Microdiscectomy: Spine Surgery for a Herniated Disc
Microdiscectomy incision and sutures
Discectomy for herniated disc with associated leg pain has high success rate
While surgery for many conditions should be a last resort, for people suffering from a pinched or compressed nerve from a herniated disc that results in leg pain and numbness, a discectomy, or microdiscectomy, is often the solution that finally brings long term relief.
More conservative options should of course be attempted first since spine surgery for a herniated disc, like all surgeries, has risks associated with it. But when non-surgical options fail, a discectomy brings relief to more than 90% of patients with associated leg pain (sciatica) caused by pressure on a nerve from the herniated disc.
Recently, my son had a microdiscectomy to relieve the pain and numbness in his left leg and left foot caused by a herniated disc. While it is way too soon to tell how he will fare in the long term, at the moment the results look very promising.
Non-surgical treatment options for herniated disc
- Time to heal: Luckily for many people who have a mild herniated a disc, time and easing up on physical activities is the only needed remedy to heal. Recovery may take 4 weeks or longer.
- Physical therapy may be used to strengthen the back or to relieve pressure that the unhealed herniated disc is placing on surrounding nerves.
- Pain killers are sometimes given to patients as a way of relieving the pain caused by compressed nerves from a herniated disc, however they may only provide short term pain relief, if any at all. Read, Herniated Disc Pain Relief, for a candid story about one herniated disc sufferer's experience with pain killers.
- Cortisone injections may only offer short term relief, but for some people the cortisone/steroid is enough to reduce swelling and inflammation to allow the disc to heal and to relieve pressure on any nerves.
My son's herniated disc
Please note, I am not a doctor or medical professional, just a mother telling of her son's experience with a herniated disc and treatment.
Possible cause of herniated disc
It was the last weekend of summer before heading off to college and my son and his friends were getting together for a fun weekend of jet skiing at the lake. After returning from their weekend's adventure my son told me how his back was killing him after slamming down on a wave while riding on a tube attached to a jet ski.
I didn't think much of his back pain at the time, especially since we were in the midst of packing and moving him into his dormitory away at college. In fact, I actually forgot that he hurt his back, thinking at the time that it would feel better in a few days.
Back pain gets worse and now has leg pain too
By mid October my son called me and told me that he was having horrible back and leg pain. I knew he had brought his skateboard to college with him and figured his back was sore from all the hard jumping and landing involved in the sport, forgetting about the jet ski incident. Additionally, he was regularly doing a lot of weightlifting, which I also thought could be the cause of his pain.
He went to the doctor at the college's health center (luckily we had student health insurance for college, as well as our own employee health insurance) and the doctor prescribed him prescription-strength Tylenol and muscle relaxers. He was advised to see another doctor if the pain did not go away.
Back pain lessens but leg pain worsens
Needless to say, for anyone that has had a herniated disc with compression on a nerve, the Tylenol and muscle relaxers only helped mildly at best, and probably only because they helped him sleep. We figured when he returned home for Thanksgiving break that we would bring him to the orthopedic doctor. The doctor we had in mind is a very well regarded physician and we knew he would offer us an accurate diagnosis.
By the time my son came home for the Thanksgiving holiday break, he really was not complaining about his back anymore, but he did have an upper respiratory illness. With five family members from out-of-town visiting us for the holiday and the fact that my son was otherwise sick with a virus, as well as his sister too, we never got him to the orthopedic doctor as we had intended.
Leg pain becomes unbearable
During the three weeks he was back at college between Thanksgiving break and winter break he called me multiple times telling me how bad his leg was, how he could hardly walk on some days. The extreme pain he was in was very evident in his voice. Helpless to do much, and very concerned about his final exams and grades, I wasn't sure what to do.
MRI reveals herniated disc
After coming home for winter break, he finally had an appointment with the orthopedic surgeon. After getting the MRI results we had a diagnosis; it was confirmed that he had a herniated disc (L4/L5). Unfortunately, since the doctor was on vacation by the time we got the MRI completed, we did not get the results until a couple of days after my son returned to college.
Apparently, with some herniated discs the back pain subsides on its own, but it is the leg and foot pain, as well as tingling and numbness in those extremities, that cause all the misery. Material from the herniated disc itself can put pressure on surrounding nerve roots or the spinal canal, leading to extreme pain and discomfort. The nerve in question, near the L4/L5 disc in my son's case, affects the leg and foot.
MRI of L4-L5 Herniated Disc
Herniated disc treatment options
We were uncertain of which treatment option to select for my son's herniated disc, especially since he was away at college with hopes to complete the semester. Since it was around four months since the sciatica began due to nerve root impingement, he stood the best chance for a good long term outcome if something was done sooner than later.
Since my son was well beyond the window of time where healing may have occurred on its own, the only two options left were:
- Cortisone injections
- Microdiscectomy surgery (discectomy)
At first we decided that the best course of action was to attempt an x-ray guided cortisone injection. In fact, we set the wheels in motion to schedule a time for him to return home for this procedure and even got it scheduled at the surgical center. In the meantime, however, his leg and foot pain were worsening to the point where he could no longer get out of bed many days.
Elects to have microdiscectomy (discectomy) surgery
After speaking to the doctor again, the decision was made to forgo the cortisone injection, and instead opt for the microdiscectomy surgery. It turns out cortisone injections may only provide short term relief, it could be weeks, it could be a year, but many times it is not a permanent solution.
In fact, the doctor explained that some insurance companies are beginning to not cover these injections due to their failure rate. The microdiscectomy surgery, on the other hand, while more invasive and risky than an injection, has a very high success rate for herniated disc patients with accompanying leg pain.
