Microdiscectomy Spine Surgery: Risks, Complications, and Success Rates

Microdiscectomy Spine Surgery: Risks, Complications, and Success Rates

microdiscectomy
Fig 1:
Approach for microdiscectomy
(larger view)

Usually, a microdiscectomy is performed on an outpatient basis (with no overnight stay in the hospital) or with one overnight in the hospital. Post-operatively, patients may return to a normal level of daily activity quickly.

Some spine surgeons restrict a patient from bending, lifting, or twisting for the first six weeks following surgery. However, since the patient's back is mechanically the same, it is also reasonable to return to a normal level of functioning immediately following this spine surgery.

There have been a couple of reports in the medical literature showing that immediate mobilization (return to normal activity) does not lead to an increase in recurrent lumbar herniated disc.

Microdiscectomy Success Rates

The success rate for microdiscectomy spine surgery is approximately 90% to 95%, although 5% to 10% of patients will develop a recurrent disc herniation at some point in the future.

A recurrent disc herniation may occur directly after back surgery or many years later, although they are most common in the first three months after surgery. If the disc does herniate again, generally a revision microdiscectomy will be just as successful as the first operation. However, after a recurrence, the patient is at higher risk of further recurrences (15% to 20% chance).

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For patients with multiple herniated disc recurrences, a spinal fusion may be recommended to prevent further recurrences. Removing the entire disc space and fusing the level is the most common way to absolutely assure that no further herniated discs can occur. If the posterior facet joint is not compromised and other criteria are met, an artificial disc replacement may be considered.

Recurrent herniated discs are not thought to be directly related to a patient's activity, and probably have more to do with the fact that within some disc spaces there are multiple fragments of disc that can come out at a later date. Unfortunately, through a posterior microdiscectomy spine surgery approach, only about 5 to 7% of the disc space can be removed and most of the disc space cannot be visualized.

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Also, the hole in the disc space where the disc herniation occurs (annulotomy) probably never closes because the disc itself does not have a blood supply. Without a blood supply, the area does not heal or scar over. There also is no way to surgically repair the annulus (outer portion of the disc space).

Following a microdiscectomy spine surgery, an exercise program of stretching, strengthening, and aerobic conditioning is recommended to help prevent recurrence of back pain or disc herniation.

Microdiscectomy Risks and Complications

As with any form of spine surgery, there are several risks and complications that are associated with a microdiscectomy, including:

  • Dural tear (cerebrospinal fluid leak) -- this occurs in 1% to 2% of these surgeries, does not change the results of surgery, but post-operatively the patient may be asked to lay recumbent for one to two days to allow the leak to seal.
  • Nerve root damage
  • Bowel/bladder incontinence
  • Bleeding
  • Infection

However, the above complications for microdiscectomy spine surgery are quite rare.

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