What are the indications for a lumbar microdiscectomy?
A lumbar microdiscectomy is an operation to remove the pressure on a nerve from a herniated disc. The surgery is very effective for relieving the leg pain (also known as radiculopathy or sciatica) symptoms caused by the herniated disc. For most patients, the back and leg pain symptoms from a herniated lumbar disc will improve within 6-8 weeks. If the pain is tolerable and the patient can function adequately, then it is advisable to try conservative options such as anti-inflammatory medications, muscle relaxants and physical therapy to manage the pain. If the pain persists beyond 8 weeks, then surgery is a reasonable option. Surgery may be considered sooner than 6 weeks if the leg pain is severe making it difficult to sleep, go to work, or perform everyday activities. If the herniated disc is causing significant leg/foot weakness in addition to pain or difficulty with urination, then surgery may need to be performed on a more urgent basis.
How is a lumbar microdiscectomy surgery performed?
A lumbar microdiscectomy is performed under general anesthesia. A small vertical incision measuring approximately 1-2 inches is made in the midline of the low back area. The back muscles are separated from the bony arch (lamina) and retracted to the side (muscles are not cut). A small amount of bone (lamina) and ligament (ligamentum flavum) needs to be removed to create a small opening to visualize the nerve and the underlying disc herniation. A microscope is then brought in to help better visualize the disc and nerve. The nerve is identified and gently moved to the side. The disc material that is herniated and compressing the nerve is gently removed from underneath the nerve. The incision is closed in several layers and a sterile dressing is applied. The surgery takes anywhere from 1-2 hours to complete.
What is the recovery for a lumbar microdiscectomy?
The surgery is typically an overnight stay in the hospital although patients can go home same day after the surgery if they desire. Incisional pain in the low back area is common. The surgical pain usually resolves after 3-4 weeks. Nerve pain (the pain radiating into the buttock and leg area) can resolve immediately after the surgery or may take longer due to inflammation of the nerve. The majority of the nerve pain symptoms should resolve within 4-6 weeks of surgery. The nerve pain can continue to improve up to 1-2 years after the surgery. Activity recommended for first 2 weeks after surgery is short walks and mainly rest. Physical therapy guidance is recommended from 2-3 weeks after surgery for 6-8 weeks. Return to work can vary depending on extent of surgery, rate of recovery, and the physical demands of the job. For a nonphysical job, reasonable timeline to return to work is 2 weeks to 2 months, whereas more labor intensive work may require to be out of work for up to 3 months.