This minimally invasive technique is used to remove the herniated portion of a vertebral disc.

This minimally invasive technique is used to remove the herniated portion of a vertebral disc. It is done with the assistance of a microscope and uses a very small incision to minimize the amount of trauma to the surrounding muscles. This decreases post-operative pain and helps improve function more quickly than a standard open procedure. Only the herniated portion of the disc that is pinching your nerves and any added loose fragments are removed. The majority of your remaining disc is preserved.

You will need a complete physical exam to be sure you are in good health. A blood test, electrocardiogram (EKG), and chest X-ray need to be performed. Discuss all medications (prescription, over-the-counter, and herbal supplements) you are taking with your health care provider. Some medications need to be continued or stopped the day of surgery.

Medications that thin the blood should be stopped prior to surgery. Your Internist or primary doctor should be consulted prior to changing or discontinuing any medications. Also, stop drinking alcohol 1 week before and 2 weeks after surgery because these activities can cause bleeding problems. An important thing you can do to ensure the success of your spinal surgery is to quit smoking. This includes cigarettes, cigars, pipes, chewing tobacco, and smokeless tobacco. Nicotine prevents bone growth and puts you at higher risk for a failed fusion.

Morning of surgery

  • Shower using antibacterial soap. Dress in freshly washed, loose-fitting clothing.
  • Wear flat-heeled shoes with closed backs.
  • If you have instructions to take regular medication the morning of surgery, do so with small sips of water.
  • Remove make-up, hairpins, contacts, body piercings, nail polish, etc.
  • Leave all valuables and jewelry at home (including wedding bands).
  • Bring a list of medications (prescriptions, over-the-counter, and herbal supplements) with dosages and the times of day usually taken.
  • If you have a cold, fever or some other illness the day before surgery, please call your surgeons office.
  • Bring a list of allergies to medication or foods.

The procedure is performed through a small (less than one inch) incision in the back. Most of the surgical dissection and exposure is performed with the help of a microscope. After creating the in incision directly over the herniated disc the surgeon creates a small window in the lamina. The lamina is the bone covering the spinal canal. The pinched nerve root and the herniated disc can be seen through the opening. The surgeon uses a nerve retractor to gently move the spinal nerve away from the herniated disc. The herniated portion of the disc is removed, eliminating pressure on the nerve root. Only the remaining damaged portion of the disc is removed, leaving the healthy disc material to perform its function as a cushion between the vertebrae. The tools are removed, the spinal nerve returns to its original position and the incision is closed. Sutures are buried under the skin and dissolve over time.

Most patients go home the day of the surgery. You will want to have a driver available to help you to get home. Your surgical dressing may be removed the following morning and the wound can be left open to air. You may shower the day after surgery. Please keep your surgical site clean with soap and water. Do not apply ANY ointments to the surgical site. You will have some lifting restrictions for 3-4 months following surgery. Most patients can return to a sedentary job within 2-6 weeks after surgery. At 6 weeks, you are generally allowed to lift up to 25 pounds. If you are not able to perform activities at full capacity at 3 months we will typically start a work conditioning program to build your exercise endurance. Note that doing too much too soon may place you at risk for having a recurrent disc herniation. If that occurs, you may have to start the treatment process from the beginning and added surgery may be necessary.

Microdiscectomy is typically effective at relieving the nerve pain you are experiencing before surgery. Back pain may be improved but that is not a major goal of the operation. Most patients find they can do most activities without substantial pain after complete recovery. Numbness and tingling often remains for months to years and is sometimes permanent. Remember that as with any surgery, there are no guarantees with this procedure.