Texoma Living Well Magazine July/August 2017 | Page 21

Minimally Invasive Microdiscectomy
By M. Viktor Silver, MD, FRCSC, FACS, FAANS
Overview and Indications
Microdiscectomy is performed for pa-
tients with a painful lumbar herniated
disc often known as sciatica. Microd-
iscectomy is a very common surgery
performed by spine surgeons. The op-
eration consists of removing a portion of
the intervertebral disc, the herniated or
protruding portion that is compressing
the spinal nerve root.
and stretch or walk for a little bit, then
sit down again if desired.
Brace
Patients are generally not required or recom-
mended to wear a back brace after surgery.
Shower/Bath
Patients can shower immediately after
surgery, but should cover the incision
area with a small bandage and tape,
and try to avoid water hitting directly
over the surgical area for 10 days. Pa-
tients should not take a bath until the
wound has completely healed, which is
usually around 2 weeks after surgery.
Today, many surgeons use a microscopic
surgical approach with a small, minimally-
invasive, one-inch incision to remove the
disc herniation, allowing for a more rapid
recovery with less blood loss, less pain
and shorter hospital stay.
Surgical Technique
A 1-inch longitudinal incision is made in the
midline of the low back, directly over the
area of the herniated disc. Special retrac-
tors and an operating microscope are used
to allow the surgeon to visualize the region
of the spine, with minimal or no cutting of
the adjacent muscles and soft-tissues.
A few millimeters of bone of the superior
lamina may be removed to fully visual-
ize the disc herniation. The nerve root
and neurologic structures are protect-
ed, so that the herniated disc can be
removed. Small dental-type instruments
and biting/grasping instruments are
used to remove the protruding disc ma-
terial. All surrounding areas are also
checked to ensure no additional disc
fragments are remaining. The total sur-
gery time is approximately 1 hour.
Driving
Patients may begin driving when the
pain level has decreased to a mild
level, which usually is between 2-10
days after surgery. Patients should not
drive while taking pain medicines (nar-
cotics). After patients feel comfortable
with a short drive, they can begin driv-
ing longer distances alone.
Return to Work and Sports
Patients may return to light work duties
as early as 1-2 weeks after surgery,
Figure 1 (middle, above): Minimally Invasive
depending on when the surgical pain
Tubular Retractor allowing for minimal mus-
has subsided.
cle retraction with less pain, smaller incision
and faster recovery times.
Doctor’s Visits and Follow-Up
Patients will return for a follow-up visit
to see Dr. Silver approximately 8-10
days after surgery. The incision will be
inspected. Patients will be given a pre-
scription to begin physical therapy for
back exercises, to start 3-4 weeks after
the surgery. Medications will be refilled if necessary.
Figure 2 (above): One-inch incision: Inlet
view of the surgeon’s direct visualization of
the spinal elements through microtubes al-
lowing for ideal visualization without muscle
retraction and injury.
Post-Operative Care
Most patients are able to go home the same day or early
the next day after surgery. Patients are instructed to avoid
bending at the waist, lifting (more than five pounds), and
twisting in the early postoperative period (first 2-4 weeks)
to avoid a strain injury or recurrent disc injury.
Patients should try to avoid sitting in the same position for
more than 30-45 minutes in the first few weeks after sur-
gery. After sitting for 30-45 minutes, patients should get up
Results and Outcome Studies
The results of microdiscectomy surgery in the treatment of
a painful, herniated disc are generally excellent but can
vary according to the degree and duration of compression
of the spinal nerves which can lead to a permanent nerve
damage. However, most patients are noted to have a rapid
improvement of their pain and return to normal function.
Dr. Silver is a double-board certified Neurosurgeon by the American Board of Neurological Surgery and by the Royal College of
Physicians and Surgeons of Canada. He graduated from one of the largest neurosurgical training centers in North America
only to further specialize in the treatment of Spine Disorders. Learn more about Dr. Silver’s state-of-the-art office by visiting
www.silverneurosurgery.com.
TEXOMA AREA Living Well Magazine | JULY/AUGUST 2017
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