This surgery treats lumbar disc herniation. The ‘lumbar’ refers to the lower back region.
Lumbar disc herniation
Your lumbar region is at the lower end of the spine, commonly referred to as the lower back. The lumbar is composed of intervertebral discs along with actual vertebrae. The discs are a jelly-like material, cushioning the two neighboring vertebrae. If the middle part of the jelly-like discs tears, it spills into the bordering layers. This can compress and irritate the spinal cord nerves – a condition called disc herniation (or disc prolapse/slipped disc).
Symptoms of a slipped disc include nerve irritation, a feeling of ‘pins and needles’ and even numbness. It can also cause pain specifically in the legs (sciatica) as well as muscle weakness. In rare cases, you may have trouble urinating or defecating. These symptoms vary in intensity and duration.
Indications for surgery
For a majority of people, these symptoms will fade without requiring any surgery. Surgery may be necessary when:
- Symptoms do not decrease following a reasonable period of non-operative treatment
- Significant or increasing muscular weakness due to the nerve compression
- Difficulties in urinating or defecating occur as a result of nerve compression.
Lumbar Microdiscectomy – surgical procedure to treat a disc herniation
Anesthesia: The surgery is done under general anesthesia. During the procedure, the patient will be lying face down on the operating table.
Procedure: The surgeon makes a 2.5-5 cm incision on the skin over the affected area. The muscle is then separated to expose the underlying bone (lamina) that surrounds the nerves/spinal cord. A fragment of the lamina (laminotomy) or the whole lamina (laminectomy) is removed along with the surrounding ligaments to expose the prolapsed disc. The bulging parts of the intervertebral disc, along with loose disc fragments, are removed. This now empty space is eventually filled with scar tissue. A drain tube is inserted to prevent any excess blood from filling up. The skin is closed with dissolvable sutures (stitches).
In the recovery room: After the surgery, you may feel some pain on the operated area when you wake up. Pain medications, antibiotics, and IV fluids will help you stay hydrated and stable. You may also receive a temporary urinary catheter to use the bathroom.
In the ward: After your surgery, you’ll be on a liquid diet before slowly going back to a full, regular diet. You will be provided with medications to relieve your pain for 1-2 weeks. However, please remember to notify a nurse if you feel extreme pain! Additionally, the drain tube and catheter will be removed a day after the surgery. You will then be able to walk around with a support brace. Typically, you’ll stay in the hospital for 1-3 days, depending on your surgeon’s suggestions.
At home: Remember to stay active to speed up your recovery! Take short walks every day and slowly increase the distance. Please avoid heavy lifting, strenuous activity, and excessive movement of your neck. If you can, try to have someone to help you with your chores and errands for the first few weeks. The last thing you want to do is over-exert yourself!
Risks and potential complications
Keep in mind all surgical procedures come with a risk of complications. You should thoroughly talk about these risks with your surgeon before the procedure. Remember to list out any allergic reactions to anesthesia or other medicines. Other chronic illnesses related to your heart or lungs – such as hypertension, diabetes and asthma – should also be disclosed. Provide a list of all your current and past medications. Remember, unexpected complications such as stroke, heart attack, and pneumonia are not caused by surgical treatment and are generally rare. However, these rare complications may have serious consequences.
Surgical complications may consist of infection, bleeding, spinal fluid leak, injury to the veins and arteries near the spine or injury to the spine’s nerve tissue or its surrounding protective layer. Injury to the spinal cord or the nerves may occur during surgery and can result in complete paralysis of all four limbs or paralysis of certain muscles in the arms or legs, with loss of normal sensation. Loss of bowel and bladder control can also occur in consequence of injury to the nerves. An injury to the covering layers of the nerves (dura) can result in a leak of spinal fluid and this may occasionally require a surgery again
Although antibiotics are given before and after surgery, there is a 1-5% chance of wound infection. Superficial mild infections can be treated with antibiotics, while deep infections may require a wound wash-out under anaesthesia. If you have had an infection in any other area (urinary bladder, chest and skin) immediately before surgery, you may be at a higher risk of post-operative infection in the spine, so make sure to let your surgeon know.
Deep vein thrombosis (DVT: clotting of blood in your calf muscles) and pulmonary embolism (clot migrating to your lungs) are not common after an elective spine surgery, particularly when you are out of bed and walking within 24 hours after surgery. We use calf compressors and TED stockings to prevent the clotting of blood in legs; we do not routinely use medications. However, if you have had an episode of DVT in the past, let your surgeon know.
Results of surgery
The good news is that 80 to 85% of patients have a better quality of life after a lumbar disc surgery. It may take 3 to 6 months for symptoms such as the ‘pins and needles’ feeling, numbness and weakness in the legs to completely go away. This depends on how severe the nerve compression was prior to surgery. These sensations and muscular weakness may not totally go away if nerve compression was happening for a long time. Additionally, there is a 5-10% incidence of recurrent disc herniation post-surgery.
Notify your surgeon immediately if you notice the following after surgery:
- Excessive bleeding
- Redness or discharge from the wound
- Persistent headache
- Weakness or numbness in the arms and legs
- Difficulty urinating
Talk to your surgeon
This is a concise overview and does not include all the known facts about your condition and the treatment options. If you have any questions, make sure to seek any clarifications from your surgeon and his team. It is important for you to attain a clear understanding of your condition and the risks, benefits, and limitations of the surgical procedure before taking action.