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Lumbar Disc Microsurgery Discectomy - Learn The Procedure
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A Lumbar Disc Microsurgery is a technique of performing low-back surgery through a small opening. There are two types of lumbar microsurgery. Micro decompression is removal of bone from the spine. Microdiscectomy is removal of the disc. This removal takes pressure off nerves and reduces symptoms. Degenerative changes of the lumbar spine are an important cause of morbidity in adults. Changes include lumbar spinal stenosis with neurogenic, claudication as well as lumbar disc herniation, both of which can lead to back pain, sciatica, and radiculopathy. Lumbar disc microsurgery is used to treat patients suffering from herniated discs in their lower backs, which occur when the inner, jelly-like material of discs pushes through the outer layer of cartilage and puts pressure on the spinal cord. This procedure removes only the damaged part of the disc, leaving the healthy remainder intact. The surgeon makes an incision into the back through which a small window is made into the bone directly above the herniated disc. The spinal cord is gently moved aside while the damaged disc material is removed. As the patient heals, the spinal cord returns to its normal position, the pressure from the damaged disc is relieved, and the pain is alleviated.
Herniated discs are often known as slipped disc. The term is derived from the action of the nuclear tissue when it is forced from the center of the disc. The disc itself does not slip. However, the nuclear tissue located in the center of the disc can be placed under so much pressure that it can cause the annulus to herniate or rupture. When the disc becomes herniated or ruptures, it may create pressure against one or more of the spinal nerves which can cause pain, weakness or numbness in the lower back, leg or foot. A herniated disc in the cervical spine can cause similar symptoms that extend from the neck into one or both arms. Sometimes the symptoms are so severe that activities of daily living are limited. Fortunately, most patients respond well to medication, physical therapy and time. Surgery is considered only if significant symptoms persist despite a good trial of non surgical treatment.
Procedure of Lumbar disc microsurgery
An incision is made in the midline of the low back, directly over the area of the herniated disc. Special retractors and an operating microscope are used to allow the surgeon to visualize the area of the spine, with minimal or no cutting of the adjacent muscles and soft-tissues. After the retractor is in place, an x-ray is used to confirm that the appropriate disc is identified. A few millimeters of bone of the superior lamina may be removed to fully visualize the disc herniation. The nerve root and neurological structures are protected and carefully retracted, so that the herniated disc can be removed. Small dental-type instruments and biting/grasping instruments are used to remove the protruding disc material. All surrounding areas are also checked to ensure no additional disc fragments are remaining. The wound area is usually washed out with sterile water containing antibiotics. The skin can usually be closed using special surgical glue, leaving a minimal scar and requiring no bandage. The surgery takes approximately 1 hour. This minimally invasive procedure removes the herniated portion of a damaged disc in the spine. It is 95 - 98 percent effective in eliminating sciatica caused by nerve root impingement.
Pain after any operation is common and expected. After a lumbar microdiscectomy, there may be some pain in the leg which occurs as the nerve attempts to heal. The patient may feel some muscle spasms across the back and down the legs. And if there was inflammation in the nerve root, some pain may persist until this inflammation diminishes. The patient will be given appropriate medication to control pain, relieve back spasms and reduce inflammation.
- Opening the Lamina
After creating a small incision directly over the herniated disc, the surgeon makes a small opening in the lamina to gain access to the spinal canal. With the help of a microscope, the surgeon can see the pinched nerve root and the herniated disc through the opening.
- Moving the Spinal Cord
Using a nerve retractor, the surgeon slowly and gently moves the spinal nerve away from the herniated disc, giving him the space to perform the surgery.
- Removing the Herniation
The surgeon identifies and removes the herniated section of the disc. It stops the pressure the disc exerted on the nerve root, which also eliminates the leg pain. Complications of Lumbar disc microsurgery
- Dural tears
- Failure to improve
- Spinal fluid leak
- Nerve root injury
- Wound problems