What is a lumbar microdiscectomy
This is a minimally invasive procedure to remove a slipped disc (disc prolapse) when it is pressing on a nerve causing sciatica.
What does it involve?
You come to hospital on the day of the operation. The procedure is performed using a general anaesthetic. A small incision is made in the middle of your lower back and a small amount of bone and ligament is removed to allow access to the spinal canal. The bulging part of the disc is removed to relieve the pressure on the nerve. The wound is normally closed with dissolvable stitches under the skin.
What are the alternatives?
Continue with conservative measures: these include taking pain killers and staying as active as possible. Performing physiotherapy exercises to reduce muscle spasm and keep your core muscles functioning is important. A large number of slipped discs do actually settle down by themselves over 3-12 months.
Nerve root injection: this puts some steroid around the slipped disc and painful nerve and aims to reduce the inflammation in this area whilst the body is healing the disc prolapse. 40-50% of people will find this settles things enough to not require any further intervention.
You will start to mobilise out of bed fairly soon after the operation. Some people can go home the same day whilst others may need to stay one night. When you go home, your back will be sore but this will quickly settle over the course of 2-3 weeks. Changing your position regularly will help reduce muscle stiffness in your back.
You will have a dressing covering your scar for at least 2 weeks and this will be checked by a healthcare professional to ensure it is healing well. Please do not remove this by yourself.
It is important to stay active and aim to take 2 or 3 short walks a day, gradually building up the distance you are walking. It may be beneficial to start physiotherapy exercises and gentle core stability work at 4-6 weeks following the operation.
There is a small chance of more disc slipping out in the first 3 months. To reduce this risk, you may be advised to avoid heavy lifting, deep bending, and awkward twisting for 3 months.
Medications: Continue taking your normal medications after the operation and, when the pain starts to improve, you can reduce them gradually one at a time. There are some medications that should not be stopped abruptly so please check with your doctor about this.
Sciatic symptoms: Some people find their leg pain disappears immediately, whilst others may find it takes a few weeks for any nerve inflammation to settle down. The pain may disappear but some people do experience numbness down the leg, which often reduces in size over subsequent months. If you have leg weakness due to nerve compression prior to the operation, this may slowly improve over the next 18 months; however, it may not return to normal.
Post-operative problems: if you experience any unexpected symptoms, please seek medical advice. Seek immediate advice if you cannot pass urine, develop numbness around your buttocks, or weakness in your legs; or if you feel unwell and the wound is red or oozing,
Returning to work: for office-based jobs, you may be able to return at around 4 weeks after the operation. For more manual jobs, you may require light duties for the first 2-3 months. Consider returning to work part-time for the first 1-2 weeks to ensure you are comfortable.