Evolution of Technology

Microdiscectomy

Microdiscectomy, also sometimes called microdecompression or microdiskectomy, is a minimally invasive surgical procedure performed on patients with a herniated lumbar disc. It is one of the most common spine surgeries with roughly 300,000 cases performed a year in the US. There are a number of different techniques to perform the surgery to include a small open incision, dilating tubes, and endoscopic with a small video camera. During this surgery, a surgeon will remove portions of the herniated disc to relieve pressure on the spinal nerve column.

Most microdiscectomies take about an hour to complete. While it may take weeks or months for the nerve root to fully heal and any numbness or weakness to get better, patients normally feel relief from the leg pain almost immediately after a microdiscectomy. The success rate for microdiscectomy spine surgery is generally high, with one extensive medical study showing good or excellent results in 84% of people who had the procedure.

Evolution of Procedure

Herniated Vertebral Disc Excision Surgery

Discectomy, is a procedure in which the disc causing pressure on the nerves is surgically removed. This is the most common surgery performed for a herniated disc in the lumbar region. Years ago, most spine surgeons would remove a herniated disc using a large surgical incision causing significant disruption to the underlying soft tissues. This would often involve a long hospital stay and prolonged recovery period.

Today, with more modern developments, many surgeons use a microscopic surgical approach with a small, minimally invasive, poke-hole incision to remove the disc herniation, allowing for a more rapid recovery. Usually, only the small portion of the disc that is pushing against the nerve root needs to be removed, and the majority of the disc remains intact. It has a high success rate, especially in relieving leg pain (or sciatica), caused by the herniated portion of the disc pressing against a nerve.

Two common surgical options are a microdiscectomy and an endoscopic discectomy. These two minimally invasive approaches to discectomy are done through a thin tube, or series of tubes, which are inserted into the lower back to provide a corridor of sorts to allow the surgeon to access the offending disc herniation with minimal tissue disruption.

Evolution of Diagnosis

Herniated Vertebral Disc

A herniated disc, also known as a bulged, slipped, or prolapsed disc is when one of the cushion-like pads between the vertebrae moves out of position and presses on the adjacent nerves. This is one of the nation’s leading causes of sudden back pain in adults. Typically, this phenomenon occurs in the lumbar region of the spine (lower back region). The discs are located between the vertebral bodies and cushion the spine as well as gives the spine flexibility making movements such as twisting and bending possible.

As we age the discs naturally become dry and brittle, and are at a higher risk of herniating. Additionally, trauma, poor lifting technique, and obesity can cause disc herniation. Typical presenting symptoms include sudden back pain that may or may not radiate to the legs, also called sciatica. Most of the times herniated discs do not require advanced imaging, however an MRI may be obtained for symptoms that persist or present with specific concerning symptoms such as bowel and bladder dysfunction. These discs usually heal on their own through a process called resorption, where the disc fragments are absorbed by the body.

Most people suffering from herniated disc respond well to conservative treatment (i.e. physical therapy, pain medication, activity modification) and do not require surgery. However, if these measures fail, surgery may be indicated to remove the herniated disc.