Micro Discectomy / Laminectomy
Lumbar microdiscectomy is a surgical procedure employed to relieve the pressure over the spinal cord and/or nerve roots, caused by a ruptured (herniated) intervertebral disc. A herniated disc, common in the lower back (lumbar spine) occurs when the inner gelatinous substance of the disc escapes through a tear in the outer, fibrous ring (annulus fibrosis). This may compress the spinal cord or the surrounding nerves, resulting in pain, sensory changes, or weakness in the lower extremities.
It is usually indicated in patients with herniated lumbar disc, who have not found adequate pain relief with conservative treatment. This procedure involves the use of microsurgical techniques to gain access to the lumbar spine. Only a small portion of the herniated disc that compresses the spinal nerve is removed.
A microdiscectomy is performed under general anaesthesia. Your surgeon will make a small incision in the midline over your lower back. Through this incision, a series of progressively larger tubes are placed and positioned over the herniated disc. The affected nerve root is then identified. Your surgeon removes a small portion of the bony structure or disc material that is pressing on the spinal nerve using microsurgical techniques. The incisions are closed with absorbable sutures and covered with a dressing.
Following the surgery, patients will be discharged home on the same day or the next day. Post-operatively, patients are advised to gradually increase their activity levels. If required, physical therapy is started after four to six weeks of the surgery to improve strength and range of motion.
Benefits of microdiscectomy include:
- Less muscle and soft tissue disruption
- Shorter recovery time
- Minimal postoperative pain and discomfort
- Fewer risks of complications
Lumbar laminectomy is a surgical procedure to relieve the pressure over the spinal nerves which results in pain and numbness in the legs. The narrowing of the spinal canal can occur either due to wear and tear or degenerative changes of the different parts of the spine. This results in a condition known as spinal stenosis. Laminectomy involves the complete removal of the lamina, a small bony plate covering the spinal canal. Laminectomy is another spinal decompression surgical procedure in addition to foraminotomy and facetectomy.
The spinal nerves may be compressed due to following reasons:
- Age related wear and tear of the spine
- Excessive stress and strain causing weakening of the spinal disc
- Abnormal bulging or even rupture of the intervertebral disc into the spinal canal
- Degenerative changes such as bone spur formation around the facet joints or along the edges of the vertebrae
The symptoms of spinal stenosis and nerve compression include back pain, leg pain, leg numbness and difficulty in walking.
Lumbar laminectomy involves the following steps:
- The procedure is conducted under general anesthesia
- The patient is placed, facing downward, in a special frame
- This frame is designed to relax the abdomen to prevent blood loss as well as provide more space for surgery
Fluoroscopy is used to identify the positioning of the incision.
An incision is made through the skin, over the back, to approach the spine.
The muscles are retracted with the help of a retractor.
- The bony projections present on each side of the vertebra and the lamina are removed by cutting along the inner edge of the facet joint until the pedicle bones are reached.
- A small portion of the ligamentum flavum, present between the lamina bones and the spinal cord, is also removed.
- Removal of this ligament exposes the nerves present in the spinal canal.
- Soft tissues present around the spinal nerves are carefully removed with small cutting instruments.
- Any bone spurs or intervertebral disc fragments present near the nerves, are also removed.
- All of these surgical interventions help in relieving the pressure over the spinal nerves, present in the spinal canal
- Finally the muscles and soft tissues are repositioned and the wound is sutured.
Post operative care
Generally patients are discharged home on the same day of the surgery. Patients are instructed to move their back carefully and avoid strain for the next few days. Other post-operative instructions include:
- Avoid driving for at least 2-3 weeks
- Patient can perform light work after 4 weeks
- Avoid heavy work for at least 2-3 months
- Physical therapy should be started after 3-4 weeks
Risk and complications
There are always some complications associated with any major surgery. Some of the common complications associated with lumbar laminectomy include:
- Complications related to anesthesia
- Conditions such as thrombophlebitis
- Damage to the spinal nerves
- Persistent pain
- Spinal segments instability