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
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.
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
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
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
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
Stephen Saris M.D.
Neurosurgery Associates, Inc.
1 Davol Square, Suite 302
Providence, Rhode Island 02903
FAX (401) 453-3533
© Neurosurgery Associates, Inc.