Overview of surgery
Lumbar (lower back) microdiscectomy involves the surgical removal of a herniated disc in the lumbar spine. A majority of patients with a lumbar disc herniation have relief of symptoms with non-surgical treatment (medications, nerve root block etc). Surgery is indicated when there is a) failure of symptoms to subside after non-operative treatment, b) significant weakness in the legs and feet at presentation and c) involvement of the bladder with difficulty in passing urine.
Steps of the surgery:
- The surgery is performed under general anaesthesia, with the patient lying on the tummy (face down)
- The spine is exposed through an incision on the skin at the back over the involved region of the spine. The spine is accessed by moving the muscles aside. A small part of the bone and ligaments are removed and the nerve root pulled aside gently to visualize and remove the herniated disc. Either a microscope or special magnifying eyewear (operating loupes) is used to improve the safety and accuracy of the procedure
- The incision (cut) is closed with dissolvable sutures. A drain tube may be placed to remove the blood that collects at the surgical site. A urinary tube may be used to drain the bladder.
The Success rates and the outcomes
This surgery has a relatively high success rate (90%) in managing the sciatica pain that radiated down the leg. If muscle weakness and numbness was present prior to surgery, it usually improves over a period of time.
Your pathway to recovery:
- Following surgery, the patient will be moved to the recovery room. Adequate pain relief and intravenous fluids will be provided. When the patient is comfortable, he/she may be transferred to a high dependency ward for an overnight stay or moved straight back to the ward
- Most patients will be encouraged to walk the day after surgery with or without a back brace. Normal diet or a soft diet is usually advised either in the evening after the surgery or the next morning
- The duration of stay in the hospital may extend from 1-3 days depending on comfort and ability to walk and the surgeon will decide on the date of discharge.
Allergic reactions to medications and conditions like pneumonia, stroke or heart attack, though rare and not directly caused by the surgical treatment, may have serious consequences.
Surgical complications can include bleeding, infection, spinal fluid leak, injury to the veins and arteries near the spine, injury to the spinal cord and nerves and its surrounding protective layer (dura). Injury to the nerves during surgery can result in varying degrees of muscular paralysis, alteration of normal sensations and loss of bowel and bladder control which may be permanent or may recover over a period of time. An injury to the covering layers of the nerves (dura) can result in a leak of spinal fluid and may rarely require a repeat surgery.
A 1-5% incidence of post-operative wound infection is possible despite antibiotics given before and after surgery. Superficial infections can be treated with antibiotics, while deep infections may require a wound wash-out under anaesthesia. The presence of an infection in any other region (urinary bladder, chest and skin) immediately prior to surgery, increases the risk of post-operative infection, so inform your surgeon about this.
Deep vein thrombosis (DVT – clotting of blood in your calf muscles) and pulmonary embolism (clot migrating to your lungs) are uncommon after an elective spine surgery, particularly when you are out of bed and walking within 24 hours after surgery. We do not routinely use medications to prevent DVT; however, if you have had an episode of DVT in the past, let your surgeon know.