Our Summary

Lumbar disk herniation (LDH) is a condition where the soft center of a spinal disk pushes through a crack in the tougher exterior casing. In some cases (about 10%), the cracked piece may move to higher or lower levels of the spine. Traditional surgical methods can’t always be used in these cases, as they may require removing parts of the spine. An alternative method, called the translaminar approach, is more tissue-friendly and can be used when the disk fragment has moved towards the nerve root, particularly in certain areas of the spine.

This approach is better than the traditional one as it reduces symptoms, causes less pain after surgery, and allows for quicker recovery times. It also does not risk causing further instability in the spine, and can even be used in cases where there are already signs of instability.

One of the main benefits of this technique is that it allows the surgeon to avoid damaging the flavum ligament, a crucial part of the spine. Therefore, the translaminar approach is safe and effective. This paper provides a detailed analysis of the surgical technique, along with tips and tricks for its use.

FAQs

  1. What is lumbar disk herniation and how often does it affect different levels of the spine?
  2. What is the translaminar approach and how does it differ from traditional surgical methods for treating LDH?
  3. What are the benefits of the translaminar approach in treating lumbar disk herniation?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about microdiscectomy is to follow the post-operative care instructions carefully. This may include avoiding heavy lifting, bending, or twisting for a certain period of time, as well as participating in physical therapy to help strengthen the muscles surrounding the spine. It is also important to stay active and maintain a healthy weight to prevent future back issues. Lastly, be sure to attend all follow-up appointments with your doctor to monitor your progress and address any concerns.

Suitable For

Patients who are typically recommended for a microdiscectomy include those who have not responded to conservative treatments such as physical therapy, medication, and epidural injections for at least 6 weeks. They may also have symptoms such as severe leg pain, weakness, or numbness that radiates down the leg and into the foot, as well as loss of bladder or bowel control. Patients who have a lumbar disk herniation that is pressing on a nerve root and causing these symptoms may benefit from a microdiscectomy.

Additionally, patients who have a large herniated disk fragment that is causing significant compression of the nerve root or spinal cord may also be recommended for a microdiscectomy. This procedure can help relieve pressure on the nerve and improve symptoms such as pain, weakness, and numbness.

Overall, patients who are experiencing severe symptoms and have not responded to conservative treatments may be good candidates for a microdiscectomy. It is important for patients to discuss their symptoms and treatment options with their healthcare provider to determine if a microdiscectomy is the best course of action for their specific condition.

Timeline

Timeline of patient experience before and after microdiscectomy:

Before surgery:

  • Patient experiences symptoms of lumbar disk herniation, such as lower back pain, leg pain, numbness, and weakness.
  • Patient undergoes diagnostic tests, such as MRI or CT scans, to confirm the diagnosis of lumbar disk herniation.
  • Patient discusses treatment options with their healthcare provider, including conservative treatments such as physical therapy, medications, and steroid injections.
  • If conservative treatments are not successful in relieving symptoms, patient and healthcare provider decide on surgery as the next step.

After surgery:

  • Patient undergoes microdiscectomy surgery, where the herniated portion of the disk is removed through a small incision in the back.
  • Patient may experience some pain and discomfort immediately after surgery, which is managed with pain medications.
  • Patient is typically able to go home the same day or the day after surgery, and is advised to rest and avoid strenuous activities for a few weeks.
  • Patient may undergo physical therapy to help strengthen the back muscles and improve flexibility.
  • Over the following weeks and months, patient gradually resumes normal activities and experiences relief from symptoms of lumbar disk herniation.
  • Patient follows up with their healthcare provider for post-operative care and monitoring of recovery progress.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with microdiscectomy surgery?
  2. How long is the recovery time after microdiscectomy surgery?
  3. Will I need physical therapy or rehabilitation after the surgery?
  4. What type of anesthesia will be used during the procedure?
  5. How successful is microdiscectomy in relieving symptoms and improving quality of life?
  6. Are there any alternative treatments or procedures that could be considered instead of microdiscectomy?
  7. How many microdiscectomy procedures have you performed and what is your success rate?
  8. Will I need to make any lifestyle changes or modifications after the surgery?
  9. How soon can I return to work or normal activities after the surgery?
  10. What can I expect in terms of pain management and follow-up care after the surgery?

Reference

Authors: Vanni D, Galzio R, Kazakova A, Guelfi M, Pantalone A, Salini V, Magliani V. Journal: J Spine Surg. 2015 Dec;1(1):44-9. doi: 10.3978/j.issn.2414-469X.2015.10.03. PMID: 27683678