Percutaneous Discectomy for a Lumbar Herniated Disc

Overview

Microdiscectomy is surgery to remove part or all of a bulging or damaged (herniated) disc in the spine. A herniated disc in the low back (from the first lumbar vertebra to the sacrum) is called a lumbar herniated disc. If it irritates or presses on the spinal nerves, it can cause pain and numbness in the buttock and leg.

Surgery is done to stop the pressure on the nerves. This may help with pain and numbness. And it may help you move better. It will also help prevent further damage. Some people notice that their symptoms improve very soon. But your back may feel stiff and sore for a few weeks.

A doctor or nurse will give you medicine to make you sleep. You will not feel pain during the surgery.

Your doctor makes a 1- to 2-inch cut in the skin over the spine. This cut is called an incision. The doctor uses a microscope (scope) and surgical tools to remove a small amount of bone and other tissues around the bulging disc. Then your doctor removes the bulging part of the disc. You will have a small scar on your back. It will fade with time.

You will be asleep for the surgery. You might go home the same day you have surgery. Or you might need to stay in the hospital or surgery center overnight. If you work in an office, you may go back to work in a week or two. If your job requires physical labor (such as lifting or twisting), you may be able to go back to work in 4 to 8 weeks. Your doctor may also suggest physical therapy and home exercises.

What To Expect

After surgery, you will be encouraged to get out of bed and walk as soon as the numbness wears off. As you recover, you can slowly resume exercise and other activities.

Here are some other things to think about:

• You may not be comfortable sitting at first. But sitting will feel more comfortable over time.
• Walk as often as you can for the first several weeks. Getting up often to walk around will help lower the risk that too much scar tissue will form.
• Many people can go back to work and their daily routine soon after surgery. In some cases, your doctor may suggest a rehabilitation program. This may include physical therapy and home exercises.
• If you work in an office, you may go back to work in a week or two. If your job requires physical labor (such as lifting or operating machinery that vibrates) you may be able to go back to work 4 to 8 weeks after surgery.

Why It Is Done

Surgery is done to decrease pain and allow you to regain normal movement and function.

You and your doctor may consider surgery if:

• You have very bad leg pain, numbness, or weakness that keeps you from being able to do your daily activities.
• Your leg symptoms do not get better after at least 6 weeks of nonsurgical treatment.
• Results of a physical exam show that you have weakness, loss of motion, or abnormal feeling that is likely to get better after surgery.

Surgery is an emergency if you have cauda equina syndrome. Signs include:

• New loss of bowel or bladder control.
• New weakness in the legs (usually both legs).
• New numbness or tingling in the buttocks, genital area, or legs (usually both legs).

How Well It Works

Surgery for a lumbar (low back) herniated disc works well for many people, but not for everyone. For some people, it can get rid of all or most of their symptoms.

In a study of people who had sciatica caused by a herniated disc, the chances of having no symptoms or almost no symptoms 3 months to 2 years later was a little higher with surgery than with nonsurgical treatment. But, overall, most people felt better with or without surgery.^{footnote 1}

In a study of people who had 6 to 12 weeks of severe sciatica related to a herniated disc, one group was assigned to have surgery soon (the surgery group). The other group (the nonsurgical group) was assigned to try nonsurgical treatments for 6 months, followed by surgery if their symptoms didn't improve. Both groups were asked about their recovery 2 months after surgery or the start of nonsurgical treatment. People in the surgery group felt better (closer to complete recovery) than people in the nonsurgical group. But after 1 year, both treatment groups rated their recovery about the same.^{footnote 2}

If you don't choose surgery now, you can change your mind later if your symptoms haven't gotten better or have gotten worse even with other treatments. Surgery seems to work just as well if it's done within 6 months after symptoms start.

Risks

As with any surgery, there are some risks.

• Surgery doesn't always work. Or it may not work any better than other treatment.
• There is a slight risk of damaging the spine or nerves.
• There is some risk of infection.
• There are risks with anesthesia.