Lumbar Microdiscectomy
Who Needs It?
This is an operation performed to treat sciatica (leg pain) from a herniated disc. It is used when conservative methods of management such as rest, physical therapy, anti-inflammatory drugs and lumbar injections have failed to give adequate relief. Whether or not a patient is suitable for a microdiscectomy will depend upon the MRI scan or other investigations.
Pre operative advice
48 hours before surgery, take some gentle laxatives (colace, senna) to ensure you have your bowels opened on the day of surgery.
On the day of your surgery it is important to remain Nothing by Mouth (NPO). Do not eat past midnight the night before your surgery. However you may drink small amount of water to take any medications up to two hours before admission.
It is not necessary to bring your medications with you, as these are supplied from the pharmacy at the hospital (you can use your medications when you return home). However, if you take a number of medications, please bring a list of names and doses so they can be appropriately supplied by the pharmacy department.
Please BRING YOUR SCANS WITH YOU to the hospital.
Please avoid smoking on the day of your surgery.
Please shower or bathe as normal in the morning, and remove any make up or nail polish.
How is it done?
The operation is performed under anaesthetic (usually a general anaesthetic, but an epidural can be used as an alternative) with the patient lying face down in the operating theatre. A small incision is made on the back, over the bad disc, which usually is only 2 – 3 cms in length and the spine is exposed by retracting the muscle slightly (only around 1.5 – 2 cms). A small portion of the yellow ligament (the ligamentum flavum) is removed. The surgeon can see the trapped nerve root using a microscope to obtain better vision and illumination and remove the bulging disc tissue below it. This frees up the nerve and allows the surgeon to empty any more disc material out of the disc space as needed.
Post operative care
You will wake up recovery, where you will spend a short time recovering from the anesthetic and then you will be transferred back to the floor.
You will remain to be Nothing By Mouth (NPO) until you begin having bowel sounds again. The bowels maybe slow to begin working again, and it is important not to eat or drink too quickly post operatively to avoid sickness and further complications. You will have maintenance fluids intravenously to keep you hydrated.
On day 1 post operatively, you will be seen by the physical therapy team on the floor. They will start teaching you how to safely get out of bed, and will help you to start walking again. You may feel lightheaded or dizzy the first few times you get up – this is normal, and will wear off. The therapist may also fit you with a brace to support your spine. You will have to wear this for at least 2 weeks.
Your wounds will be managed by the nursing staff; they will be dressed as needed. They will also provide you with the appropriate information for discharge.
When you go home
For the first 6-8 weeks, it is important that you take things easy. Do not start lifting or exercising during this period. You may walk about as pain allows, while wearing the brace, but not too vigorously. Several short walks, rather than one long walk.
You will not be permitted to drive for 4-6 weeks. However you may be a passenger during this time, as long as you take regular rest periods to adjust your position and wear your brace.
Flying is not a problem, but airports are. Avoid carrying luggage, especially off the carrousel. Try to avoid sitting for too long – get up and exercise when it is safe to do so. Please also check with your airline before flying.
With regards to working, please discuss this with your surgeon, as this varies depending on the work you do. Patients may return to work in a sedentary occupation when they feel comfortable. Those in manual jobs may need to be off work for longer, until the fusion is solid, as demonstrated by the x-rays.
The nursing staff on the floor will have given you some information on wound care prior to discharge. If you have any concerns regarding you wound, please do not hesitate to contact us. In general, all dressings can be changed after 72 hours, with a new dressing applied every day thereafter if the incision is draining. However, if no drainage is present, the dressing may be discontinued. Moreover, you may shower and wet the incision after 72 hours, but bathing or soaking the incision is not recommended for 2 weeks.
Pain killers can be constipating so we encourage you to eat food that will help to keep your bowels working well. Drink plenty of water. You can take colace, senna and/or fiber to help with constipation.
Rehabilitation
From 2 weeks post op, assuming the x-ray appearances are satisfactory, you will start physical therapy. These exercises are very gentle initially and increase over 6 weeks, so that by 12 weeks post-op you will be in the gym, swimming or cycling regularly.
Patients are seen at 2 and 6 weeks post-operatively and then at 3, 6 and 12 months with x-rays taken at each visit to determine the stage of healing.
Outcome of surgery
The aim of the operation is not to completely remove the disc, but to remove the parts which are trapping the nerve and causing the pain. The emptying of the disc space is always only partial. There is, therefore, the risk of further disc material coming out of the space at a later date, but this is a rare complication. Other potential complications include infection, which can lead to long term pain in the back if the disc itself is involved or nerve root damage which can lead to weakness or pain or both in the leg. These complications are rare and microdiscectomy remains a very good treatment for sciatica if other treatments have failed.
What are the Results?
Most people will have an improvement in their pain, but there are many factors determining success. These need to be discussed in detail with your surgeon. SMOKING is known to badly affect the outcomes of surgery.