Minimally invasive disc surgery

Microscopic disc surgery

Microdiscectomy Surgery is considered the gold standard for getting rid of disc pain suffered by the elderly, so it is performed by the most skilled neurosurgeons in Turkey.

Microscopic disc surgery, is the microexcision of the herniated disc, thereby reducing pressure on the spinal nerve root by removing the material that causes pain.

during operation, A small portion of the bone above the nerve root and/or disc material below the nerve root may be removed.

Microscopic herniated discectomy (also called microscopic perineural decompression) is usually more effective in relieving leg pain (also known as radiculopathy or sciatica) than lower back pain:

For leg pain, patients will usually feel immediate pain relief after a microscopically assisted discectomy.
Most of the time, they return home after surgery, after their pain is completely gone.

For numbness, weakness, or other nerve symptoms in the leg or foot, it may take weeks or even months for the nerve root to heal completely and any numbness or weakness to subside.

Despite its immediate benefit in treating pain, the nerve healing may take several months.

As a general rule, microdiscectomy is a relatively reliable surgical procedure for immediate, or near-immediate, relief of sciatica pain from a lumbar disc.

Minimally invasive disc surgery

There are two common options for an outpatient lumbar discectomy:

• Microscopic disc surgery.
•  Laparoscopic (or percutaneous) disc surgery.

In addition, there is a third option without surgery, which is laser disc decompression.

Microdiscectomy is generally considered the gold standard for removing the herniated portion of the disc pressing on the nerve, as this procedure has a long history and many spine surgeons have extensive experience with this approach.

During technically open surgery, a microdiscectomy uses minimally invasive techniques and can be performed through a relatively small incision with minimal tissue damage or disruption.

Some surgeons now have enough experience with endoscopic or laparoscopic techniques, which involve performing surgery through tubes inserted into the surgical area, rather than through an open incision.

A microdiscectomy is usually performed by an orthopedic or neurosurgeon.

Interventional reasons for disc microsurgery (herniated disc)

In general, if disc pain in the leg improves, most of the time the pain will be completely gone within six to twelve weeks of the onset of pain.

As long as the pain is tolerable and the patient can function adequately, it is usually recommended to postpone surgery for a short period of time to see if the pain resolves with non-surgical treatment alone.
Sometimes it is possible to try laser treatment

However, if the leg pain is very severe, it is also reasonable to consider surgery urgently.

 For example, if the patient is in so much pain despite having exhausted all non-surgical treatments that it is difficult for him to sleep, go to work or perform daily activities, then surgery may be considered.

Typical reasons for recommending surgical treatment with a microscope:

• Leg pain persists for at least six weeks.
• The presence of a disc hernia on the report of an MRI or other test.
• If leg pain (sciatica) is the patient's main symptom, not just lower back pain.
• If non-surgical treatments such as oral steroids, NSAIDs, and physical therapy have not adequately relieved pain.

If one of these conditions is present, the results of surgery are somewhat worse when three to six months have passed since symptoms appear, so doctors usually advise people not to delay surgery for a long time (more than three to six months).

Steps for permanent disc treatment through microscopic disc surgery in Turkey (herniated disc)

In most cases, a microdiscectomy is performed through the back, with the patient lying face down on the operating table.

General anesthesia is used, and the operation usually takes about one to two hours.

Typical surgery steps:

The Neurosurgeon and Spine Surgeon performs microdiscectomy by making incisions not exceeding 5 cm in the midline of the lower back.

First: The back muscles are lifted from the arch of the vertebrae (lamina) of the spine and moved aside.

Since these back muscles run vertically, they are fixed to the side using spacers during surgery; Since there is no need to cut the muscle.

The surgeon can then enter the spine and access the disc by removing the peritoneum above the vertebrae (ligamentum flavum).

Magnifying glasses or an electron microscope allow the surgeon to clearly visualize the nerve root.

In some cases, a small portion of the inner facet joint of the vertebra is removed to facilitate access to the nerve root and to relieve any pressure or pressure on the nerve.

Sometimes the surgeon may make a small incision in the bony plate of the vertebra if necessary to access the surgical site.

The nerve root is gently moved to the side.

The surgeon uses small tools to go under the nerve root and remove the appendages of disc material emerging from the disc.

The muscles return to their place.

The incision is closed and sterile strips are placed over the incision to help hold the skin in place for healing.

In a microdiscectomy, only the small portion of the disc that has herniated — or has leaked — is removed.
The majority of the disk is left as is.

Importantly, because all joints, ligaments, and muscles remain intact, microdiscectomy does not alter the mechanical structure of the patient's lower spine (lumbar spine).

after surgery

Patients usually stay in the hospital for a few hours after surgery before they are discharged to go home.

 Depending on the patient's condition, an overnight stay in the hospital may be recommended.

After the procedure, patients may return to a relatively normal level of activities quickly.
Patients are usually encouraged to walk within a few hours of surgery.

The surgeon will provide home care instructions, including medications, home activities, type of follow-up, and other information.

Risks and complications after disc surgery and success rates

This widely performed surgery is considered to have a relatively high success rate, especially in relieving patients' leg pain (sciatica).
As patients are usually able to return to a normal level of activity fairly quickly.

Microdiscectomy success rates

The success rate of microsurgical spine surgery is generally high Medical study Overall good or excellent results for 90% of people who have the procedure.

Medical studies also point to some benefits of surgery, when compared to nonsurgical treatment, although the difference decreases over time in some cases.

One large study found that people who had surgery for a lumbar herniated disc had a greater improvement in symptoms for up to two years compared to those who did not have surgery.

Recurrence of herniated disc

Estimates vary, but between 1% and 20% of people who have a microdiscectomy will develop another disc herniation at some point.

Additional disc herniation may occur immediately after back surgery or several years later, although it is more common in the first three months after surgery.

 If the disc herniates again, the success rate of the second operation will be approximately equal to the first operation. However, after disease recurrence, the patient is more likely to recur.

For patients with a recurring herniated disc, spinal fusion may be recommended to prevent it from recurring.

Complete disc removal and level fusion is the most common method of ensuring that no further slipped disc occurs.

If the posterior facet joint is left untouched and some other criteria are met, an artificial disc (lamellar) replacement may be considered, in place of the affected disc.

After microspinal surgery, a program of stretching and strengthening exercises is recommended to help prevent recurring back pain or disc prolapse.

Possible risks and complications of microdiscectomy

As with any form of spinal surgery, there are many risks and complications associated with microdiscectomy.

A tear in the dura mater resulting in cerebrospinal fluid leak (cerebrospinal fluid leak) occurs in about 1% to 7% of microdiscectomy surgeries.
The infusion does not alter the results of the surgery, but the patient may be asked to lie down for one to two days after surgery until the infusion stops.

Other risks and complications include:

• Nerve root damage.
• Bowel/bladder incontinence.
• bleeding.
• infection.
• Possible buildup of fluid in the lungs that may lead to pneumonia.
• Deep vein thrombosis, which occurs when blood clots form in the leg.
• Pain that persists after surgery.

See Failed Back Surgery Syndrome (FBSS): What it is and how to avoid pain after surgery

The above complications are not very common for microscopic spine surgery.