Slipped Disc Opera

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Typically performed for a herniated disc, a microdiscectomy relieves the pressure on a spinal nerve root by removing the material causing the pain.

See What's a Herniated Disc, Pinched Nerve, Bulging Disc...?

A Christ focused family church website, who believes in loving one another, is committed to bringing people to Jesus, and equipping the Church for ministry and developing it to maturity in order to Glorify God. Slipped Disc Surgery. A slipped disc occurs when the soft gel-like tissue between the bones of the spine is moved out of place and starts pressing on adjacent nerves. In most cases, slipped discs are caused by wear and tear or trauma to the spine. This condition is also known as herniated disc, ruptured disc, or prolapsed disc. I have 3 herniated discs, 3 annular tears, 1 protuding disc and 1 desiccated disc in the C-spine. I also have a rotator cuff tear in left shoulder and carpal tunnel in left hand. My shoulder doctor said that the problems from my elbow down thru the hand was related to the neck injuries and not from the shoulder. The bacteria should pose no threat as they circulate around the body, but when a person has a slipped disc, the body grows fresh blood vessels that reach into the soft disc to repair the tissue.

A microdiscectomy procedure uses minimally invasive techniques to provide relief from pain caused by a lumbar herniated disc. Watch:Lumbar Microdiscectomy Surgery Video

During the procedure, a small part of the bone over the nerve root and/or disc material under the nerve root is taken out.

See Lumbar Discectomy Outpatient Spine Surgery

A microdiscectomy (also called a microdecompression) is usually more effective for relieving leg pain (also known as radiculopathy, or sciatica) than lower back pain:1-3

  • For leg pain, patients will normally feel pain relief almost immediately after a microdiscectomy. They will usually go home from the surgery with significant pain relief.
  • For numbness, weakness, or other neurological symptoms in the leg and foot, it may take weeks or months for the nerve root to fully heal and any numbness or weakness to subside.

See Leg Pain and Numbness: What Might These Symptoms Mean?

As general rule, microdiscectomy is considered a relatively reliable surgery for immediate, or nearly immediate, relief of sciatica from a lumbar herniated disc.

See Lumbar Herniated Disc Symptoms

Minimally Invasive Microdiscectomy

There are two common options in an outpatient lumbar discectomy—microdiscectomy and endoscopic (or percutaneous) discectomy.

A microdiscectomy is generally considered the gold standard for removing the herniated portion of a disc that is pressing on a nerve, as the procedure has a long history and many spine surgeons have extensive expertise in this approach.

See Surgery for Lumbar Herniated Disc

While technically an open surgery, a microdiscectomy uses minimally invasive techniques and can be done with a relatively small incision and minimal tissue damage or disruption.

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Watch: Microdiscectomy Surgery Video: A Spine Surgeon Explains the Procedure

Some surgeons have now gained sufficient experience with endoscopic or minimally invasive techniques, which involve doing the surgery through tubes inserted into the operative area, rather than through an open incision.

A microdiscectomy is typically performed by an orthopedic surgeon or neurosurgeon.

See Orthopedic Surgeon vs. Neurosurgeon for Spine Surgery

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Indications for Microdiscectomy

If a patient's leg pain due to a disc herniation is going to get better, it will generally do so within about six to twelve weeks of the onset of pain. As long as the pain is tolerable and the patient can function adequately, it is usually advisable to postpone surgery for a short period of time to see if the pain will resolve with non-surgical treatment alone.

See Non-Surgical Treatment for a Lumbar Herniated Disc

If the leg pain is severe, however, it is also reasonable to consider surgery sooner. For example, if despite nonsurgical treatment the patient is experiencing pain so severe that it is difficult to sleep, go to work, or perform everyday activities, surgery may be considered before six weeks.

These are typical reasons for recommending a microdiscectomy:

  • Leg pain has been experienced for at least six weeks
  • An MRI scan or other test shows a herniated disc
  • Leg pain (sciatica) is the patient’s main symptom, rather than simply lower back pain
  • Nonsurgical treatments such as oral steroids, NSAIDs, and physical therapy have not brought sufficient pain relief

See Surgery for Lumbar Herniated Disc

The results of surgery are somewhat less favorable after three to six months have passed since the onset of symptoms, so doctors usually advise people not to postpone surgery for an extended period (beyond three to six months).4

  • Looking to relieve your pain? Find a surgeon or doctor in your area today

References

  • 1.Zahrawi F. Microlumbar discectomy. Is it safe as an outpatient procedure? Spine (Phila Pa 1976). 1994;19(9):1070-4.
  • 2.Pugely AJ, Martin CT, Gao Y, Mendoza-Lattes SA. Outpatient surgery reduces short-term complications in lumbar discectomy: an analysis of 4310 patients from the ACS-NSQIP database. Spine (Phila Pa 1976). 2013;38(3):264-71.
  • 3.Lang SS, Chen HI, Koch MJ, Kurash L, McGill-Armento KR, Palella JM, Stein SC, Malhotra NR. Development of an outpatient protocol for lumbar discectomy: our institutional experience. World Neurosurg. 2014;82(5):897-901.
  • 4.Jacobs WC, Van tulder M, Arts M, et al. Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. Eur Spine J. 2011;20(4):513-22.
Next Page: How Microdiscectomy Surgery Is Performed

If you and your consultant decide you could benefit from lumbar decompression surgery, you'll be put on a waiting list.

Your doctor or surgeon should be able to tell you how long you're likely to have to wait. Read more about NHS waiting times.

Before the operation

To help you recover from your operation and reduce your risk of complications, it helps if you're as fit as possible before surgery.

