Minimally Invasive Lumbar Discectomy
A minimally invasive discectomy is a surgical procedure that removes a portion of the herniated disc that is compressing spinal nerves.
Who is a candidate for a discectomy?
Patients with leg pain, weakness, or numbness who have failed conservative measures (physical therapy, medications, injections, etc.) and who have evidence of disc herniation on MRI are candidates for a discectomy.
What is a minimally invasive surgical approach?
Minimally invasive spine surgery is performed through small incisions in the back and uses intraoperative X-ray, microscope, tubular retractors, and special instruments to avoid damage to the back muscles.
Minimally invasive surgery has many advantages over traditional (or open) spine surgery that include smaller incisions, less surgical blood loss, smaller scars, a shorter hospital stay, less pain during recovery, and a faster return to work and daily activities.
What happens during surgery?
The patient is brought to the operating room and placed under general anesthesia with a breathing tube for the duration of surgery. A small incision (about 1 inch long) is made over the level of disc herniation. Without cutting through the muscles, a series of dilators are used to separate muscle fibers and provide access to the spine. A retractor is placed over the dilators and provides a working channel to perform the surgery. A microscope is then used to provide a close-up view during the procedure.
A small portion of the bone is removed to allow access to the herniated disc and compressed spinal nerves. The herniated portion of the disc is then removed, relieving pressure on the nerve. Only the herniated part is removed, not the entire disc. The incision is then closed with sutures that stay under the skin and dissolve over time, so no suture removal is necessary. A sterile dressing is placed that stays in place for two days.
What is the recovery like?
The procedure takes about 1 hour and the patient is able to go home the same day. The only restrictions after surgery are no heavy lifting (no more than 10 lbs. for 4 weeks) and no repetitive bending or twisting at the waist. Most patients return to light duty or office-type work in 1-2 weeks and more strenuous activity in 4-6 weeks. Physical therapy is started at 6 weeks if necessary.
What follow up care is necessary?
The patient is seen in one week after surgery, and then at 6 weeks, and 3 months if needed.
What are the risks?
Serious or permanent complications are rare (risk for most is less than 1%) and include bleeding, infection, spinal fluid leak, nerve damage, and failure of symptoms to improve despite surgery.
What are the benefits?
Most patients do very well after a discectomy with significant improvement or complete resolution of leg pain. Numbness/tingling and weakness may take longer to improve and in rare cases may be permanent despite surgery.