A microdiscectomy is a type of back surgery.
Microdiscectomy surgery is used to remove “herniated disc material that is pressing on a nerve root or the spinal cord”. The discectomy is usually done as microdiscectomy, which means that there is a microscope used to see the nerves and disc so that the surgeon can make a smaller cut, damaging less of the surrounding tissue. Prior to removing the disc material, “a small piece of bone (the lamina)” might also be taken out during a laminectomy (laminotomy) in order for the surgeon to see the disc better. Discectomy surgery is performed in a hospital while the patient is numb or asleep, and it generally requires an overnight stay. One type of this surgery is lumbar microdiscectomy. The patient is asked to be mobile soon after surgery and will be given medication to control the pain during recovery. At first it will be hard to sit, but over time, patients can resume normal activities. This surgery is done to decrease pain and improve movement. Patients who opt for a lumbar microdiscectomy do so for a variety of reasons, such as leg pain, weakness, or numbness that prevents regular activities, leg pain that does not improve after four or more weeks of non-surgical options, or if a patient has an emergency situation such as cauda equine syndrome. With cauda equine syndrome, patients lose bladder or bowel control, have weakness in both of the legs, and tingling or numbness in the genitals, legs, or buttocks. Surgery carries risks: it may not work, the spine or nerves may be damaged, there is a risk of infection, and anesthesia itself could cause problems.1 Many people opt for a lumbar microdiscectomy to “alleviate sciatica”.2
Microdiscectomy Recovery and Success
At first, patients may be uncomfortable when sitting for longer than 15 minutes. It will help if a patient can walk around as often as possible. Some may need a rehabilitation program of home exercises combined with physiotherapy, but many can resume regular activities quickly. For office workers, work can resume in “2 to 4 weeks”, but for those who have jobs with physical labor (vibrating machinery, lifting), the recovery period is about “4-8 weeks”. The microdiscectomy success rate is variable. In “a study called SPORT”, some people had surgery but others did not, and after two years, out of the 500 people, “most people felt better and were able to be active, whether they had surgery or not”. In another study following 500 people for ten years, “people who started with medium to very bad pain tended to feel better sooner if they had surgery”, but the surgical and non-surgical groups were similarly able to perform regular activities after five or 10 years.3 The recovery approach had been traditionally to limit lifting, bending, and twisting for 6 weeks to prevent the recurrence of a disc herniation in the lumbar region, but the “disc covering has a poor blood supply”, so healing the hole “may take three to four months to scar over”. Therefore, activity restriction will not always prevent the recurrence of a herniation. Furthermore, resuming activities quickly might help patients heal sooner, so it is now encouraged that they stretch, condition, and strengthen.4 Although the microdiscectomy success rate is “90% to 95%”, unfortunately “ 5% to 10% of patients will develop a recurrent disc herniation”, usually within three months of the surgery, but sometimes years later. Patients who have a recurrence have a higher rate of it happening again. For those, spinal fusion may be suggested.5 During the microdiscectomy recovery period, patients should eat their regular diet and have plenty of fluids. They may have trouble with bowel movements, but straining and constipation should be avoided. Fiber supplements or laxatives might help.6
Alternatives to Microdiscectomy
Surgery carries many risks, and the cost of a microdiscectomy is expensive and could range from $15K-$75K, with additional hospital bills of about $15,000.7 Before undergoing surgery for sciatica or lower back pain, patients should consider all therapy options, including chiropractic and massage care. Physical therapy and chiropractic can alleviate sciatic nerve pressure. Ice massage therapy and heat therapy, given in an alternating manner, could also be useful. For some patients, NSAIDS or steroids may be used to manage pain.8 Surgery should be considered the last resort option. Chiropractors offer various treatment modalities, and they can help patients with nutrition, tension, stress, and exercises for relaxation and strength.9 For lower back pain, a massage therapist might work on the quadratus lumborum (QL) muscle or the gluteus medius.10 A recent study showed that massage helps to treat “persistent low back pain”, more than taking NSAIDs. In fact, “36% and 39% of patients…said their pain was nearly or completely gone, compared to 4% in the usual care group”. The type of massage received did not matter in that 10 week study of 400 people.11