Indications:
This surgery is indicated in patients who have radicular pain (commonly known as sciatica) that does not resolve with conservative measures including steroid injections and painkillers. Other indications are paralysis/weakness of the leg, pins and needles, bowel or bladder disturbances mainly incontinence.
Operative Procedure
A microdiscectomy is done through a 1.5 to 2cm incision usually on the left or right of the midline depending on the side of the disc prolapse, or with a midline incision. This can also be done via a standard laminectomy for various indications that Mr Bhaskar would discuss prior to consenting for surgery.
The patient is place tummy down on the operating table under general anaesthesia. X-ray is used to identify the correct level before making the incision. The paraspinal muscles are separated from the spinal lamina and a retractor is placed. Under the microscope, the lamina is drilled with a drill and access to the disc is achieved. After moving the nerve with a small retractor, the part of the disc that is pressing on the nerve is removed. After the nerve is adequately freed, the wound is closed.
Risks/Complications
- Infection – Superficial infections are more common than deep infections.
- Bleeding – A small chance of bleeding requiring further surgery.
- Recurrence of disc prolapse – most common complication, about 1 in 10.
- Non-resolution of symptoms, especially numbness.
- Paralysis or weakness due to aggravation of previous nerve damage or new nerve injury during surgery – very uncommon.
- Damage to covering of nerves causing leak of fluid – treated at the time of surgery, but rarely can leak from wound.
Post-Operative Period
Most patients are discharged the day after surgery and are expected to start doing things that they were used to prior to the disc prolapse. Driving might be an issue and most patients are expected to drive around the 2 weeks mark. Try and avoid twisting and bending while picking up things off the floor and instead try to bend at the hips, knees and ankles. Sporting activities, especially contact sport requiring excessive twisting movements can commence 3 months after surgery. Post-operative review will be in 4-8 weeks.
