Microdiscetomy on Spine Universe

The best radiographic study for evaluation of continued back and leg pain is an MRI. The MRI demonstrates disc, nerve, and bone. It can also evaluate possible other causes of back and leg pain such as tumor or infection. For patients who are extremely claustrophobic, the MRI can be a problem. Many times these patients can manage getting through the MRI with a sedative prescribed by their referring physician. Other patients find it so difficult that they will ultimately require other studies such as CT scan or a myelogram.

Presuming the MRI does demonstrate a herniated disc, the issue still remains as to whether or not surgery might be recommended for a particular patient. When making a decision for or against a recommendation of surgery to the lumbar spine, the neurosurgeon assesses a variety of factors. These factors include the length of time that the patient has been experiencing pain, the location of the pain (is it limited to the back, or does it travel down into the leg and into the foot), and the presence of neurological signs. These neurological signs can occur along with the pain or even independent of pain. These signs include weakness in the leg, numbness and tingling in the leg, and problems controlling the bladder or bowel. Generally, if any patient has a problem controlling their bladder or bowel, this can be considered an emergency, and the patient should contact their doctor for immediate evaluation. If the numbness or weakness in the leg is becoming progressively more severe, the patient should also let their doctor know urgently.

Patients oftentimes ask what has happened to the herniated disc when they feel that they are improved and will not need surgery. Generally, the disc material shrinks in size, there is relief of pressure on the nerve, and therefore the symptoms that the patient was experiencing improve. Patients generally feel better within a few weeks after a period of initial pain with conservative nonoperative management. At times, however, the improvement is only partial, with patients unable to perform their full activities. Although improved, these patients should seek further evaluation.

Whether or not you decide to have a back operation, you should have a clear picture of your level of pain and neurological deficit. In addition, if surgery is considered, a detailed discussion with the operating surgeon should include what kind of surgery is going to be performed, the indication for performing the operation (exactly why am I getting this surgery), the goals of the operation, the alternatives to performing this particular operation, the limitations of the operation (what might the surgery not be able to improve, (e.g., chronic low back pain over years)), and finally, the risks of the surgery. Following a discussion of this sort, the patient should feel free to go home and discuss this further with his or her family, write down any questions that they might have, and either call or revisit the surgeon with further questions.

The technique of the laminotomy and microdiscectomy is a commonly performed back operation with over a 90 percent chance of improvement of pain and symptoms in the patients receiving the surgery.

A small incision is made in the back with the patient either asleep or under spinal anesthesia. The muscle immediately underneath is dissected to expose the roof of the bone (lamina). This lamina is over the top of the nerve. Small portions of this bone are then removed to expose the nerve underneath. The nerve is then dissected and held to one side, and the disc fragment that had exuded out and pressed upon the nerve is then removed. At this point, the surgeon can remove some more disc material within the disc space if he or she feels that further disc material might exude out to hurt the patient again. No matter how aggressively the removal of the disc material within the disc space is performed, there will always be some remaining disc material left behind. Most of the patients receiving the microdiscectomy and/or laminotomy go home a day after surgery. Some patients have been able to be discharged the day of surgery.

The recuperation depends upon the individual patient working with his or her surgeon postoperatively. Each person recuperates at a different pace. One factor to consider is the amount of heavy activity that the person expects to perform following their surgery. For example, an individual returning to desk work might return much earlier than another individual who is constantly lifting heavy objects and bending while at work. In addition, depending upon the individual's level of postoperative pain and function, physical therapy and/or chiropractic manipulation to assist a patient postoperatively can be requested by the surgeon after evaluating the patient in the office.