As soon as you know you're going to have lumbar decompression surgery, it's advisable to stop smoking (if you smoke), eat a healthy, balanced diet and take regular exercise.

Pre-operative assessment

You'll be asked to attend a pre-operative assessment appointment a few days or weeks before your operation.

During this appointment, you may have some blood tests and a general health check to make sure you're fit for surgery, as well as an X-ray or magnetic resonance imaging (MRI) scan of your spine.

This assessment is a good opportunity to discuss any concerns you may have or ask questions about your operation.

You should be told who will be doing your operation and you may be introduced to them. Lumbar decompression surgery is carried out either by a neurosurgeon or an orthopaedic surgeon with experience in spinal surgery.

Read more about having an operation and general advice about going into hospital.

The operation

You'll be admitted to hospital either on the day of your operation or the day before. Your surgeon and anaesthetist will explain what will happen during the operation. This will give you the opportunity to ask any questions you may have.

Before the operation, you'll be asked to sign a consent form to confirm that you know what's involved and the potential risks.

You'll usually be asked not to eat or drink for about 6 hours before the operation.

During lumbar decompression surgery, you'll usually lie face down on a special curved mattress to allow the surgeon better access to the affected part of your spine and reduce the pressure on your chest, abdomen and pelvis.

The operation is carried out under general anaesthetic, which means you'll be asleep during the procedure and won't feel any pain. The whole operation takes at least an hour, but it may take much longer, depending on its complexity.

The exact level of decompression required will be determined using an X-ray. An incision will be made in the middle of your back, running vertically along your spine. The length of the incision will depend on:

  • how many vertebrae and/or discs need to be treated
  • the complexity of the surgery
  • whether fusion has been considered

The muscles in your back will be lifted from the back bone, to expose the back of the spine. The affected tissues or nerves will be removed little by little, taking the pressure off the spinal cord or nerves. Once adequate decompression has been achieved, the muscles will be stitched back together and the incision will be closed and stitched up.

Surgical procedures

The aim of lumbar decompression surgery is to relieve the pressure on your spinal cord or nerves, while maintaining as much of the strength and flexibility of your spine as possible.

Depending on the specific reason you're having surgery, a number of different procedures may need to be carried out during your operation to achieve this.

Three of the main procedures used are:

  • laminectomy – where a section of bone is removed from one of your vertebrae (spinal bones) to relieve pressure on the affected nerve
  • discectomy – where a section of a damaged disc is removed
  • spinal fusion – where 2 or more vertebrae are joined together with a bone graft

Laminectomy

A laminectomy removes areas of bone or tissue that are putting pressure on your spinal cord.

Slipped Disc Opera News

The surgeon makes an incision (cut) over the affected section of spine down to the lamina (bony arch of your vertebra), to access the compressed nerve. The nerve will be pulled back towards the centre of the spinal column and part of the bone or ligament pressing on the nerve will be removed.

To complete the operation, the surgeon will close the incision using stitches or surgical staples.

Discectomy

A discectomy is carried out to release the pressure on your spinal nerves caused by a bulging or slipped disc.

Slip

As with a laminectomy, the surgeon will make an incision over the affected area of your spine down to the lamina.

The surgeon will gently pull the nerve away to expose the prolapsed or bulging disc, which they'll remove just enough of to prevent pressure on the nerves. Most of the disc will be left behind to keep working as a shock absorber.

To complete the operation, the surgeon will close the incision with stitches or surgical staples.

Spinal fusion

Spinal fusion is used to join 2 or more vertebrae together by placing an additional section of bone in the space between them.

This helps to prevent excessive movements between 2 adjacent vertebrae, lowering the risk of further irritation or compression of the nearby nerves and reducing pain and related symptoms.

The additional section of bone can be taken from somewhere else in your body (usually the hip) or from a donated bone. More recently, synthetic (man-made) bone substitutes have been used.

To improve the chance of fusion being successful, some surgeons may use screws and connecting rods to secure the bones.

Afterwards, the surgeon will close the incision with stitches or surgical staples.

Your surgeon can give you more information about which procedures are going to be performed during your surgery.

Keyhole surgery

Spinal decompression surgery is usually performed through a large incision in the back. This is known as 'open' surgery.

In some cases, it may be possible for spinal fusion to be carried out using a 'keyhole' technique known as microendoscopic surgery. This is performed using a tiny camera and surgical instruments inserted through a small incision in your back. The surgeon is guided by viewing the operation on a video monitor.

Microendoscopic surgery is complicated and isn't suitable for everyone. Whether it's suitable for you depends on the exact problem in your lower back. There's also a slightly higher risk of accidental injury during this operation than with an open operation.

Slipped

Some of the techniques used during microendoscopic surgery, such as using a laser or a heated probe to burn away a section of damaged disc, are relatively new. Therefore, it's still uncertain how effective or safe they may be in the long term.

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Slipped Disc Operations On Lumbar Region

An advantage of microendoscopic surgery is that it usually has a much shorter recovery time. In many cases, people can leave hospital the day after surgery has been completed.

Interspinous distraction

Operation For Slipped Disc

Interspinous distraction is a new type of lumbar surgery for spinal stenosis. This technique involves making a small incision above your spine and placing a metal device, known as a spacer, between 2 vertebrae, so that they can't move onto the underlying nerve.

Interspinous distraction appears to be safe in the short term, but as it's a new technique, it's uncertain how it will fare in the long term. One possible risk is that the spacer could move out of position and require further surgery to correct.

The National Institute for Health and Care Excellence (NICE) has more information about interspinous distraction procedures for lumbar spinal stenosis (PDF, 92kb).

Page last reviewed: 23 July 2018
Next review due: 23 July 2021