In the article, Nerve Pain: My Experience, Holle Abee (habee) describes her pain from pinched nerves and how her pain relief from a cortisone injection to her back only lasted three weeks.
Microdiscectomy (discectomy) surgery scheduled, hopes are high
Finally, the microdiscectomy is scheduled and when I pick my son up from college to head back home for surgery, any slight reservations I have about surgery are alleviated when I see him. Clearly, he is suffering, and is walking with quite a limp. It's painfully obvious that the microdiscectomy surgery for his herniated disc is his only option.
The morning of surgery arrives and my son is not nervous at all, in fact he is quite excited at the prospect of ending all the misery caused by his herniated disc and pinched nerve.
I too am hopeful for an immediate positive outcome, especially after reading the article, Herniated Disc Treatment Options, in which the author, Jason Menayan (livelonger), describes how he lived with grueling pain from a herniated disc that was only relieved by a discectomy. Menayan lives nearly two-thousand miles away and while I do not know him personally, he has given me tremendous hope that my son can not only live a life without this particular back and leg pain, but can lead a full and active life in the future.
Now at the hospital, the surgeon comes in to speak to us prior to performing the microdiscectomy. You've got to love surgeons - in a very matter-of-fact manner he explains how he will make the incision, remove some bone (laminectomy) to expose the nerve, and then remove the herniated disc material that is pressing on the nerve root. "Really, quite simple," he states, going on to say that the microdiscectomy will take forty-five minutes to an hour. I had zero doubt that my son was in very capable surgical hands.
Herniated disc material removed during microdiscectomy
After the microdiscectomy
Within a couple of hours after the surgery my son was thrilled -- thrilled that he could already tell that a lot of his leg pain was simply gone. He still had pain in his calf, as if he had done one-hundred leg lifts, he described, but for the most part he finally felt relief from months of pain.
About 48 hours post surgery he was becoming very uncomfortable again, and the prescribed painkillers did not seem to be helping. Thinking that he may be having some post-surgical inflammation (to be expected) I wondered if the inflammation itself could be pressing on the nerve root again. Instead of giving him the prescribed painkiller with Tylenol, we decided to give him Advil since it has anti-inflammatory properties. This seemed to do the trick and the next day he decided that he could return to college.
Nothing about helping your child away at college when they do not feel well is easy. Unfortunately a day after returning to school he was miserable, this time with a fever of 102 degrees and barely able to walk again. To say my bubble burst is to put it mildly.
I personally had cleaned around his surgical wound a day earlier and doubted there was any skin infection. But to be on the safe side I strongly encouraged him to go to the doctor at college so the doctor could examine my son's incision and sutures. Thankfully, no signs of infection were present. Meanwhile, back at home, the surgeon's nurse explained to me that patients can run a fever for three to five days after surgery. Apparently, inflammation from surgery can produce a febrile condition.
Eight days post microdiscectomy
Luckily, the fever only lasted a couple of days and as the fever lessened so too did the leg pain. Eight days after surgery my son told me that he had not had fever for a couple of days and he estimated that his leg was 80% better.
Nerves take time to heal, that is why full recovery from a discectomy or microdiscectomy can take many months. With his latest health report I am hopeful that the sciatica caused by the herniated disc impinging a nerve will be fully gone.
This much I know, my son really had no choice but to have the microdiscectomy surgery, and with an over 90% success rate since he also had sciatica, the outlook was positive. Unfortunately, for people with herniated discs that have back pain but do NOT have leg pain, a discectomy or microdiscectomy is not usually helpful.
Discectomy vs Microdiscectomy
WebMD defines a discectomy as,
a surgery to remove herniated disc material that is pressing on a nerve root or the spinal cord.
WebMD explains that a microdiscectomy differs from a discectomy in that a special microscope is used to view the disc and nerves. The larger view provided by the microscope does not necessitate as large of an incision as is needed for a discectomy, thereby resulting in less damage to the surrounding tissue.
During either procedure (discectomy or microdiscectomy) the surgeon may need to perform a laminectomy (aka laminotomy), which is the removal of a small piece of bone called the lamina in order to expose the nerve. Additionally, both forms of the surgery are performed under general anesthesia.
As the name sounds, the microdiscectomy is less invasive, and this is the procedure that my son underwent to remove the disc material that had become so bothersome. From the photograph of my son above you can see that the microdiscectomy incision is about 2" long.
Microdiscectomy Recovery Time
I guess in our son's case we will never know the exact cause of his herniated disc, whether or not he did in fact injure it jet skiing. If he did injure it that day, I doubt that it could have ever healed on its own as he pursued other athletic interests such as skate boarding and weight lifting. "No pain, no gain" is a real fallacy.
Whatever the cause, the microdiscectomy procedure is complete and he seems well on his way to recovery. For the first few weeks following a microdiscectomy it is important to not bend or lift items over ten pounds. However, it is also important to not lay around and to be sure and walk. In time scar tissue will "fill in" his herniated disc and movement will ensure that the scar tissue itself does not cause future issues.
Update: 4 Months Post Surgery
The first few weeks after surgery I was a bit concerned. My son developed a fever and the pain that seemed to be gone immediately after surgery came back. It turns out that this return of pain and leg numbness was due to post-surgical inflammation.
Of course, microdiscectomy recovery time will vary by patient, but in my son's case, the pain seemed to come and go for the first couple of months, with it being almost gone by the three month mark.
It's now been four months since his microdiscectomy surgery and I'm happy to report that he is virtually pain-free. He says that after he's been very active and on his feet all day that he feels a little leg soreness but it is nothing he can't live with or tolerate. For him, the microdiscectomy for his herniated disc was a definite success!