Anterior Cervical Discectomy & Fusion :: Posterior Cervical Laminectomy :: Lumbar Laminectomy :: Lumbar Microdiscectomy :: Lumbar Decompression & Fusion :: Fusion for Scoliosis :: Pedicle Subtraction Osteotomy
If a lumbar microdiscectomy has been recommended for you, you have a herniated disc in your low back that is causing significant leg pain or numbness that has failed to improve with nonsurgical treatment. The goal of this surgery is to free up the nerve that is being pinched by the herniated disc. Surgery is very successful in improving or relieving symptoms in the buttocks, thigh, calf and foot. However, this surgery may or may not improve back pain.
Surgery is recommended if your symptoms continue despite conservative treatment such as restricting activities, medications, physical therapy and epidural steroid injections. You may need surgery sooner if you have excruciating pain or develop severe weakness in your legs or lose control of your bowels or bladder.
Details Of Surgery
Lumbar microdiscetomy is an outpatient procedure. The skin incision is approximately 1 inch in length. A small amount of bone is removed to gain access to the nerve and the disc. When the nerve is identified in surgery, it is gently moved out of the way to expose the underlying disc herniation. The herniated part of the disc is then removed with instruments to free up the nerve. Any loose disc fragments are also removed but the majority of the disc is left intact. Approximately 10-20% of the disc is removed during surgery.
Preparing For Surgery
- About 2-4 weeks prior to your surgery, you should see your primary care physician for a complete medical examination and for “medical clearance”. Your doctor may order tests prior to your surgery to evaluate your risk of being put under general anesthesia.
- If you take the following medications, stop taking them for 1 week prior to surgery:
- Aspirin, anti-inflammatory drugs (Ibuprofen, Advil, Motrin, Aleve, Naprosyn, Celebrex, Mobic, Arthrotec, Voltaren, etc.), Vitamin E and Glucosamine, all prescription diet medications or herbal supplements
- If you take Plavix, Persantine, Ticlid, stop these medications 1 week prior to surgery but be certain to notify your primary care physician or cardiologist before you stop taking these medications.
- If you take Coumadin for any reason, you should stop taking Coumadin 5 days prior to surgery, but be certain to notify your primary care physician or cardiologist before your stop taking this medication to ensure it is safe for your situation.
- YOU SHOULD CONTINUE all other medications that you normally take.
- Please let me and the anesthesiologist know about alcohol use. If you drink more than 2 alcoholic beverages a day, you may experience withdrawal symptoms after surgery. Symptoms may include mild shakiness, sweating, hallucinations and other more serious life-threatening side effects. Interventions can be taken before surgery to minimize withdrawal symptoms.
- Do not eat or drink anything (including water) after midnight the night before your surgery.
- You should make plans to have some assistance at home after your surgery. The level of assistance you need depends on the extent of the surgery, your age, and general health.
A lumbar microdiscectomy is generally a very safe and effective surgery for relief of leg pain. Many precautions are taken to prevent or minimize risks but because human biology is at times unpredictable, no surgery is risk free. Risk of infection is around 1%. Risk of nerve injury is extremely rare, well less than 1%. Other potential complications include dural tear and blood clots in the legs.
The main risk of this surgery is not one that occurs during surgery but long-term. Risk of recurrent herniation is about 7-10%. This means that at some point in the future, there is a less than 1 in 10 chance of having another disc herniation at the same level that is being operated on. Recurrent herniation can occur at anytime, during the first few weeks after surgery or several years after surgery. The reason the disc can herniated again is because during a microdiscectomy, most of the disc is left intact. Only the herniated part is removed. If the entire disc was removed, of course there would be no more disc to herniated again. So why don’t surgeons remove all of the disc? Because every patient would then develop bone-on-bone arthritis without any cushioning between the vertebrae. This does not make sense as most patients (>90%) who have a microdiscectomy do very well long-term.
