Recovery after Microdiscectomy

Microdiscectomy is a minimally invasive surgical procedure to help relieve the pressure from pinched nerves known as sciatica or lumbar radiculopathy. Sciatica is most commonly caused by a prolapsed intervertebral disc. During surgery, the spine surgeon removes the protruding intervertebral disc material. The recovery after microdiscectomy surgery is usually faster as compared to open discectomies and lumbar fusion surgeries.

Procedure

During the surgery, a small incision measuring only a few centimeters is given on the back of the patient. The surgeon then carefully retracts the skin and the muscles in the lower back. An endoscope/microscope is used to aid the surgeon to see through the narrow incision.

A part of the vertebra known as the lamina may be partially cut to expose the intervertebral disc. The surgeon carefully retracts the spinal nerve roots and uses a special instrument to take small bites of the intervertebral disc. The protruding part of the intervertebral disc is removed and the surgeon carefully closes the incision in layers.

Recovery

Following the procedure when the patient is conscious, the patient is taken to the recovery area. The medical staff at the recovery area carefully monitor the patient’s vitals. The postoperative pain is managed with the help of i.v narcotic pain medications. The patient’s ability to pass urine is assessed and the majority of the patients are able to go home the same day of the procedure. Some patients may be required to stay overnight depending upon their underlying medical conditions.

At home, the patient is instructed incision site care and to avoid certain activities. The incision site is usually covered with small surgical tapes and the incision takes about 10-14 days to completely heal. The patient is instructed to keep the incision site clean and to cover it while taking a shower. The incision area may be cleaned with a towel but care must be taken to prevent the surgical tapes/strips from coming off.

The patients are advised to report any redness, swelling, discharge from the incision site. The presence of discharge from the incision site may require a doctor’s examination to rule out infection. The patients are also instructed to report worsening pain, loss of bladder/bowel control, or weakness/numbness of the lower extremities.

The initial postoperative pain is managed with the help of narcotic pain medications. The majority of the patients are able to wean off the narcotic medications in the first 1-2 weeks. Patients may drive as early as the first postoperative week but are advised to not drive while taking narcotic medications. During the initial period, patients are often advised to drive only for short distances.

During the initial and subsequent postoperative period, the patients are advised against complete rest and are motivated to remain active. The patients are advised against excessive bending or turning actions. The patients during the first 2-4 weeks are advised not to lift more than 5 pounds of weight. Light activities in the house may be permitted but strenuous activities such as yard work, lifting, pulling, pushing is not permitted.

The patients may also return to work as early as the first 2 weeks but that depends upon the nature of work. If the patient’s employment does not involve physical work such as lifting, pulling, etc, the patient may return to work. The patient may be required to move around every 45-55 mins if their work is sedentary in nature.

At 4 weeks post-op, the majority of the patients are able to return to their daily activities such as household chores, minor outside work, driving, and going to work. The patient’s participation in physical therapy is started after consultation with the operating spine surgeon. The physical therapy is usually resumed after 6 weeks post-op.

Physical therapy also helps in the workplace assessment and modifications to help the patient return to work in a safe manner. Physical therapy helps to improve the flexibility of the spine by stretching exercises. The strengthening of the muscles of the back and the abdomen help to provide support to the spine and prevent recurrent disc herniation. Physical therapy is also important to maintain a good posture after surgery.

The patient’s return to contact sports and strenuous labor depends upon the extent of surgery and the recovery of the patient. While some patients may be able to return to contact sports and heavy labor after 6 weeks, some may require continued physical therapy to build stamina and strength.

Microdiscectomy being a minimally invasive surgery, patients are able to return to their baseline earlier as compared to open surgeries. The long-term outlook of microdiscectomy is overwhelmingly positive and patients return to the activities they enjoy without pain or disability.