Surgical Treatment Options
For those patients
whose ruptured disc is pinching a nerve, a microdiscectomy often is
the recommended treatment. Lumbar microdiscectomy is usually
recommended when a ruptured disc is pinching a spinal nerve root(s)
and you have one or more of the following:
- Leg pain in a
pattern that corresponds to that particular nerve being pinched.
Pain limits your normal daily activities.
- Weakness
involving a muscle in the leg or foot that the pinched nerve
innervates.
- Numbness is your
extremities (surgery is rarely done for numbness alone, as surgery
may turn numbness to pain.
- Impaired bowel
and/or bladder function.
Lumbar microdiscectomy is an operation on the lumbar spine performed using surgical microscope and microsurgical techniques. A microdiscectomy requires only a very small incision and will remove only that portion of your ruptured disc, which is pinching the nerve. You will be put to sleep for the operation, and will lie on your stomach on a special padded frame. Your surgeon will remove a small portion of bone from the back of your vertebrae. Once this is removed, the surgeon can locate the exact area where the nerve is compressed. The ruptured portion of the disc, as well as any loose disc fragments, are removed. The outer casing, called the annulus, is left intact to maintain support. The amount of work and time required to complete the operation depends on the number of disc fragments present and the difficulty presented in finding them and removing them.
Following disc removal, an “anti-scarring” gel is applied to the dural sac (protective covering over the spinal cord and nerves) and to the nerve root. This gel decreases scar tissue formation, which in rare cases can cause compression of the nerve similar to the ruptured disc.
Each layer of the incision is closed with suture material (stitches) underneath the skin. The incision is injected with a long acting anesthetic to decrease post-operative pain. The skin is closed with skin staples, which are removed 7-10 days later. A small dressing is applied, and the patient is taken to the recovery room until awake. The patient is then transferred to the hospital room, where family/friends may visit.
Post-operative pain is well controlled by the use of a “pain-pump”. When pain is present, the patient pushes a button connected to the pump, which administers a small amount of pain medication directly into the intravenous line (I.V.). Pain is decreased or eliminated within several minutes.
The patient is usually up walking short distances the evening of surgery. The hospital stay is normally 1-2 days.
The Recovery Process usually lasts 4-6 weeks. The following are specific guidelines for patients of Dr. Robert Ho, M.D. following a lumbar microdiscectomy or a decompressive lumbar laminectomy:
- You should continue to gradually increase
your activity. Walking within and outside the home is encouraged.
Try to walk on a flat, hard surface, such as cement rather than
grass.
- Do not sit longer than 30 minutes for the
first several weeks. If you are uncomfortable, take a walk or lie
down. Sitting puts more pressure on you spine than lying or
standing/walking. Recliner chairs are acceptable as long as they
support your entire spine.
- Avoid lifting, bending or strenuous
activity. Do not lift objects greater than 5 pounds. Avoid lifting
above waist level and reaching above your head for any length of
time. Maintain a straight spine. Never bend from your waist. Use
your thighs to pick up something on the floor.
- Rest at frequent intervals. Fatigue
contributes to spasms of the back muscles.
- When standing for long periods of time,
you may rest one foot on a small stool or step, alternating
between feet.
- You are not allowed to drive for 2 weeks.
If you feel able and can work the gas and break pedals, you may
begin to drive short distances. Limit to approximately 30 minutes
at a time. We recommend driving first in a parking lot. You should
be able to firmly press the brake without pain before attempting
to drive in traffic. Use common sense and your level of pain as a
guide. If you still require narcotic pain medications, you should
not operate a vehicle or machinery.
- Limit your time in the car as a passenger
to bare essentials only such as traveling to the doctor’s office
for your follow-up appointment. After 2 weeks, you can increase
time as a passenger per comfort. Use common sense.
- Climbing stairs at home is permitted.
However, try to limit the number of times you climb the stairs to
two times a day initially. As you are feeling better, you may
slowly increase as necessary. Use a handrail if available. Take
your time going up and down stairs. Make sure to place your entire
foot on each step carefully.
- Sexual activity may resume after 2-4
weeks depending on level of pain. Again, common sense is
important. If certain activities increase pain levels, refrain
from those activities.
Click here for more detailed Post Operative Instructions
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