Lumbar Discectomy (Microdiscectomy)

Overview

Lumbar discectomy is a surgical procedure to remove the portion of a herniated disc that is compressing a nerve root in the lower back. The procedure aims to relieve leg pain, numbness, and weakness caused by nerve compression. Microdiscectomy refers to performing this procedure through a smaller incision using magnification or microscope assistance.

Indications

This procedure may be considered when:

• •Lumbar disc herniation causing radicular symptoms (sciatica) that persist despite conservative treatment
• •Progressive neurological deficits such as weakness or numbness
• •Cauda equina syndrome (rare but urgent indication requiring emergent surgery)
• •Significant functional limitation affecting quality of life despite non-surgical management
• •MRI or CT findings correlating with clinical symptoms

How It Works

The procedure typically involves several coordinated steps:

• •Preoperative evaluation typically includes imaging review, medical optimization, and discussion of expectations
• •The procedure is usually performed under general anesthesia
• •A small incision is made in the midline of the lower back over the affected level
• •Muscle is carefully retracted to expose the lamina (back part of the vertebra)
• •A small portion of the lamina may be removed (laminotomy) to access the spinal canal
• •The nerve root is carefully identified and protected
• •The herniated disc fragment compressing the nerve is removed
• •Additional loose disc material may be removed from the disc space
• •The nerve root is confirmed to be free of compression
• •The incision is closed in layers

Risks

As with any surgical procedure, potential risks include:

• •Recurrent disc herniation at the same level
• •Infection (wound or disc space infection)
• •Bleeding or hematoma formation
• •Nerve root injury causing persistent numbness, weakness, or pain
• •Dural tear with cerebrospinal fluid leak
• •Persistent or recurrent pain despite technically successful surgery
• •Spinal instability (rare, more common with extensive disc removal)
• •General surgical risks including anesthesia complications and blood clots

Recovery Expectations

Recovery follows a gradual progression:

• •Many patients may go home the same day or after an overnight stay
• •Walking is typically encouraged soon after surgery
• •Activity restrictions such as limiting bending, lifting, and twisting are often recommended initially
• •Pain at the incision site is common and typically managed with medication
• •Leg pain relief may be immediate or may improve gradually over weeks
• •Physical therapy may be recommended to restore strength and flexibility
• •Return to desk work may occur within 2 to 4 weeks for many patients
• •Return to more physically demanding activities may require 6 to 12 weeks or longer
• •Full recovery and maximum improvement may require several months

Alternatives

Depending on individual circumstances, alternatives may include:

• •Continued conservative management including physical therapy, medications, and injections
• •Epidural steroid injections for temporary symptom relief
• •Activity modification and lifestyle changes
• •Endoscopic discectomy (minimally invasive technique available at some centers)
• •Laminectomy if stenosis is also present
• •Spinal fusion in cases of instability or recurrent herniation

Sources

• Mayo Clinic – Diskectomy
• Cleveland Clinic – Microdiscectomy