How is microdiscectomy performed for the treatment of lumbar disc disease?

Updated: Sep 25, 2018
  • Author: Kamran Sahrakar, MD, FACS; Chief Editor: Brian H Kopell, MD  more...
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Answer

In a standard lumbar microdiscectomy, the patient is anesthetized and placed in the prone position. Variations in technique exist depending on the institution, region, and surgeon.The hips are flexed to open the interlaminar spaces. A protuberant belly should hang as freely as possible to reduce venous hypertension. The ulnar nerves at the elbow are padded to prevent neuropathy. The legs cannot be overflexed. The back is parallel to the ground. A preoperative radiograph with a spinal needle is obtained to confirm localization. The back is shaved and prepared.

After injection of a long-acting local anesthetic agent, a 3-cm incision is made over the disc space (as determined by radiograph). Unipolar cautery is used to dissect down through midline subcutaneous fat. The lumbodorsal fascia is opened paramedially. Muscles are stripped from the lamina. Obtain a repeat radiograph to confirm the appropriate location.

A small laminotomy is created with a drill or rongeurs. The ligament is excised with rongeurs or a knife. An operating microscope is now used. The medial facet is partially resected in most patients. Some evidence indicates that joint angles smaller than 35° result in resection of larger portions of the medial facet and result in more immediate postoperative pain. [26] The root is then identified and retracted. The disc fragment is evident below the retracted root.

The annulus is incised and the disc removed with pituitary rongeurs. Loose fragments of the disc in the interspace are removed. The course of the nerve root is palpated with an angled instrument along its entirety to ensure adequate decompression. Significant controversy exists regarding the optimal extent of discectomy. [27] Bleeding is stopped, the wound is irrigated, and then it is closed in interrupted absorbable sutures layer by layer. A light dressing is applied.


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