Microdiscectomy is a minimally invasive surgical procedure to remove a herniated disc in the spine. The surgery is performed under general anesthesia with the patient lying prone. A small incision is made and surgical tools are used to remove the protruding disc material compressing the nerve root. Post-operatively, patients are instructed to avoid heavy lifting and twisting to allow the incision to heal. Most patients can return to light work within 1-2 weeks and full activity within 4-6 weeks following microdiscectomy. Potential complications include cerebrospinal fluid leakage, nerve damage, and infection.

1. JOHNY WILBERT, M.Sc[N]
LECTURER,
APOLLO INSTITUTE OF HOSPITAL
MANAGEMENT AND ALLIED SCIENCE

2. DISKECTOMY:-
 Diskectomy is a surgical procedure to remove the
damaged portion of a herniated disk in the spine.
MICRODISCECTOMY:-
 The operation consists of removing a portion of the
intervertebral disc, the herniated or protruding portion that
is compressing the traversing spinal nerve root using a
microscopic surgical approach with a small, minimally-
invasive, poke-hole incision.
INDICATIONS:-
 Painful lumbar herniated disk

3. PROCEDURE:-
 The surgery is performed utilizing general anesthesia.
 A breathing tube (endotracheal tube) is placed and the
patient breathes using a ventilator during the surgery.
 Preoperative intravenous antibiotics are given.
 Patients are positioned in the prone (lying on the stomach)
position, generally using a special operating table with
special padding and supports.
 The surgical region (low back area) is cleansed with a
special cleaning solution. Sterile drapes are placed.

4.  A 1-2 centimeter longitudinal incision is made in the
midline of the low back, directly over the area of the
herniated disc.
 Special retractors and an operating microscope are used to
allow the surgeon to visualize the region of the spine, with
minimal or no cutting of the adjacent muscles and soft-
tissues.
 After the retractor is in place, an x-ray is used to confirm
that the appropriate disc is identified.

5.  A few millimeters of bone of the superior lamina may be
removed to fully visualize the disc herniation.
 The nerve root and neurologic structures are protected and
carefully retracted, so that the herniated disc can be
removed.
 Small dental-type instruments and biting/grasping
instruments (such as a pituitary rongeur) are used to
remove the protruding disc material.
 All surrounding areas are also checked to ensure no
additional disc fragments are remaining.

6.  The wound area is usually washed out with sterile water
containing antibiotics.
 The deep fascial layer and subcutaneous layers are closed
with a few strong sutures.
 The skin can usually be closed using special surgical glue,
leaving a minimal scar and requiring no bandage.
 The total surgery time is approximately 1 hour.

7. POST-OPERATIVE CARE:-
 Most patients are able to go home the same day or early
the next day after surgery. Before patients go home,
physical therapists and occupational therapists work with
patients and instruct them on proper techniques of getting
in and out of bed and walking independently.
 Patients are instructed to avoid bending at the waist,
lifting (more than five pounds), and twisting in the early
postoperative period (first 2-4 weeks) to avoid a strain
injury or recurrent disc injury.

8.  Patients should try to avoid sitting in the same position for
more than 45-60 minutes in the first few weeks after
surgery. After sitting for 45-60 minutes, patients should
get up and stretch or walk for a little bit, then sit down
again if desired.
 Occasionally, patients may be issued a small, soft lumbar
corset that can provide additional lumbar support in the
early postoperative period, if necessary.

9. Wound Care
 The wound area can be left open to air. No bandages are
required. Small surgical tapes affixing the suture should be
left in place. The area should be kept clean and dry.

10. Shower/Bath
 Patients can shower immediately after surgery, but should
cover the incision area with a small bandage and tape, and
try to avoid water hitting directly over the surgical area.
After the shower, patients should remove the bandage, and
dry off the surgical area. Small surgical tapes affixing the
suture should be left in place. Patients should not take a
bath until the wound has completely healed, which is
usually around 2 weeks after surgery.

11. Driving
 Patients may begin driving when the pain level has
decreased to a mild level, which usually is between 2-10
days after surgery. Patients should not drive while taking
pain medicines (narcotics).

12. Return to Work and Sports
 Patients may return to light work duties as early as 1-2
weeks after surgery, depending on when the surgical pain
has subsided. Patients may return to heavy work and
sports as early as 4-6 weeks after surgery, if the surgical
pain has subsided and the back strength has returned
appropriately with physical therapy.

13. Doctor's Visits and Follow-Up
 Patients will return for a follow-up visit at 8-10 days after
surgery. The incision will be inspected and one stitch will
be removed. Patients will be given a prescription to begin
physical therapy for back exercises, to start 3-4 weeks
after the surgery. Medications will be refilled if necessary.

14.  COMPLICATIONS:-
 Dural tear (cerebrospinal fluid leak
 Nerve root damage
 Bowel/bladder incontinence
 Bleeding
 Infection