Sciatica/lumbar radiculopathy is caused by a prolapsed intervertebral disc in the lumbar spine. The resulting symptoms may include radiating leg pain usually in one side. The radiating pain may be associated with paresthesia such as numbness and tingling sensation. Patients may also complain of weakness of the lower extremity.
The inciting event may be age-related wear and tear of the spine known as degenerative disc disease or trauma as a result of fall or repetitive action. The nucleus pulposus herniates through the annulus and may compress the nerve lying near the disc. The resulting inflammation also causes lower back pain.
The natural course of the sciatica is favorable and the majority of the patients get better with nonsurgical treatment. The nonsurgical treatment consists of pain medications, physical therapy and heat/cold therapy, etc. Surgical treatment is advised in patients who fail to improve with the medical therapy.
The popular microdiscectomy surgery involves a small incision of 1.5 to 2 inches in the midline of the lower back directly on the involved disc. The surgeon uses an operating microscope to visualize the tissues through the small incision. The surgeon cuts the muscle attachments on the back of the vertebrae and carefully reaches the lamina and the ligamentum flavum.
The surgeon removes a small part of the lamina and uses instruments to remove the protruded part of the disc. The incision is closed in layers and the patients are able to go home the same day of the procedure.
In a tubular discectomy, while the surgeon uses the same surgical technique, the muscles are separated instead of being cut. Serial dilators are used to separate the muscles. The surgeon gives a small incision about 1.8 to 2cm slightly away from the midline. A wire is passed under image intensifier control to the facet lamina junction.
Serial dilators are passed over the wire to separate the muscles and the tissues. The surgeon again uses a microscope to visualize the spine segment through the dilators. The herniated part of the intervertebral disc is removed and the incision is closed.
The patients are able to go home the same day of the procedure and are advised similar precautions as of microdiscectomy during the initial post-op period. Owing to the separation of muscles, patients undergoing tubular discectomy experience less postoperative back pain. The less cutting of the tissues leads to a faster rehabilitation as compared to microdiscectomy.
The patients may be able to return to their activities and work sooner as compared to traditional microdiscectomy. The intraoperative blood loss is less in the case of tubular discectomy and also the associated hospital stay. Patients report less use of narcotic pain medications after undergoing tubular microdiscectomy.
As with microdiscectomy, a tubular discectomy may be associated with complications such as a dural tear, damage to the spinal nerve roots, bleeding, infection, hematoma formation, and systemic complications such as blood clots or urinary tract infection.
Tubular discectomy presents a significant improvement over the traditional microdiscectomy but has a learning curve. The type of discectomy, open, micro, or tubular may be dependent upon the patient’s underlying anatomy and the disease process. A discussion with the operating surgeon may help you decide which procedure is best suited for you.
Tubular discectomy is a safe and successful procedure for the treatment of lumbar radiculopathy. The procedure offers several benefits in the form of less bleeding, less back pain, and early return to therapy and work as compared with traditional microdiscectomy.
The learning curve of tubular discectomy requires meticulous attention to position, manipulation of the nerves, and controlling bleeding. Fellowship-trained spine surgeons at Complete Orthopaedics may help you decide which procedure is best for you.