This is a surgical procedure to treat a lumbar disc herniation.
Lumbar disc herniation
Lumbar refers to the lower end of the spine and the intervertebral disc (or disc) is the soft jelly like substance that lies between two adjacent vertebrae. Occasionally the central portion of the disc (nucleus pulposus) tears through the surrounding layers (annulus pulposus) and can compress and irritate the nerves extending from the spinal cord. This condition is referred to as a disc herniation (also referred to as disc prolapse or slipped disc). Compression and irritation of the nerves causes pain in the legs (sciatica), numbness, pins and needles, and muscular weakness in the legs. The presence and severity of these symptoms vary from person to person. Rarely, there may be difficulty in passing urine and stools.
Lumbar disc herniation
Indications for surgery
The symptoms subside in a majority of people without surgery. Surgery is considered when -
- Symptoms fail to subside following a reasonable period of non-operative treatment
- Significant muscular weakness resulting from the nerve compression
- Difficulty in passing urine and stools resulting from nerve compression
Lumbar Microdiscectomy - surgical procedure to treat a disc herniation
Anaesthesia: The surgery is performed under a general anaesthetic, with the patient lying face down on an operating table.
Procedure: The surgeon makes a 2.5-5cm incision (cut) on the skin over the affected area of the spine. The muscle is detached from the bone to reveal the underlying bone (lamina) that surrounds the nerves/spinal cord. A portion 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 adjacent loose disc fragments, are removed. The resultant space eventually becomes filled with scar (fibrous) tissue. A drain tube removes the blood that collects at the surgical site. Dissolvable sutures are used to close the skin.
Lumbar disc herniation
In the recovery room: Following surgery, you will be transferred to the recovery room and may feel some pain at the operated site when you wake up. You will be given pain medications, antibiotics, intravenous fluids to keep you hydrated and a urinary catheter will empty your bladder. When you are comfortable you will be transferred to your room.
In the ward: You will be allowed to drink sips of fluids after surgery and gradually progress to a full diet. Medications will be provided to reduce your pain after surgery and at home for the first 1-2 weeks. However, if you have excessive pain while you are in the hospital, the attending nurses should be informed. The day after surgery, the drain tube and the urinary catheter will be removed and you will be encouraged to walk wearing a brace to support your spine. You will stay in the hospital for 1-3 days and your surgeon will decide when you can go home.
At home: Once you are at home, it is important to stay active and take short walks at regular intervals to help reduce pain and hasten your recovery. Gradually increase the distance you walk each day but avoid strenuous activities, heavy lifting and twisting. You may require some help with chores and errands for the first few weeks and it is advisable to have someone to help with these activities.
Risks and potential complications
All surgical procedures are associated with a risk of complications and all risks should be discussed with your surgeon. Allergic reaction to the anaesthetic or other medications and unforeseen complications such as pneumonia, stroke or heart attack are not caused by the surgical treatment and although rare it may have serious consequences. Please let your surgeon and anaesthetist know if you are allergic to medications and if you have any medical problems (relating to your heart, lungs, diabetes or increased blood pressure) and provide a list of your current and past medications.
Surgical complications can include bleeding, infection, spinal fluid leak, injury to the veins and arteries near the spine or injury to the nerve tissue or its surrounding protective layer. Injury to the nerves may occur during surgery resulting in paralysis of certain muscles in the legs and loss of sensations. Loss of bowel and bladder control can also occur following nerve injury. An injury to the covering layers of the nerves (dura) can result in leakage of spinal fluid and may occasionally require a repeat surgery to control the leak.
Lumbar disc herniation - Axial view
Although antibiotics are given before and after surgery, there is a 1-5% incidence of wound infection. Superficial 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 region (urinary bladder, chest and skin) immediately prior to surgery, you may be at a higher risk of post-operative infection in the spine, so let your surgeon know.
Venous thrombosis (DVT: clotting of blood in your calf muscles) and pulmonary embolism are uncommon 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
Eighty to eighty-five per cent of patients have a good outcome after a lumbar disc surgery. While there is considerable relief of the leg pain after surgery, the pins and needles, numbness and weakness in the legs may take 3-6 months to resolve, depending on the duration and severity of nerve compression. If the compression has occurred for a long period, complete resolution of the abnormal sensations and weakness may not occur. There is also a 5-10 % incidence of recurrent disc herniation at the same level after surgery.
Notify your surgeon at once 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 in passing urine
Talk to your surgeon
This is a brief overview and does not contain all the known facts about your condition and the treatment options. Feel free to seek any clarifications from your surgeon and his team. It is important for you to obtain a clear understanding of your condition and the risks, benefits and limitations of the surgical procedure before proceeding.