A microdiscectomy is generally considered a minimally invasive surgery, as there is minimal disruption of the tissues and structures in the lower back.
A variation of the microdiscectomy surgery is an endoscopic microdiscectomy.
Traditional Microdiscectomy Surgery Step-By-Step
A microdiscectomy is performed through the back, so the patient lies face down on the operating table for the surgery. General anesthesia is used, and the procedure usually takes about one to two hours.
These steps are typical:
- A microdiscectomy is performed through a 1 to 1½-inch incision in the midline of the low back.
- First, the back muscles (erector spinae) are lifted off the bony arch (lamina) of the spine and moved to the side. Since these back muscles run vertically, they are held to the side with a retractor during the surgery; they do not need to be cut.
- The surgeon is then able to enter the spine by removing a membrane over the nerve roots (ligamentum flavum).
- Operating glasses (loupes) or an operating microscope allow the surgeon to clearly visualize the nerve root.
- In some cases, a small portion of the inside facet joint is removed both to facilitate access to the nerve root and to relieve any pressure or pinching on the nerve.
- The surgeon may make a small opening in the bony lamina (called a laminotomy) if needed to access the operative site.
- The nerve root is gently moved to the side.
- The surgeon uses small instruments to go under the nerve root and remove the fragments of disc material that have extruded out of the disc.
- The muscles are moved back into place.
- The surgical incision is closed and steri-strips are placed over the incision to help hold the skin in place to heal.
In a microdiscectomy, only the small portion of the disc that has herniated—or leaked out of the disc—is removed; the majority of the disc is left as is.
Importantly, since almost all the joints, ligaments and muscles are left intact, a microdiscectomy does not change the mechanical structure of the patient's lower spine (lumbar spine).
After the Surgery
Patients typically stay in the surgery center or hospital for a few hours after surgery before being released to return home. Depending on the patient’s condition, one overnight stay in the hospital may be recommended.
Following the operation, patients may return to a relatively normal level of activities quickly. Patients are typically encouraged to walk within a few hours of the surgery.
The surgeon will provide home care instructions, typically including medications, activity restrictions, a follow-up care appointment, and other information.