Microdiscectomy Surgery in Delhi, India

Microdiscectomy is also called Microlumbar Discectomy (MLD). It is required to treat patients with lumbar disc prolapse who have significant pain, neuro deficits, or are not improving on conservative management. Neurosurgeons routinely perform this procedure. In this procedure, the herniated portion of the disc compressing the nerve root is removed so that there is no pressure on the nerve root, and the patient will be pain-free.

The herniated disc was traditionally removed by making a large incision, and complete disc removal was used. Because of the larger cut and more invasive surgery, it used to require more recovery time and hospital stay. Now, microdiscectomy is done under high magnification using microscopes, which provides 3D vision and requires a smaller incision. A smaller incision leads to fast recovery, less bleeding, and a smaller hospital stay.

When is Surgery needed?

Microdiscectomy is needed if:

• Leg pain occurs due to a herniated disc that does not get well with conservative management.
• Patient is having weakness of foot or leg with or without urinary symptoms.
• Pain is affecting the day-to-day activity of a patient and changing their lifestyle.
• Leg pain or sciatica is the patient's main symptom, rather than simply lower back pain

Diagnosis

To confirm the diagnosis, we need to do a quality MRI of the Lumbosacral region, examine the patient, and assess his pain and disability. When there is clinicoradiological correlation between the MRI and clinical examination findings, the patient is advised surgery. Before planning of surgery patient routine blood test are done and his/ her pre existing disease are evaluated and optimised before surgery. If a patient is on blood thinner depending on medication it has to be stopped for a short duration of time.

Treatment

Aim of surgery is to decompress the nerve by removing the herniated part of the disc which is compressing over the nerve root.

After general anaesthesia patient is made prone and after cleaning and draping under C arm guidance level of disc is confirmed and small cut  is mad and under microscope subperiosteally dissection is done and desired lamina is exposed and small laminotomy is made and ligament is excised and nerve root is identified which is under pressure after dissection using microscope under high magnification nerve root is retracted medially and disc level confirmed and prolapsed portion of disc is excised and now root is freed from pressure and lax root is seen. If there is any bleeding is controlled and the incision is closed with sutures and dressing is done. The patient is reversed from anaesthesia and depending on patient comorbidities, is shifted to the ICU of post operative care.

Who are the Best Candidates for surgery?

Any patient who has significant pain with or without neuro deficit with clinicoradiological correlation are good candidate for surgery and supposed to have relief in symptoms.

• Excruciating pain, weakness, or numbness in the limbs
• Leg pain or sciatica that is worse than a backache
• Persistent symptoms that have not improved with treatments such as physical therapy or medication
• Weakness in the legs, loss of feeling in the genital area, and lacking bladder or bowel control, a condition termed cauda equina syndrome.

Who Should Not Consider Surgery?

Microdiscectomy is not indicated in patients who are medically unfit for surgery or who are not willing to undergo it. There is doubt in the diagnosis.

Preparation for surgery

Patients are usually admitted a day before surgery and required blood tests and other investigations are performed. After fitness for anaesthesia is obtained, the patient is kept nil per oral overnight and the next day surgery is done in the morning. 

After the procedure, light, regular activities can be performed, such as walking, eating, and going upstairs. At the physician's discretion, one can start driving in about a week or less and exercising in about four to six weeks. Doctors evaluate the patient's progress and accordingly decide when they can resume normal activities.

Possible Complications

Even though microdiscectomy is a safe procedure, some complications may occur. These include:

• Dural tear or leakage of the cerebrospinal fluid
• Nerve root damage
• Bleeding
• Infection
• Recurrent disc herniation
• Bowel/bladder incontinence
• Recurrence of Pain or sometimes mild residual pain after the surgery

Care After Surgery

About two weeks after lumbar microdiscectomy, most patients begin to experience significantly less pain and a higher energy level. Therefore, a gradual return to more low-impact activities is recommended. However, it is still not advised to play contact sports, perform strenuous activities, or lift heavy objects. Performing light, regular activities helps heal tissues faster and regain strength in the back.

Activity Restrictions to Prevent Re-injury

Some activities that require excessive bending, lifting, and twisting are not advisable until fully recovered from the surgery. However, as the comfort level increases, patients can start performing slower yet gentle movements. Avoiding contact sports may be a good choice for at least six to eight weeks post-surgery.

Low-Impact Exercises

Low-impact workouts such as walking, stretching, and mild exercises help recover faster. They also permit better mobility and ease of living. Starting physical therapy under an expert's guidance will help, too. However, this is recommended after at least six to eight weeks post-surgery. Consult the surgeon before starting any new exercises or stretches.

Resuming daily activities

One can start and resume her daily routine activity after one week of discharge. One should avoid contact sports and lifting heavy weight for 6 weeks.

Review

Reviewed by Dr Kapil Jain, Principal Consultant – Neurosurgery, Neurosciences, Spine Surgery, Paediatric (Ped) Neurosurgery on 31 May 2024.