experienced significant improvement in sciatica-related leg pain after surgery, with another 20–25 percent saying they experienced some improvement.

Only 5 percent said that they had no improvement, and only 1 percent said their symptoms were worse. When your back and leg pain get better, your quality of life improves in several ways:

• You can move around better, meaning you can do things you enjoy but haven't been able to participate in for a while
• You'll be more comfortable day to day
• You may be more effective at work
• When you have less pain, you're less distracted, you sleep better, etc.

Typically, patients report increased satisfaction, comfort, and quality of life due to decreased symptoms after surgery.

Recovery from microscopic lumbar discectomy is relatively quick. You will be encouraged to get up and walk around as soon as you're no longer numb. You'll probably spend a night in the hospital and go home the next day. Most patients return to work within two to eight weeks, depending on how physically demanding their jobs are (office workers generally return sooner than people who perform physical labor). Follow-up visits and physical therapy might be required.

In any surgery, there are risks, including bleeding, infection, and lack of results. With spine surgery, there is also the rare chance of nerve damage, as well as the chance that symptoms may come back in the future.

This is a case of a 34-year-old female with progressive low back and right leg pain and weakness. The pain radiated into her right buttock, the back of her thigh, and her calf, and onward towards her heel and the outside part of her right foot. She also noted weakness on her right side in the push-off phase of walking. She had an MRI that demonstrated an eccentric to the right disc herniation at L5-S1 (Figure 1). Figure 2 demonstrates her normal L4-5 disc level. She had failed non-surgical management in the form of medications, injections, and physical therapy. She ultimately underwent an MLD on the right at L5-S1 with immediate relief of her right leg pain. Figure 3 displays the small surgical incision.

Magnetic Resonance Image L5-S1
MRI image through L5-S1 demonstrating
right paracentral disc herniation.

Magnetic Resonance Image L4-5
MRI image through L4-5 demonstrating a normal disc.

Image of Surgical Incision
Surgical incision of 2 cm in length.