Lumbar Microdiscectomy for Lumbar Disc Prolapse

What is a lumbar disc prolapse?

A lumbar disc prolapse is a protrusion of part of a lumbar disc.  When the protrusion presses against one of the nerves in the back, pain radiates down the leg.  This pain is called sciatica.  Lumbar disc prolapse is also called prolapsed disc, protruding disc, herniated disc, ruptured disc, collapsed disc and slipped disc.

What causes a disc prolapse?

Most people with sciatica have experienced minor or intermittent backache previously.  Over a number of years, the disc gradually deteriorates.  Eventually, the weakened disc prolapses and the severe symptoms develop.  Often, people develop sciatica without being aware of any specific injury or event.  While some everyday activity, like a game of tennis or a day's gardening seems to have caused the prolapse, this is really only "the straw that has broken the camel's back".  A normal, healthy disc does not prolapse unless a severe accident occurs.

How is a prolapse diagnosed?

Often, a diagnosis can be made with CT scans of the lumbar spine.  An MRI scan may also be required.  An MRI scan is a simple and safe test, similar in many ways to a CT scan.  MRIs use a technique known as magnetic resonance imaging.  No radiation is involved.  There is no need to be admitted to hospital and usually no need for injections, although people prone to claustrophobia may find the examination stressful and should discuss their anxiety with medical staff at the time of the test.  People with heart pacemakers cannot have an MRI.

Why do I need surgery?

The main reason for surgery is to relieve sciatica, the pain that radiates down your leg.  Surgery is performed on the back, to treat the leg.  Surgeons do not usually perform a disc operation to relieve back pain.  If there is evidence of nerve damage causing weakness in your foot or leg, surgery may also be advisable, even if the pain is not severe.

What happens during the operation?

Prior to surgery, you may be taken to x-ray for a 'marker'. The radiologist places a small mark over the problem area in the spine, usually involving a minor injection just into the skin.

During the operation, the surgeon makes an opening between the vertebrae, normally no bigger than a five-cent piece in diameter, through an incision running vertically over the small of the back.  The protruding disc is identified, the nerve moved gently to one side, and the protrusion trimmed flush.  Often, the surgeon will remove some additional disc material to reduce the risk of prolapse recurrence, especially in the early weeks after the operation.  A small hole is left in the disc at the site of the prolapse, which seals naturally after several weeks.

Often a lumbar microdiscectomy is called a laminectomy, but a laminectomy involves removing part of the vertebra known as the lamina.  Usually, a microdiscectomy is performed without removing the lamina.  Occasionally, however, it is necessary to remove the lamina to get to the disc prolapse. 

What risks and complications are there?

Serious complications are rare and the risk of death is remote.  As with any operation, there may be general complications related to age and underlying disease.  A 75-year-old with diabetes and heart disease has a greater risk of complications than, for example, a 40-year-old in perfect health.  General complications can include stroke, heart attack, bleeding in the wound post-operatively, blood clots in the legs (which can travel to the lungs or heart) and infection.

Possible complications specific to a lumbar microdiscectomy include damage to one or more of the nerves travelling through the spinal canal, which could cause permanent numbness or weakness in the legs or feet (or to some part of either leg) and, on rare occasions, affect control of the bladder or bowel.

Failure of the surgery to meet expectations (without anything going wrong) is a possibility.  Sometimes, despite the best efforts of the surgeon and patient, symptoms do not respond to surgery as expected.  This occurs in up to 10 per cent of cases.

What can I expect after the operation?

There will be some pain around your wound and in your leg in the first few days.  An intravenous drip inserted during the operation will provide strong pain relief in the first 48 hours or so.  After that, you will be given tablets and occasional injections, as required.  It will be difficult to roll over in bed for the first few days.  You should be able to stand about 48 hours after surgery, although you may feel able to try this sooner.  After a few days, most people are able to get in and out of bed unassisted and walk around the ward quite comfortably.  Bowel actions normally do not occur until four or five days after surgery.

Will I need physiotherapy?

Most patients see a physiotherapist during their hospital stay, mainly to ensure that they are doing simple movements, like getting out of bed, correctly.  Usually, there is no physiotherapy during the first six weeks or so after discharge from hospital, and only a small number of people need on-going physiotherapy after that.

What should I do when I get home?

For six weeks when you get home, the two most important things to do are to rest and to walk.  Your wound needs time to heal, internally as well as externally.  Avoid undue bending and lifting.  Minimise sitting to essentials such as eating and toileting.  It is advisable to avoid driving, and even sitting as a passenger, in a car.

Schedule two good walks of about 15 minutes each per day.  Swimming is excellent exercise after spinal surgery but you should wait to begin until after your post-operative review, which is usually six weeks after surgery.

In most cases, the symptoms caused by the disc prolapse will have eased within six weeks of surgery but this varies greatly from person to person.

Will I need rehabilitation?

Many people do not need formal rehabilitation.  If, however, it will be difficult for you to cope alone at home, or you were significantly incapacitated prior to surgery, or have complicating medical conditions that might slow your recovery, rehabilitation is advisable.

If your disc prolapse is the result of a work injury, you might need a rehabilitation program (as an inpatient or outpatient) that takes account of the nature of your work, the size of your workplace, the duration of symptoms and the details of your surgery.  The program may involve input from a number of people, including your family doctor, employer or rehabilitation service providers.

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