To view an animation of the surgery, click on the projector to the left.
The Surgeon’s Role
Your surgeon will:
- Review your neurological history and examination
- Review your diagnostic studies (such as a myelogram, CAT scan or MRI)
- Plan a surgical approach
- Review the procedure with you
You must have a thorough understanding of the diagnosis (what is causing your back and/or leg symptoms) and the risks and benefits of the proposed surgery. Once you are confident that surgery is the correct option for you, turn your thoughts to the future and the recovery process.
Beginning the Operation
In the operating room, a lumbar microdiscectomy begins with a small incision in your lower back. Through this opening, your surgeon will insert microsurgical instruments. Because the work is viewed through a microscope (Fig. 6, above), this approach requires a relatively small incision.
Reaching The “Pinched” Nerve
Guided by diagnostic studies, your surgeon will remove a small portion of bony material from the back of your vertebra (Fig. 7). Once this material is removed, the surgeon can locate the exact area where the nerve root is being pinched.
Identifying the Cause of the Pressure
Once the “pinched” nerve is located, the extent of the pressure on the nerve can be determined. Using microsurgical procedures, your surgeon will remove the ruptured portion of the disc and any disc fragments which have broken off from the main disc (Fig. 8). The amount of work required to complete your microdiscectomy will depend in part on the number of disc fragments present and the difficulty presented in finding and removing them.
Closing the Incision
The operation is completed when each layer of the incision is closed with suture material (stitches) or surgical staples. If the outer incision is closed with staples or non-absorbable sutures, they will have to be removed after the incision has healed.
The Healing and Recovery Process
Once the ruptured disc has been removed, healing can begin (Fig. 9). Healing is the body’s natural process of restoring its damaged tissues to a normal, or nearly normal condition. Healing occurs on its own, but is influenced by such factors as general good health, physical fitness, nutrition and rest. Recovery is the process during which you work at becoming well. You must commit yourself to staying in good health (exercising), maintaining a positive mental attitude and following your physician’s instructions.
Have Realistic Expectations
Recognize that healing and recovery will not happen overnight. It is a process. You may find that much of your progress will be like taking “two steps forward and one step back.” Accept it! And then do all that you can to make sure your steps “forward” are large ones and your steps “backward” are small ones.
Be Patient and Persistent
During the recovery period in the hospital and at home, try to rebuild your strength gradually. Rest when you feel fatigued – but be persistent in your efforts.
It is important for you to recognize that we all heal at a different rate. The speed at which you will recover depends in part on your age, your general level of health, your overall physical fitness and your mental attitude. Generally, you will heal more slowly if you are overweight, out of shape or smoke, or if you are a diabetic or have other pre-existing medical problems.
Expect Some Pain After Surgery
It is normal to have some pain after any operation. After a lumbar microdiscectomy, there may be some leg “aching” which occurs as the nerve(s) attempts to heal. You also may feel some muscle spasms across your back and down your leg(s). And if there was inflammation in the nerve root, some pain may persist until this inflammation diminishes. You will be given appropriate medication to control your pain, relieve back spasms and reduce inflammation.
Be Prepared for Some Emotional Changes
It is not unusual to feel tired and discouraged for several days following surgery. These feelings may be your body’s natural reaction to the cutback of extra hormones it generated during surgery. Although some emotional letdown can be expected, you must not let it get in the way of your recovery. Don’t look back at past problems. It is important for you to look at even the smallest positive steps you make as progress towards your recovery goal.
Develop a Positive Mental Attitude
You should begin to work on a positive mental attitude even before the surgery is performed. Direct your energies toward the solution of your problem, rather than worrying about what caused your problem. Don’t be discouraged by minor setbacks during the recovery process. Concentrate on the progress you make, and will continue to make in the future.
Commit to a Healthy Lifestyle
Now is the time to commit yourself to a healthier lifestyle. You can begin by taking these important steps:
- Watch your weight: If you are overweight, you must gradually return to your proper weight. Crash diets rarely work. Commit yourself to better eating habits and stay with them for the rest of your life.
- Become more active: Your physician will tell you when you can resume normal physical activities after surgery. Make up your mind now that you will develop a regular aerobic exercise routine, such as walking, swimming or riding a bike. However, always check with your physician before starting any exercise program.