What is lumbar microdiscectomy?

Microdiscectomy is a surgical technique that allows the damaged tissue of the lumbar disc to be removed when it compresses a nerve root (herniated disc). It is performed with the aid of a special microscope, which magnifies the image so that the operation requires only a minimal incision. This decreases the damage of the surrounding tissues and allows for a faster recovery.

What cases is it used for?

Microdiscectomy is used in cases when the patient’s symptoms are due to compression of the lumbar nerve roots. For each patient, we must take into account how long they have been suffering the symptoms, the severity of the symptoms, and what their response has been to other treatments.

Your doctor may propose surgery in the following cases: 

  • Intense pain that usually radiates from the lower back to the leg and sometimes reaches the foot, affecting the patient’s ability to carry out normal activities of daily life, and which does not respond to other medical treatment.
  • Discomfort in the form of numbness, tingling, or lack of touch. 
  • Decreased strength or loss of mobility.
  • Loss of sphincter control

What is involved in the operation?

As a general rule, the patient is admitted to the hospital the same day as the surgery and is usually discharged 24 to 48 hours after the operation.

Before starting the operation, the patient is given antibiotics to reduce the risk of infection. The operation is performed under general anesthesia with the patient lying face down on the operating table.

With the aid of the optical magnification of a microscope, the surgeon makes a small incision at the level of the lower back. The site of the lesion is located using a radioscopy (X-ray) device. The muscles of the area to be operated are then separated and a small window is made in the lamina of the vertebra (laminectomy).

Once the hernia is located, the affected material is removed using specific instruments, making sure that the nerve root is free. Finally, the incision is closed and local anesthesia is administered to reduce postoperative pain.

Recovery and rehabilitation

Within a few hours after the operation, in most cases, the patient can get up and use the toilet on their own. The patient can also walk slowly around the room and around the hallways.

After the operation, while the patient is still in the hospital a physical therapist will come to will explain some appropriate exercises and what actions are to be avoided. The patient must abstain from lifting heavy objects and bending over during the first weeks following surgery.

We recommend that the patient take short and frequent walks in order to promote blood circulation in the legs and avoid contractures or stiffness. At first, there may be some discomfort when sitting for more than 20 or 30 minutes, but gradually tolerance will increase.

We will recommend what medications the patient should take to control pain and inflammation during recovery. At the time of discharge from the hospital, the patient will be given an appointment for a few days later to see how the surgical wound is healing, and an appointment to begin physiotherapy. 

We will recommend an early rehabilitation program that the patient can begin a few days after surgery. A team of professionals will be in charge of applying specific physical therapy techniques and teaching you the appropriate exercises at every stage of your recovery.

Depending on the patient’s level of postoperative discomfort, they can begin light, non-impact, physical exercise around 6 weeks after the operation. Stationary cycling can be a suitable exercise in the early stages of recovery. Other sports, such as swimming or running, can be introduced gradually.

If the patient feels up to it, they can return to work about 3-4 weeks after surgery, as long as it is work that doesn’t require physical effort, such as office work. For activities that require intense physical activity, the wait should be approximately 3 months.

Risks of lumbar microdiscectomy

As with any surgery, there are some risks that the patient must be aware of.

Residual pain

Although microdiscectomy is an operation with a high rate of good results, sometimes it is not possible to eliminate the root pain entirely. This is more frequent when the nerve root has been compressed for a long time (more than 3-6 months).

Nerve damage

Fortunately, this is a rare complication because use of the microscope makes it easy to see the nerve structures clearly.

Injury to the dura mater and leakage of cerebrospinal fluid

If this occurs, the lesion is repaired and sealed during the operation. In the event of this complication, the patient will be asked to remain in bed for 24-48 hours in order for the scar to heal.

Hematoma or seroma

Sometimes a hematoma or seroma (build up of clear liquid) occurs in the operated area. Treatment usually consists of rest and compression. On some occasions it may be necessary to drain the hematoma or seroma.

Infection

Infection is rare, but when it occurs it requires treatment with antibiotics and sometimes, it requires having the operated area cleaned in a surgical operation (debriding).

Recurrence of the hernia

Approximately 5 % of hernias recur. When these cases occur, it is usually within the first 3 months following the surgery. If this happens, your doctor may recommend a new operation to remove the hernia.

Who are the doctors who perform lumbar microdiscectomy at Instituto Clavel?

All doctors on the Instituto Clavel team.

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