Surgery for disk herniations
Disk herniations come in all sizes and shapes and they cause all sorts of symptoms. Some symptoms, such as leg pain, numbness in the legs, and muscular weakness can be improved with surgical treatment, whereas some symptoms, such as back pain, are less likely to improve. The best candidates for a microscopic discectomy are people with a disk herniation that is causing significant nerve root compression and the patient wants the nerve root pain alleviated. For example, here are a series of slides from a talk that I give on MRI anatomy of the lumbar spine that demonstrate the different types of disk hernations. Click on each image to enlarge it to full size and to see the caption…..
This series of images should convince you that there are disk herniations in name only, and those that really need treatment (the fourth slide). The surgical treatment of disk herniations is relatively controversial, because medical research has shown that if you wait long enough, most people with a disk herniation will improve without surgical treatment. In fact, it is considered dogma in the US that surgical treatment of disk herniations does not change the LONG TERM outcome, but simply helps patients to get over their pain and return to work faster. In my experience, most patients WILL get better with physical therapy, medical management, and selective nerve root blocks, and they are able to avoid surgical treatment if they are patient enough. However, there are those patients that clearly do better with a microdiscectomy and they tend to have the following findings:
- Their leg pain is worse than their back pain
- Their pain has been present for at least 6 to 8 weeks without any trend towards gradual improvement
- The disk herniation is large, a free or extruded fragment, and appears to be causing significant nerve root compression
- They have tried a course of physical therapy, NSAIDs, and possibly a selective nerve root block and each time the pain has come back.
microdiscectomy technique: a step by step explanation
