What is Microdiscectomy?
Microdiscectomy also known as microdecompression represents a surgical procedure in which either a portion of a bone or vertebral disc is removed. The main purpose of this removal is to relieve the pressure applied to a nerve root, such as it the cause of neural impingement. By eliminating the pressure, the nerve is able to heal and the patient will no longer suffer from upsetting symptoms. This procedure is generally recommended for patients who have been diagnosed with vertebral hernia (especially in the lumbar region) but it is also used for the treatment of various radiculopathies.
The most common symptom of a radiculopathy is pain in different areas of the leg, depending on the nerve root that is suffering from impingement. After the microdiscectomy, the pain will be reduced almost immediately, even though the complete healing process of the nerve can take several months. Other symptoms, such as numbness and muscle weakness, will also take longer to subside but the pain relief is almost instant.
What to expect after microdiscectomy?
In the first two days after the surgery, ice pack applications are recommended in order to decrease the pain experienced. However, these should not be applied directly on the skin and they should not be left for prolonged periods of time, or they can lead to further circulatory problems. After the surgery, you should expect to feel stiff or sore but these symptoms usually improve over the next few weeks. You might have a hard time sitting or standing or you might be able to resume such positions only after you have taken anti-inflammatory medication. The doctor will recommended that you start physical therapy as soon as possible; the physical therapist will not only show you what exercises you need to make but he will also teach you how to properly move.
When you get home, be sure to get proper rest and sleep, as this guarantees a better recovery. Increase the amount of time walking on a daily basis, as it is a known fact that movement can prevent problems such as constipation or pneumonia, plus it will help to get the blood circulating. During the initial period after the surgery, it might be for the best to avoid heavy lifting and other strenuous physical activity. Do not carry heavy grocery bags and avoid doing housework that requires a lot of movement. It is for the best that you wait until you are better. Avoid riding the car, do not stay too long in a position and talk to your doctor about any prolonged symptoms you might experience.
A few years ago, this procedure was performed by doing a large incision in the back, cutting the upper muscles and removing the actual part of the bone or disc creating pressure on the nerve root. Today, thanks to the modern advancements in the field of medicine, doctors perform this procedure as microdiscectomy. The surgical exposure has reduced considerably, as the doctor uses telescopic glasses or a miniature microscope to visualize the affected area. This is also advantageous because it guarantees a faster recovery for the patient and less downtime. The microsurgical approach is considered to be minimally invasive and it can be used on elderly patients as well.
In order to perform the surgery, the surgeon will make a small incision in the affected area. He will then lift the back muscles, as this is preferred to cutting them. The next step will be to either remove the membrane of the nerve roots or to use a special microscope to better the see the nerve root. The part of the bone or the disc creating pressure on the nerve root is going to be removed. The important thing to understand is that this procedure does not affect the mechanical structure of the vertebral column.
These are the most common risks of microdiscectomy:
- Injury to the nerve
- Incontinence of the bowels or the urinary bladder (injury to the nerves that innervate the said regions)
- Infection at the site of the surgery – in order to prevent infections, the doctor might decide to administer antibiotics before the surgery
- Surgery fails to remove the fragments that cause pressure on the nerve root
- Risk to damage the spine
- Risk of condition becoming worse
The costs of the microdiscectomy procedure depend on the geographical location, the facility in which the surgery is performed and the actual surgeon performing the procedure. You need to take into account the additional costs of the surgery, including the facility fees, the physician’s and other medical staff fees. Plus, there are anesthesia costs that you will have to handle and, in case there are complications, the overall costs will increase. Keep in mind that post-operative complications can require additional care measures, these being supported by the patient as well.
The recommended thing is that you check with your insurance company and see whether this procedure is covered totally or partially. This information is going to prove out to be useful, especially since there may be certain clinics that work with your insurance. Also, be sure to check out their policy on pre-existing conditions, as this may be a determining factor as well. As this is not an emergency procedure, it pays to be informed and not rush into anything until you would have gathered all the needed information. Also, it might help to talk with other people who have gone through similar procedures. On average, such a procedure goes over $30.000 with all the feeds included.
These are the most common complications of microdiscectomy:
- Dural tear – if the membrane protecting the spine is torn during the surgery, then the cerebrospinal fluid might leak out. This translates into more downtime for the patient, as staying put will allow for the leak to heal and the fluid to reabsorb.
- Anesthesia complications – the patient can develop an allergic reaction from the anesthesia. If you suffer from any kind of allergy to medication, you will have to mention it to the doctor before the surgery. If the patient enters into vascular collapse after the administration of the anesthetic, emergency medical treatment will be required.
- Postoperative discitis – this is an inflammation of the vertebral disc that can occur after the surgery.
- Post-operative muscle hernia
- Subcutaneous post-operative hematoma
- Deep vein thrombosis – blood clots from the surgery area travel to the veins in the leg or into the lungs, causing vascular collapse and even death.
- Lung problems (pneumonia)
- Permanent nerve damage, resulting in paralysis
- Complications can occur from wrong-level complications
- Anterior vessel or visceral injuries
In the past, it was believed that the early mobilization of the spine after microdiscectomy could do more harm than good. Patients were advised to avoid bending and rotating their back, so as not to ruin the surgery. However, recent studies have shown that the early mobilization of the spine after microdiscectomy results in a faster healing process. What happens is that those patients, because of the significant pain experienced before the surgery, have limited their range of movement. By introducing an adapted physical therapy program in the early period, the patient will heal faster and better. The program should include stretching exercises and also something to develop more strength in the back muscles.
Pain management is extremely important after such an intervention. The doctor might recommend anti-inflammatory drugs and also narcotics, in cases where there is severe pain. However, it is a well known fact that narcotics can become addictive, this is why this treatment should be followed only for short periods of time. Narcotic pain medication should be replaced with regular anti-inflammatory medication as soon as it is possible. Return to usual activities is usually possible after a period of least eight weeks but this may be longer if complications occur during the surgery.
During this period, you can benefit from the help of a physical therapist. He or she will show you the best ways in which daily activities can be performed, so as to put as little pressure on the spine as possible. Each activity can either help or harm the spine; do not believe that you know better than a physical therapist and be sure to follow the exercise program that was given to you. You need to strengthen those back muscles in order to have a straight and healthy spine as well.
Watch this useful video of Microdiscectomy to find more information about the surgical procedure: