How Microdiscectomy Surgery Is Performed

Microdiscectomy is generally considered a minimally invasive surgery, as there is minimal disruption of the tissues and structures in the lower back.

Preparing for Microdiscectomy Surgery

Medical preparations help reduce the risk of complications during and after surgery and typically include:

• Reporting current medications. Patients itemize their medications, including homeopathic medications, vitamins, and nutritional supplements, and make sure they are safe to take before and after surgery. 
• Stopping specific medications. Two weeks before surgery, the patient may be asked to stop taking certain medications, including but not limited to:
  • Medications that make it more difficult for blood to clot, for example, aspirin or other blood-thinning medication, such as warfarin and clopidogrel 
  • Medications that suppress the immune system, such as steroids 
• Eliminating or cutting down on the use of tobacco products. Nicotine, the active agent in tobacco, impedes soft tissue and bone healing and increases the risk of postsurgical complications. It is highly recommended to stop using any product containing nicotine several weeks before and after surgery.
• Getting pre-approval from medical specialists. Additional specialists may be consulted if there are concomitant medical conditions, such as diabetes or heart disease.

Any specific questions or concerns regarding home and medical preparations should be discussed with the surgeon.

Microdiscectomy: Step-by-Step Procedure

The surgical approach 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.

• Microdiscectomy is performed through a small incision – usually 1-2 inches – in the midline of the lower back.
• 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, and in most cases, they do not need to be cut.
• The surgeon approaches the spine by removing a thick ligamentous membrane over the nerve roots (ligamentum flavum).
• Surgical glasses (loupes) or a microscope allow the surgeon to clearly visualize the surgical field.
• 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, such as forceps, to remove fragments of herniated disc material under the nerve root.
• The muscles are moved back into place.
• The surgical incision is closed, and surgical 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 or a small part of the disc—is removed; the majority of the disc is left intact.

Procedure and Technique Used in Endoscopic Discectomy

Endoscopic or percutaneous discectomy follows the same general principles as microdiscectomy but uses less invasive methods. ¹ Meyer G, DA Rocha ID, Cristante AF, Marcon RM, Coutinho TP, Torelli AG, Petersen PA, Letaif OB, DE Barros Filho TEP. Percutaneous Endoscopic Lumbar Discectomy Versus Microdiscectomy for the Treatment of Lumbar Disc Herniation: Pain, Disability, and Complication Rate-A Randomized Clinical Trial. Int J Spine Surg. 2020 Feb 29;14(1):72-78. doi: 10.14444/7010. PMID: 32128306; PMCID: PMC7043817.

• In the endoscopic technique, the disc is approached from the side.
• Through fluoroscopic (live-x-ray) guidance, guide wires and dilators are inserted into the soft tissues to create a working canal and provide access to the surgical site. 
• A cannula containing an endoscope is then inserted into this canal to access the area where decompression is needed. The endoscope allows visualization of the herniated parts of the disc and the surrounding spinal canal structures.
• Instruments such as forceps are passed through the working canal to remove the herniated part(s) and relieve pressure on the spinal nerves.

Endoscopic discectomy is a newer form of surgery than a microdiscectomy, but the approach is gaining popularity due to its potential benefits. ² Page PS, Ammanuel SG, Josiah DT. Evaluation of Endoscopic Versus Open Lumbar Discectomy: A Multi-Center Retrospective Review Utilizing the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) Database. Cureus. 2022;14(5):e25202. Published 2022 May 22. doi:10.7759/cureus.25202  

Post-Surgical Care After Microdiscectomy 

Patients typically stay in the surgery center or hospital for a few hours after surgery before being released to return home. In some cases, depending on the patient’s condition and ability to perform self-care activities, an overnight stay in the hospital may be recommended.

Within a few hours of the surgery, patients are encouraged to walk and may gradually return to a relatively normal level of activities. 

See Postoperative Care for Lumbar Microdiscectomy Surgery

The health care team provides home-care instructions, including medication schedules, activity restrictions, a follow-up care appointment, and other relevant postsurgical information.