Microdiscectomy Surgery
Microdiscectomy is the gold standard for relieving disc pain, especially in the elderly, performed by top neurosurgeons in Turkey.
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Microdiscectomy is a minimally invasive surgery for herniated discs, relieving pressure on the spinal nerve root by removing pain-causing material.
During the procedure, a small portion of the bone above the nerve root or disc material beneath it may be removed.
Microdiscectomy (microscopic nerve decompression) is often more effective at relieving leg pain (radiculopathy or sciatica) than lower back pain.
For leg pain, patients typically experience immediate relief after microdiscectomy and often return home pain-free the same day.
Full nerve root recovery may take weeks or even months for numbness, weakness, or other neurological symptoms in the leg or foot.
Despite its immediate pain relief benefits, nerve healing can take several months.
Microdiscectomy is generally a reliable procedure for providing immediate or near-immediate relief from sciatica caused by lumbar disc herniation.
Minimally Invasive Disc Surgery Options
Two common outpatient procedures for herniated lumbar discs are:
- Microdiscectomy
- Endoscopic Discectomy (or Percutaneous Discectomy)
A third non-surgical option is Laser Disc Treatment.
Microdiscectomy is widely regarded as the gold standard for removing herniated disc portions and compressing nerves. This approach has a long history, and many spine surgeons are highly experienced in this technique.
While technically an open surgery, microdiscectomy employs minimally invasive techniques, allowing it to be performed through a relatively small incision with minimal tissue disruption.
Some surgeons have gained expertise in endoscopic or minimally invasive techniques that use tubes inserted into the surgical site instead of an open incision.
An orthopedic surgeon or neurosurgeon typically performs microdiscectomy.
Indications for microdiscectomy (Herniated disc surgery)
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In general, if the leg pain caused by a herniated disc improves, it will usually go away completely within six to twelve weeks of its onset.
As long as the pain is tolerable and the patient can function adequately, it is usually advisable to postpone surgery for a short period of time to see if the pain goes away with non-surgical treatment alone.
In some cases, laser treatment can be tried.
However, if the leg pain is very severe, it is also reasonable to consider surgery urgently.
For example, if the patient is in severe pain despite exhausting all non-surgical treatments, such that it is difficult for him to sleep, go to work, or perform daily activities, then surgery may be considered.
Typical reasons for recommending microdiscectomy surgery
- Leg pain persists for at least six weeks.
- A herniated disc is found on an MRI or other test.
- If leg pain (sciatica) is the patient’s main symptom, rather than just low back pain.
- If non-surgical treatments such as oral steroids, NSAIDs, and physical therapy do not provide adequate pain relief.
In these cases, the results of surgery are somewhat worse after three to six months from the onset of symptoms, so doctors usually advise people not to postpone surgery for a long period (more than three to six months).
Steps for definitive herniated disc treatment through microdiscectomy in Turkey
In most cases, microdiscectomy is performed through the back, with the patient lying face down on the operating table.
General anesthesia is used, and the procedure usually takes about one to two hours.
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Typical surgical steps for microdiscectomy
- Incision and Access:
The neurologist and spine surgeon perform microdiscectomy by making small incisions, no larger than 5 cm, along the midline of the lower back. - Muscle Separation:
The back muscles are gently lifted from the vertebral arch (lamina) and moved aside without being cut. A spacer is used to keep the muscles in place since they run vertically. - Spinal Access:
The surgeon accesses the spine and disc by carefully removing the ligamentum flavum, which is located above the vertebrae. - Nerve Visualization:
Magnifying glasses or an electron microscope are used to clearly visualize the nerve root, ensuring precision during the procedure.
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- Facet Joint Removal (if needed):
In some cases, a small portion of the vertebra’s facet joint is removed to provide better access to the nerve root and relieve any pressure or compression. - Bone Plate Opening (if necessary):
If required, the surgeon may create a small opening in the vertebral bone plate to reach the surgical site. - Nerve Root Movement:
The nerve root is gently moved aside to allow the surgeon to work in the area. - Disc Material Removal:
Using small instruments, the surgeon carefully removes the herniated disc material under the nerve root. - Muscle Repositioning and Incision Closure:
The muscles are returned to their original position, and the incision is closed. Sterile tape is then applied to hold the skin in place for proper healing. - Preservation of Disc Integrity:
In microdiscectomy, only the protruding portion of the disc is removed. The majority of the disc remains intact, preserving the mechanical structure of the lumbar spine, as all joints, ligaments, and muscles are kept in place.
After microdiscectomy surgery
Patients typically stay in the hospital for a few hours after surgery before being discharged home.
Depending on the patient’s condition, an overnight stay in the hospital may be recommended.
After the procedure, patients may return to a relatively normal level of activity quickly.
Patients are usually encouraged to walk within a few hours of surgery.
The surgeon will provide home-care instructions, including medications, home activities, type of follow-up, and other information.
Risks, complications, and success rates of microdiscectomy surgery
This widely performed surgery is considered to have a relatively high success rate, especially in relieving patients’ leg pain (sciatica).
Patients can usually return to a normal activity level fairly quickly.
Microdiscectomy Success Rates
The success rate of microdiscectomy spine surgery is generally high. A large medical study showed that 90% of people who had the procedure had good or excellent overall results.
Medical studies also suggest some benefits to surgery when compared to non-surgical treatment, although the difference diminishes over time in some cases.
One large study found that people who had lumbar disc surgery improved their symptoms for up to two years more than those who did not have surgery.
Recurrence of a herniated disc
Estimates vary, but between 1% and 20% of people who have microdiscectomy will develop another disc herniation at some point.
Additional disc herniations can occur immediately after back surgery or several years later, although they are most common in the first three months after surgery.
If a disc herniates again, the success rate of the second procedure is about the same as the first. However, after a recurrence, the patient is more likely to have a recurrence.
For patients with multiple recurrences of herniated discs, spinal fusion may be recommended to prevent further recurrence.
The most common way to ensure that a disc herniation does not occur again is to remove the entire disc and fuse it.
If the posterior facet joint is intact and certain other criteria are met, an artificial disc replacement (plate) may be considered to replace the affected disc.
After microdiscectomy, a program of stretching and strengthening exercises is recommended to help prevent the recurrence of back pain or disc herniation.
Possible risks and complications of microdiscectomy
As with any form of spine surgery, microdiscectomy has several risks and complications.
Dural rupture resulting in a cerebrospinal fluid leak occurs in approximately 1% to 7% of microdiscectomy surgeries.
The leak does not affect the surgery’s results, but the patient may be required to lie still for one to two days after surgery until the leak stops.
Other risks and complications include:
- Nerve root damage.
- Bowel/bladder incontinence.
- Bleeding.
- Infection.
- Possible buildup of fluid in the lungs that can lead to pneumonia.
- Deep vein thrombosis, that occurs when blood clots form in the leg.
- Pain that persists after surgery.
See Failed Back Surgery Syndrome (FBSS): What It Is and How to Avoid Pain After Surgery
The above-mentioned complications are not very common for microsurgical spine surgery.
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