Micro-Lumbar Discectomy

Micro-Lumbar Discectomy

Overview:Lumbar discectomy is a surgery to remove a herniated or degenerative disc in the lower spine. The incision is made posterior, through the back muscles, to remove the disc pressing on the nerve.

Micro- Lumbar Discectomy is one of the most common spine surgeries performed world-wide. It is performed in the lumbar region (lower back) through an incision to remove the disc herniation compressing the spinal nerve.

Surgery is usually suggested as the last resort. Failure of medical management, severe neurological compression causing weakness are usual circumstances when surgery is advised. In very few cases causing weakness of legs/urine and motion incontinence (Cauda Equina Syndrome) is an emergency procedure recommended. After a thorough discussion (understanding risks and benefits) with the surgeon, the decision for surgery is taken.

The procedure is done under general anaesthesia. A tube is inserted in the throat to help breathing during anaesthesia. Patient is placed prone (face down) on the operating table. A small 1-1.5 inch incision is taken over the lower back. The interspace and laminae covering the spinal cord is exposed after dissection of muscles and soft tissues. This surgery is preferably done under magnification of microscope/ loupes. Operative level is confirmedunder C-arm (Intra operative X-ray). A small part of bone (Lamina) is removed and spinal cord is approached after removing the ligamentum flavum. The cord and nerve root are retracted and disc space is reached. If the disc fragment is loose, it is picked up. If it is contained, a small incision is taken over the covering of disc (annulus) and removed. Any compression over the root and loose disc fragments are removed. Wound in stitched in layers. After the surgery, patient may be shifted to ICU for observation or to the room depending upon the medical condition. Patient is usually made to walk on the same/ next day.  Normally, 1-3 days of hospital stay is required. Once medical condition is stabilized, patient has adequate pain relief and mobilized, discharge is planned.

Patient is asked to follow up for stich removal between 2-3 weeks from surgery. A waterproof dressing may be applied in some patients so that bath can be taken. Patient is required to follow up at 6 weeks, 3 months, 6 months, 1 years and then annually after surgery for examination. Based on recovery – gradual increase in activities is advised.

Specific complications:

Dural Tears: There is a small risk of dural tear during surgery. It is a tear in the outer lining/ covering of spinal sac land contains fluid known as CSF. This fluid may leak from the tear. These are usually repaired during surgery or closed with tissue sealents. Even then, it may leak through the wound and cause headaches. Sometimes it may get infected and further surgery and longer hospitalization stay may be required.

Recurrence: There are chances of reherniation of disc. This can occur because the passage through which the disc is removed takes time to heal and other loose fragments may come out.

The same surgery when done through Minimally Invasive Techniques is known as Tubular Endoscopic Discectomy.

Disclaimer: The description of procedure is how usually a surgery is done. During the procedure, based on intra operative encounters which varies from patient to patient different steps may be performed.

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