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Dr Josip Buric

Microsurgical Discectomy

In Brief

  • What it is A minimally invasive procedure that relieves compressed nerve roots using a microscope, through very small incisions
  • When this procedure is used Lumbar disc herniation, foraminal or lateral recess stenosis, when conservative treatments have not resolved the symptoms
  • How it is performed Through one or two skin accesses of just a few millimeters; the surgeon operates while viewing a monitor; hospital stay is generally short

Microsurgical removal of a lumbar disc herniation may be indicated in patients presenting with low back pain and/or pain radiating down the lower limb, especially when these symptoms are associated with reduced muscle strength in one or more nerve territories.

The procedure may also be considered in the presence of acute, intense and persistent pain that does not respond satisfactorily to conservative treatments, such as medication therapy and physical therapy, or to minimally invasive procedures.
The decision to proceed with surgery must in any case be evaluated on a case-by-case basis, taking into account the severity of symptoms, any neurological deficits, the results of diagnostic tests and the patient’s general condition.

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Surgical technique

The patient is generally positioned on the operating table in the knee-chest position, which allows adequate access to the lumbar region and reduces pressure on the abdomen.
In most cases the procedure is performed under spinal anesthesia, although the type of anesthesia is determined based on the patient’s characteristics and the assessments of the anesthesiologist and surgeon.

The procedure is carried out using a microsurgical technique, using the surgical microscope to magnify the surgical field and visualize the anatomical structures with greater precision. This makes it possible to limit the invasiveness of the procedure and reduce the risk of injury to the nerve roots and surrounding tissues.
The surgical access generally requires a skin incision of about 2-3 centimeters. Through this small access, the surgeon reaches the compressed nerve root and removes the disc fragment responsible for the symptoms.

Convalescence after the procedure

The recovery period must be tailored based on the type of procedure, the clinical condition and the instructions provided by the surgeon. In the first few days, it may be advisable to limit prolonged sitting, alternating short periods of standing with moments of rest lying down. Home rest is generally recommended for about two or three weeks, while avoiding complete immobility. During the first two weeks, it is advisable to reduce normal daily activities and avoid subjecting the spine to intense, sudden or prolonged strain. In particular, it is recommended to: avoid sudden movements and twisting of the trunk, not lift weights over about 2 kilograms, limit long car journeys, avoid sitting for prolonged periods, and alternate lying down with short walks and periods of standing. Sitting can be resumed gradually, starting with short intervals, generally no more than ten minutes, two or three times a day, and increasing progressively based on tolerance and the guidance received. After about two weeks, if the postoperative course is regular and the surgeon considers it appropriate, moderate physical activity aimed at recovering mobility and muscle tone may be started. Activities such as stationary cycling, water gymnastics or swimming can be introduced gradually, avoiding intense exertion and painful movements. The resumption of work, sports activity and driving must be agreed upon with the specialist and adapted to the type of work performed, the clinical condition and the pace of individual recovery.

Possible complications

The bi-portal technique, now increasingly widespread, uses two small separate accesses. One of the two is used to introduce the endoscope, which allows continuous visualization of the surgical field; the second access is instead dedicated to introducing the surgical instruments needed for decompression and discectomy. This separation between the visual channel and the operative channel gives the surgeon greater freedom of movement compared with the single-portal technique. The instruments can be maneuvered with a wider range of angles and with movements more similar to those of traditional surgery, while still maintaining the advantages of minimal invasiveness. Using the bi-portal technique, it is possible to remove herniated disc fragments, decompress nerve roots, enlarge the vertebral foramina and, in selected cases, treat even more complex degenerative stenosis.

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    Neurosurgeon · Minimally invasive spine surgery

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