Minimally Invasive Lumbar Discectomy

Minimally invasive lumbar discectomy is a surgical procedure performed using specialized instruments inserted through a small skin incision in the lower back to remove part of a herniated disc in the lumbar spine.

The lumbar spine is the lower part of the backbone situated between the thoracic spine and the lumbar sacrum or tailbone. It is made up of 5 lumbar vertebrae. In between the vertebrae are intervertebral discs, which have a soft gel-like center and a harder outer covering. These discs act like shock absorbers to cushion the spine.

Indications 

Age-related degeneration or excessive pressure on the lower back due to lifting and bending activities can cause cracks in the outer covering of the lumbar discs resulting in herniation or bulging of the inner soft part of the disc that can press against a nerve root and cause significant symptoms. This is known as lumbar disc herniation.

A minimally invasive lumbar discectomy may be indicated if:

• Imaging studies such as an MRI or CT scan show a lumbar herniated disc
• You have significant back pain, tingling and weakness 
• You experience pain radiating down the leg
• Symptoms are not relieved by conservative treatments

Preparing for a Minimally Invasive Lumbar Discectomy

Specific instructions will be provided by your surgeon. In general, you should:

• Inform your surgeon regarding any health conditions, allergies, and medications.
• Avoid smoking as it can slow down the healing process.
• Follow the pre-surgery eating and drinking restrictions.

Minimally Invasive Lumbar Discectomy Procedure

A minimally invasive lumbar discectomy procedure involves the following steps:

• The surgery may be performed under general or local anesthesia.
• An approximately 1-inch incision is made in the midline of the lower back.
• A thin wire is passed through the incision until it contacts the bone.
• Progressively larger dilators are placed over the wire to gradually push the overlying muscles to the side to create a working channel through which the surgical instruments will be inserted.
• The protective membrane covering the spine, known as the ligamentum flavum, is removed.
• A small portion of the vertebra, known as the facet joint, may need to be removed to gain access to the compressed nerve and herniated disc.
• The nerve root is gently moved aside and the bulging portion of herniated disc that is pressing against the nerve root is excised or removed to reduce inflammation and pain. The healthy part of the disc is left in place.
• The surgical tools are then removed, and a bandage is placed over the incision site.

Recovery after a Minimally Invasive Lumbar Discectomy

You will be moved to a recovery room and monitored for a few hours to ensure there are no complications and then discharged home. You will need to have someone drive you home after the surgery. Specific postsurgical instructions will be provided by your surgeon. In general, you should avoid heavy lifting or excessive bending and may be required to wear a back brace for a short time. There may be some pain and discomfort for which medications may be prescribed. A slight discharge from the surgical site may occur, which is considered normal, but excessive drainage should be brought to the notice of your surgeon. Most patients can return to work or routine activities within a week’s time.

Risks and Complications

The risks and complications associated with a minimally invasive lumbar discectomy include:

• Bleeding or blood clots
• Damage to surrounding nerves
• Infection of the surgical site
• Reaction to anesthesia
• Failure to relieve symptoms

Benefits

The benefits of minimally invasive lumbar discectomy include:

• Significant relief of painful symptoms
• Smaller incision size
• No muscle excision
• Less postsurgical discomfort
• Minimal scarring
• Faster recovery

Summary

Minimally invasive lumbar discectomy is a surgical procedure to relieve symptoms associated with a herniated disc in the lower back.  The procedure offers significant relief to patients experiencing pain associated with a ruptured disc in the lumbar region when conservative treatment measures have failed.