The goal of Lumbar Microdiscectomy, also sometimes called microdecompression or microdiskectomy, is a minimally invasive surgical procedure performed on patients to resolve a herniated lumbar disc.
During a microdiscectomy, Dr. Paul removes and uses a small 1 to 1.5-inch incision to access the spine. The incision is longer if there is more than one level of surgery scheduled. A minimally invasive retractor is used to move muscles to the side gently.
A small amount of bone and ligament are removed to expose the affected nerve. The nerves are moved to expose the disc fragment compressing the nerve and are then removed. While he does look in the disc to remove any other loose pieces, Dr. Paul leaves the remaining disc in place.
If there is any spinal stenosis or bone spurs, he removes those as well to ensure there is no pressure on the nerve.
The entire procedure is done using magnifying loupes (glasses) with additional lighting and is done microscopically. The procedure is done under general anesthesia. You will be unconscious during the entire procedure and unable to feel anything. The procedure is performed with you lying face down.
How long does it take Dr. Paul to perform the Lumbar Microdiscectomy?
Approximate surgical times would be 30 to 40 minutes for one level, 40 to 60 minutes for two levels. We must emphasize, these are approximate times.
These times are much higher if you have had prior surgery on your spine.
Remember, there is substantially more time involved in putting you to sleep, prepping and draping prior to surgery, and more time required to wake you up. As a result, many additional hours are required. Time required to go to sleep, wake and recover can vary from two to three hours. Most of the variability is in the post-anesthesia recovery unit.
Please allow an additional hour ½ – two hours if there is additional surgery required from the back.
Dr. Paul typically calls the waiting room to update a family member or friend about you briefly. Kevin or Adam will typically check on you in the recovery room and speak to the nurse and Dr. Paul about your recovery. Nursing will let your family know when they can see you.
We have attempted to define the more common risks of surgery under each of the procedures outlined. It is impossible to outline all potential poor outcomes, but we have attempted to do so in good faith. It has not been formed as legal protection for us – only to better inform you. Please read them thoroughly.
Infections are a known complication of lumbar surgery. Infection rates are more associated with smoking, poorly controlled diabetes, obesity as well as other health factors. Less invasive and shorter procedures also have lower complication rates. Infections requiring additional surgery are extremely rare in Dr. Paul’s practice.
Bleeding can be a serious complication since blood accumulation can compress the spinal cord or nerve roots. For that reason we require discontinuing blood thinners, some anti-inflammatories and all herbal medications.
Spinal Leaks are a known complication in spine surgery but typically can be managed. They occur approximately 3 to 5% of the time They can be the result of adherent bone, disc, ligament or scar tissue to the dura and the membrane surrounding your nerves or spinal cord. They are far more associated with revision surgery, severe nerve compression and advanced age. If this occurs, we typically repair the leak during your operation. You may be required to lay flat for a short period of time afterwards. Late presenting or persisting spinal leaks can require additional surgery. Spinal leaks typically do not affect long term outcomes.
Neuropraxia & Nerve Injury nerves under pressure can react with pain or increased weakness after being decompressed. These issues are expected and usually resolve with treatment or time. The goal of fusion is to realign and improve the position of the spine which can cause some nerves to be stretched and also induce typically temporary changes. Rarely, these changes are permanent As a precaution, Dr. Paul utilizes a state of the art nerve and spinal cord monitoring system to avoid neurologic problems.
Non-Union not all fusions heal. Some heal as early as three months but many take longer. Some fusions require a year to heal. Dr. Paul’s team gets x-rays regularly during the first year and meets with you to make sure the fusion is successful. Some fusions will require revision surgery to fix the problem.
Medical Complications related to the heart, lung and kidneys and other organs are also a possibility. Although shorter less invasive procedures are associated with lower complication rates, they can still occur. We work closely with your primary care doctor and other specialists to make sure your medical conditions are optimized prior to surgery.
How Do People Function After LM Surgery?
Your surgery was performed because you have a degenerative condition that can affect the rest of your spine. Therefore, if you have had surgery at one level in your spine, it would be reasonable to assume you could have problems at the same or other levels. Since the spine has 36 levels, this is not unusual. Most people handle degenerative difficulties with self-care and non-operative care. That being said, Dr. Paul and his team go to great lengths to minimize the chances of needing additional care for your spine. That includes careful surgical planning, intraoperative decision making, and post-operative care.
Life After Lumbar Microdiscectomy
In the early weeks, gradually increase activities. Remain on your feet for more extended periods and improve your walking distances. You may return to a sedentary job in as little as 2-3 weeks. No bending, twisting, or lifting more than 10 pounds. Sit only in chairs with good lumbar support. You may start a regular aerobic activity such as vigorous walking, Stairmaster, or low impact aerobic exercise classes if allowed after the first follow up appointment. This is typically in 2-3 weeks.
It is not uncommon to feel mildly depressed or anxious for the first 4-6 weeks after surgery, but those feelings should go away as your daily activities and exercise resume. This is more common with larger or multilevel surgeries. If the depression continues, please consult with your primary care doctor.
Preparing For Surgery
Things to do Leading up to Surgery
Optimization For Spinal Surgery
Before undergoing surgery, Dr. Paul and his team will work with your primary care provider and other specialists to optimize your health to minimize the risk of complications.
People who have had cardiac interventions such as stents, ablations and surgery or a history of significant cardiac diagnoses will need to see their cardiologist prior to surgery. Your cardiologist may require additional testing or interventions prior to surgery.
We require all patients undergoing spine surgery to quit smoking two weeks prior to surgery. Nicotine is a significant risk factor for many complications, including infections, recurrent nerve problems, fusions failure, and others. Click here for more information and support.
A BMI over 35 is associated with major complications from spine surgery. Your pain and recovery are also adversely impacted by excess weight. If your BMI is over 35 we postpone surgery because the weight must be improved. We are happy to offer additional help from our weight loss clinic. For more information, see our DMG weight loss clinic by clicking here.
Supplements to Begin Before Surgery
We recommend all our patients start the following regimen of supplements two weeks prior to surgery. There is some evidence that they improve wound healing and bone healing (if fusion is required).
Calcium is essential for normal bodily functioning. If not received in great enough quantities, the body will look to mobilize other sources, namely the bones. Naturally, this leads to weakening of the skeletal system, and increases the risk of injury. Adults should aim to consume approximately 1000 mg of calcium per day.
Necessary for the formation of collagen, vitamin C is another essential supplement if normal daily intake is inadequate. Collagen is used in bone building and supports the skeletal system in connective tissues. A recommended daily dosage is at least 1000 mg.
Another crucial vitamin for healthy bones, vitamin D aids in calcium absorption. Inadequate levels can lead to thin or brittle bones prone to damage. Optimal daily intake for adults is approximately 1000 IU.