If you have had previous microdiscectomy done, and have now developed another heniation at the same level, risk of dural tear is higher than the first surgery. This is because scarring around the nerves makes it difficult to move them out of the way, and the possibility of spinal fluid leak is higher for this reason. If there is a dural tear, it is repaired with sutures and you will be kept flat in bed for 24-48 hours to allow the tear to heal.
On the day of surgery, I will see you before you go back to the operating room to answer any additional questions you may have. You will then be taken back to the operating room where the anesthesiologist will give you either a general or spinal anesthestic. The surgery itself usually takes less than 1 hour, but the preparation time (positioning, anesthesia) may add another 30-60 minutes to the surgery.
After the surgery, you will be taken to the recovery room where your blood pressure, temperature, pulse and respiration will be checked frequently. You will stay in the recovery room for one to three hours. Meanwhile, I will speak with your family or friends in the waiting room regarding your condition. You will then be transferred to a regular hospital room. You will be given IV fluids until you are able to drink on your own. You will also be given IV pain medication initially, and then oral pain medication depending on your level of pain.
Although the nerve has been freed, it is still injured. The pain, numbness, or tingling in your leg usually begins to improve shortly after the surgery. In some cases, it may take longer (several days to a couple of weeks) before an improvement is noticed. Nerves heal very slowly and it depends on how long the nerve has been pinched and how much damage there is to it. Every patient experiences this healing process differently.
You will be discharged from the hospital when the following goals have been met:
- Your pain is reasonably controlled with oral pain medication
- You are able to eat a meal without nausea or vomiting
- You are able to walk safely on your own
- You are able to urinate on your own.
- Your vital signs (temperature, blood pressure, heart rate, respiration) are normal.
Depending on how soon the above goals are met, some patients are able to go home on the evening of the day of surgery while others go home the next day. Most patients go home the same day and this is an outpatient procedure.
At Home After Surgery
There is a small hole in the disc where the herniated part was removed. It takes a few weeks for scar to form and seal this hole. Returning to normal activity before this healing is complete may cause the disc to herniate again.
The post-operative instructions outlined below will give you the best possible chance of having a positive outcome from this surgery:
- Take short walks as your comfort allows. You can start walking the morning after your surgery. Gradually increase the amount of walking you do each day
- Avoid bending over at the waist, twisting or bending motions for the first 4 weeks. Do not bend over to tie your shoe laces. Also avoid lifting anything heavier than 20 lbs for the first 4 weeks. These activities may cause the disc to herniated again
- Avoid all strenuous activities for 2 months. Do not lift heavy bags or luggage. Use proper lifting technique: when picking an object off the ground, bend at your knees, not at the waist
- Wound care:
- On the second day after your surgery, you can take a shower but keep your incision covered with gauze and Tegaderm dressing to keep the incision dry. After showering, pat the incision dry and cover it with a new dressing.
- Keep your incision covered with Tegaderm dressing for 1 week when you take a shower. After that, you can shower without anything covering your dressing as long as there is no drainage from the incision. Do not take baths or soak your incision (swimming, etc.) until your wound is fully healed, usually at around 3 weeks.
- Do not apply any lotions or creams to the incision.
- Reasons to contact us immediately:
- If there is any redness around the incision
- If there is any drainage from the incision after the second day.
- If you have a fever higher than 101 deg F.
- If your leg pain or numbness is significantly worse than before surgery. You should expect some pain and stiffness in your low back from the surgery. This improves with time as the wound heals.
- If you have any problems with bowel or bladder function, you should go to the emergency department right away.
- Returning to work depends on your occupation and your employer’s acceptance of your activity restrictions.
- You may resume sexual activity as your comfort allows. Please keep in mind the activity restrictions listed above.
- I will see you in the office 2-3 weeks after your surgery. If you do not have an appointment, please contact the office.
- After 4 weeks, you will need physical therapy depending on your progress. The therapist will help you strengthen your back muscles with back exercises. These exercises should be part of your lifelong fitness program. The therapist will also teach you how to perform everyday tasks with proper body mechanics.