Lumbar Microdiscectomy

Lumbar microdiscectomy is the current state of the art surgical procedure for treatment of sciatica due to herniated discs in the lumbar spine.  The ideal candidate for this procedure is one who has primarily leg pain (sciatica), has failed 6-8 weeks of conservative care which includes medication, activity modification, and 1-2 epidural cortisone injections, and who has an MRI that demonstrates a discreet disc herniation that matches the patients symptom pattern..  Microdiscectomy is performed through an incision 1 inch or smaller in the midline of the lower back. The muscles on the side of symptoms are moved away from the spine allowing access to the space between the vertebrae where the disc herniation resides. The nerve is then identified and retracted allowing removal of the herniated portion of the disc.  The portion of the disc that is not herniated is left alone.  This procedure is usually performed on an outpatient basis.  After surgery patients usually experience rapid and dramatic improvement or relief of leg pain, with surgical back pain improving over a 2 week period.  Patients are allowed to return to daily activity as tolerated, and are allowed to return to full unrestricted activity by 6 weeks.  Up to 10 % of  patients will experience a recurrent herniation which may occur in days to years after the procedure.  Activity restrictions do not reduce this incidence.  Formal physical therapy has not been shown to be of benefit on a routine basis after microdiscectomy procedures

Some surgeons have promoted microdiscectomy surgery performed through Medtronics  Metrix tubular retractors as a major improvement or minimally invasive approach to microdiscectomy surgery.  The use of these retractors has not been shown to reduce surgical tissue injury, speed recovery, or improve outcomes.  In fact, one study has shown an increase in the incidence of residual back pain in patients in whom Metrix tubular retractors were used in comparison to standard microdiscectomy.  Dr. Tack currently performs microdiscectomy utilizing standard microsurgical technique as the proven state of the art treatment for lumbar disc herniations requiring surgery.