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PATIENT GUIDE TO MINIMALLY INVASIVE LUMBAR MICRODISCECTOMY

A minimally invasive microdiscectomy is a common, safe and effective operation. Our practice generally carries out three such procedures per week, and Dr. Saris and Mr. Casper have performed well over a thousand. Below is a description of the procedure that we hope you will find helpful.

The most important thing to remember is that this operation has changed. We view this procedure the way you might view endoscopic knee surgery for a meniscus injury. A microdiscectomy is a 45-minute, outpatient, almost bloodless procedure with a very high cure rate during which a small piece of cartilage (your disc herniation) is removed under a microscope.

PREPARATION: You will be asked to shower using a special soap, the night before or the morning of the surgery. It will be given to you by the hospital at your pre-operative evaluation. You should not eat or drink anything after midnight before the day of the surgery. You will be instructed if you need to stop any medications prior to your surgery by our office staff, and which medications to take the morning of your procedure, by the nurse at your pre-operative appointment.

THE DAY OF SURGERY: When you come into the Operating Room, you will first enter the Holding Area. You will meet the nursing staff, the anesthesia staff, and have an intravenous placed. You will feel and remember nothing of the procedure. In general, it takes about 45 minutes. If you have friends or family waiting, from the time they leave you in the holding area to the time I come out to tell them how things went, is about 90 minutes.

At the start of the operation, you will be rolled gently onto your belly. A small incision is made in your low back, anywhere from half a toothpick to a toothpick in length. This incision is just big enough so that we can use the microscope. Most people understand a herniation like the jelly coming from a jelly donut when it is squeezed. In your case, the herniation is a small piece of cartilage about the size of a baby pea. This disc fragment is pressing the nerve against the bone. A small amount of muscle is moved aside to expose the spine. An opening in the bone is made, about the size of a little fingernail, to expose the nerve and the disc. The disk fragment is removed, but the normal and healthy disc is left behind. In all, far less than 5% of the disc is taken out. The operation is done under the operating microscope that provides a minimally invasive approach.

When the nerve is free, the operation is finished. The skin is closed, either with a surgical glue or stitches.

BENEFITS AND POST-OPERATIVE CARE: A pinched nerve causes pain, weakness and numbness in the leg. The benefit of surgery is that of resolution of the pain traveling down the leg, and the cure rate is over 90%. Usually it is immediate, but sometimes it is delayed over a few weeks.

In regard to strength, that usually improves quickly and is back to normal in a matter of a few months. Numbness is the least predictable in terms of recovery. The majority of the time, it will completely go away and you will feel back to normal. However, sometimes even years later, the numbness will persist. Although this is annoying, most people generally tolerate this well.

The benefit of outpatient surgery is the simple advantage of being in your own home and bed to recover from the microsurgery. Any pain medication you might receive via an intravenous in the hospital, you can take as easily by mouth at home.

Once you fully wake up from the anesthesia, you will be able to walk out of the hospital with a friend or family member. After the surgery, people usually have stiffness in the back that is moderate, but not severe. It will feel as if you pulled a muscle. The back pain, also called "incisional pain", will be bothersome for a few days, but then will ease off over a few weeks. You will be able to drive a few days after surgery. You can sleep in any position, and sit, stand and walk, as tolerated, without limitations. You will have a lifting restriction, and be asked to limit your bending and twisting, until instructed at your first postoperative appointment.

RISKS: Although this is an operation done with the greatest of care with a high-powered operating microscope, complications may occur. Fortunately, these are extremely uncommon, and a microdiscectomy is generally considered amongst the safest operations in all of neurosurgery. Bleeding. This is the main risk after the operation. In the lumbar spine after a microdiscectomy, this could result in weakness in the legs. However, in over 35 years of performing this procedure, I have not caused a single case of this. Infection. The approximate incidence of infection after a lumbar microdiscectomy is 1%. The majority of these are superficial infections involving the skin. These are generally easy to treat with oral antibiotics. On a rare occasion, the infection can track down to the disc itself, possibly requiring another surgery or intravenous antibiotics. Spinal fluid leakage. The lower spinal cord and nerves are covered by a membrane about half the thickness of a credit card, and leathery tough in texture. On occasion, while working near the nerve or lower spinal cord, we detect a small hole in this membrane. This can allow release of a watery fluid (spinal fluid). We repair the hole at the time of surgery. This usually heals quickly, though it may cause your hospitalization to be prolonged by a day or two. On a rare occasion, a second operation will be needed to repair the membrane, if it does not close completely. Vascular or bowel injury. There is a large artery called the iliac artery, that, along with the bowel, is just in front of the discs. In over 35 years, and in over 1000 procedures, I have never damaged the artery or bowel. I estimate the incidence of this to be under 1/100,000. Risk of anesthesia. In a generally healthy person, the risk from anesthesia is extremely low. The chance of death from this form of surgery is almost unmeasureable (less than 1:300,000). I have been performing these operations for over 25 years and this has not occurred to someone under my care for this condition.


You will see me before the operation, in the Holding Area, to answer any questions. Your postoperative appointments will occur at approximately 2 weeks and 6-8 weeks after surgery. Physical therapy will be started after the 2 weeks visit, if needed. In general, for a white-collar job you are back to work in 2 weeks, blue-collar job 6 weeks. Either the physician assistant or I are always available, 24 hours a day, 7 days a week, if there are any questions or concerns after your surgery.



_________________
Stephen Saris M.D.



Neurosurgery Associates, Inc.
1 Davol Square, Suite 302
Providence, Rhode Island 02903


(401) 453-3545

FAX (401) 453-3533

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Neurosurgery Associates
Neurosurgery Associates