Orthopaedic Procedures | Micro-Discectomy

Introduction

The discs lie between the vertebrae at the front of the spine. The disc has a soft centre (nucleus pulposus) and a tough outer layer (annulus fibrosus). The nerve roots coming out of the spine pass very close to the disc. Sometimes the outer layer of the disc becomes weakened allowing the disc to bulge or for the soft centre to protrude through the disc wall. As a result the nerve can be irritated and becomes painful. Nerve pain is usually felt along the path of the nerve, which varies depending on which nerve root is affected. Nerve pain is often very difficult to control with pain killers.

 

Sometimes the nerve does not function and weakness and numbness can occur. Rarely bowel and bladder function can be effected. If such neurological symptoms are experienced they should be reported immediately as they may require emergency treatment.

 

Micro-Discectomy

 

Operation

 

Micro discectomy is designed to take away the disc which is irritating the nerve resulting in resolution of the leg pain. The procedure is performed using a small incision in the middle of the back. The spine is approached and a small window is made in the spinal canal. The nerves are identified, protected and gently moved to expose the disc.
The disc is removed to decompress the nerve and the canal and disc space is explored to identify any other "loose fragments" which could cause problems later. A microscope is used to improve light and vision enabling a minimal access approach to be used.

 

When possible an anti adhesion gel is used to coat the nerve root to reduce the risk of tethering due to scar tissue.

 

The wound is closed with absorbable sutures leaving a short scar with no cross hatching and no need for suture removal. Occasionally the suture ends do require trimming.


Post op

 

After the operation you will be encouraged to mobilize as soon as possible with the assistance of physiotherapists and nurses. Once mobile enough to manage at home you can be discharged.


You will be give instructions with regard ongoing mobilization and physiotherapy. An outpatient appointment will be arranged.


Outcomes

 

The outcome of any surgery can not be guaranteed. Most patients experience a dramatic reduction in leg pain. Improvement in numbness and weakness if present is less certain. Any reduction in back pain is considered a bonus as the operation is not designed to primarily treat back pain.

 

In order to monitor the results of surgery you will be asked to complete outcome questionnaires from time to time.


Possible Complications

 

Most patients are pleased with the result of their surgery and do not suffer any adverse problems. Occasionally complications do occur and can require further treatment.

 

Nerve damage is rare during surgery. If it occurs it can cause areas of numbness, pins and needles and weakness. Neuralgic pain can also be troublesome.

 

Cauda equina syndrome is very rare and occurs when the nerves to the bowel and bladder are affected. Any numbness around the bottom or problems with passing stool or water should be reported immediately.

 

Scar tissue can form around the nerve root tethering the nerve causing ongoing pain. Occasionally further surgery is required to free up the nerve.

 

Infections can occur in the wound and rarely deep in the disc. These can be treated usually with antibiotics but occasionally require surgical cleaning and debridement.

 

Recurrence of the disc prolapse can occur and may require a further microdiscectomy procedure.

 

Residual disc material can sometimes be left behind in the canal despite careful exploration and further exploration may be required.

 

Damage to the lining of the nerve root (Dura) can result in a leak of fluid (csf). This is usually noticed and repaired at the time of surgery. A short period of bed rest is advised after the operation. Rarely the leak persists and has to be repaired surgically.

 

Post discectomy syndrome is the name given to the problem of having a damaged disc due to degeneration, prolapse and surgery. It causes aching in the low back and sometimes leg pain. It is usually treated with pain relief and physiotherapy and some modification of activity. Occasionally further surgery can be helpful.

 

Bleeding, most commonly from the small veins within the spine can be troublesome and is controlled at the time of surgery. Rarely bleeding continues post operatively and a second procedure is required to control it.

 

Neuralgic pain occasionally persists after surgery despite successful discectomy, and is thought to be due to inflammation, damage and fibrosis inside the nerve itself. This can not be treated surgically.

 

Anaesthetic complications will be explained by your anaesthetist.

 

Please be assured that every effort is made to avoid the complications listed and any others which can very rarely occur.


Questions

 

If you have any questions or wish to discuss things further please ask at any time. It is important that you have all the information you require and we will assist you in every way possible.

 

MR ANDREW HOWARD

Consultant Spinal and Orthopaedic Surgeon

Ref No MD0804