Microdiscectomy (microdecompression) spine surgery

Fig 1:
Approach for microdiscectomy
(larger view)

In a microdiscectomy or a microdecompression spine surgery, a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to relieve neural impingement and provide more room for the nerve to heal. A microdiscectomy spine surgery is typically performed for lumbar herniated disc.

Microdiscectomy helps leg pain

A microdiscectomy surgery is actually more effective for treating leg pain (radiculopathy) than for lower back pain. The impingement on the nerve root (compression) can cause substantial leg pain, and while it may take weeks or months for the nerve root to fully heal and any numbness or weakness get better, patients normally feel relief from leg pain almost immediately after a microdiscectomy surgery.

Microdiscectomy spine surgery procedure

• First, the back muscles (erector spinae) are lifted off the bony arch (lamina) of the spine. Since these back muscles run vertically, they can be moved out of the way rather than cut (see Figure 1).

• The surgeon is then able to enter the spine by removing a membrane over the nerve roots (ligamentum flavum), and uses either operating glasses (loupes) or an operating microscope to visualize the nerve root.

• Often, a small portion of the inside facet joint is removed both to facilitate access to the nerve root and to relieve pressure over the nerve.

• The nerve root is then gently moved to the side and the disc material is removed from under the nerve root.

Importantly, since almost all of the joints, ligaments and muscles are left intact, a microdiscectomy spine surgery does not change the mechanical structure of the patient's lower spine (lumbar spine).

When to have microdiscectomy spine surgery

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

If the leg pain does not get better with conservative treatments, then a microdiscectomy surgery is a reasonable option to relieve pressure on the nerve root and speed the healing. Immediate spine surgery is only necessary in cases of bowel/bladder incontinence (cauda equina syndrome) or progressive neurological deficits. It may also be reasonable to consider back surgery acutely if the leg pain is severe.

Microdiscectomy spine surgery is typically recommended for patients who have experienced leg pain for at least six weeks and have not found sufficient pain relief with conservative treatment (such as oral steroids, NSAID's, and physical therapy). However, after three to six months, the results of the spine surgery are not quite as favorable, so it is not generally advisable to postpone microdiscectomy surgery for a prolonged period of time (more than three to six months).

• Peter F. Ullrich, Jr., MD

December 18, 2003

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