Micro Lumbar Discectomy

By | April 4, 2015

A generic photo of a surgeon preparing for microsurgery, probably a reimplantation.  For a better illustration of an advanced neurosurgical microscope look at this page from leica.com.

A generic photo of a surgeon preparing for microsurgery, probably a reimplantation. For a better illustration of an advanced neurosurgical microscope look at this page from leica.com.

 

Micro lumbar discectomy also known in some circles as the Tiger Woods procedure is probably the simplest and safest spinal operative procedure and is used most commonly to treat single level unilateral disc herniations. An approximately inch to inch and a half incision is made slightly lateral to the midline directly over the offending disc. The dissection is carried down to the level of the spine and a special retractor, which often looks like a overgrown thimble with the bottom cut out is inserted. At this point an operating microscope is brought in. The surgeon and his assistant look through the twin eyepieces and have true binocular vision with excellent depth perception. The rest of the surgical team can watch the procedure on a large flat screen monitor connected to the scope. The herniated disc is then exposed and resected in small pieces using long thin Kerrisons or curettes. The wound is then irrigated and closed. An experienced surgeon can accomplish the procedure in as little as 30 to 45 minutes with virtually no blood loss. Patients usually wake up with complete relief of their radicular back pain and only minimal discomfort from the incision. Healthy patients done early in the day often go home that afternoon. Patients operated on later in the day or with significant medical problems are usually discharged the following day. Patients are usually able to return to normal daily activities within a week and sports in about 6 weeks. Due to the limited nature of the dissection, surgical complications are rare. The major problem with the procedure is that there is an up to 20% recurrence rate for the disc herniation. The recommendation of the American Association of Neurological Surgeons in cases of recurrent herniation is a second Micro Lumbar Discectomy, the rationale being that the procedure is so simple and safe that only after a second failure is more aggressive surgical approach, usually fusion, indicated. My experience at Schlesinger Pain Centers is a little different because our surgeons have a higher success rate. In the past 10 years I have had only one patient require reoperation for a second herniation after Micro Lumbar Discectomy and none of my patients have needed fusion.


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