Microdiscectomy and discectomy. Lumbar disc herniation.

Microdiscectomy is a neurosurgical minimally invasive operation that involves removing a herniated intervertebral disc. Carrying out this operation in a multidisciplinary CELT clinic allows you to achieve excellent results, since it is performed using high-precision equipment.

Microdiscectomy in Moscow in our clinic is a gentle procedure and is performed using microsurgical instruments and a powerful microscope, which eliminates the involvement of healthy muscles and tissues in the process. This approach allows you to eliminate the intervertebral hernia completely, without violating the integrity of the bone structures, joints and ligaments of the spine.

Preparation for the event

Lumbar microdiscectomy is performed most often. Preparation for it includes:

• preoperative examination: tests, ECG, fluorography, etc.
• ;
• MRI.

In addition, our experts recommend stopping taking anti-inflammatory drugs and blood thinners. It is forbidden to eat or drink water for 8 hours before the procedure.

You can find out the price of microdiscectomy in our clinic in the corresponding section of our official website or by calling us. The cost of microdiscectomy is affordable, and its results are always predicted by our doctors.

Indications

The main indication for microdiscectomy is intervertebral disc herniation. It is carried out when:

• pronounced symptoms of nerve compression;
• lack of desired results from taking medications;
• compression of blood vessels;
• muscle weakness;
• disorders of the urination process

Contraindications

Microdiscectomy is not performed if:

• spinal infections;
• stenosis;
• neoplasms;

2.What to expect after surgery?

After your lumbar disc herniation is removed, once you have recovered from the anesthesia, you will be asked to stand up and try to walk. To combat pain, you can use painkillers. Over time, you will be able to return to your normal lifestyle and physical activity.

It is also worth knowing the following facts:

• After a microdiscectomy or discectomy, most people feel discomfort when sitting, especially for longer than 15 to 20 minutes. This will pass with time.
• Walk as much as possible, especially in the first weeks. This will reduce tissue scarring. This is especially true for discectomy.
• Most people return to their normal routine quickly, especially after microdiscectomy. In some cases, you will be offered a rehabilitation program and physical therapy.
• If your job involves physical labor, then you will be able to return to it in 4-8 weeks, but if not, then in 2-4 weeks.

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How is the operation performed?

Microdiscectomy can be performed in different ways:

• using an endoscope with an incision of about 2 cm;
• using a cannula, using a stylet under local anesthesia;
• using a laser pulse and evaporating the nucleus pulposus;
• using an endoscope.

All methods, except percutaneous (using a cannula), involve the use of general anesthesia. The procedure is preceded by disinfection of the surgical field, micro-incision or puncture, surgical manipulations, followed by layer-by-layer suturing of the wound. Typically, the operation lasts from thirty minutes to one and a half hours.

After the procedure is completed, the patient should remain at rest for 2 hours. The recovery period depends on how the operation was performed, as well as on the individual characteristics of the patient. Wearing a corset is recommended for two months after lumbar discectomy.

1.​What is microdiscectomy and discectomy?

A discectomy is a surgical procedure in which a herniated disc is removed.

compressing a nerve or spinal cord. A good doctor, if possible, tries to perform a microdiscectomy, which uses a microscope and small incisions. With microdiscectomy, damage to surrounding tissue is noticeably less than with conventional discectomy.

Before removing a herniated disc, a small portion of the bone (surface) of the affected vertebra may also be removed. This operation is called laminotomy. It allows the doctor to gain better access to the herniated disc.

Discectomy and microdiscectomy are performed by a surgeon under general anesthesia. After surgery, you will likely need to stay overnight in the hospital.

A must read! Help with treatment and hospitalization!

Reviews of doctors providing the service – Microdiscectomy

In 2000, Andrei Arkadyevich performed spinal surgery on me.
Four days in the clinic and I have been living a full life for 20 years without restrictions on movement and I remember with gratitude Dr. A.A. Khodnevich. God bless him. And in 2000 he could walk no more than 10 meters. Read full review Viktor Alexandrovich

20.05.2020

Low bow to Alexander Semenovich Bronstein and Andrei Arkadyevich Khodnevich. I arrived at CELT on July 2, 2021 with extreme pain that I endured for 10 days. Hernia C6-C-7. I was given two blockades in Ivanovo, about 9 complex IVs, I lost 6 kg in a week and was in a panic, I didn’t see a way out and nothing happened to me... Read full review

Elena Nikolaevna L.

20.10.2019

A.L. Krivoshapkin, V.V. Fonin (Research Institute of Traumatology and Orthopedics), A.D. Nekrasov (State Regional Clinical Hospital), E.T. Mordanov (State Medical Academy), Novosibirsk

It is known that only 1-3% of patients have back pain accompanied by a bulging intervertebral disc (Greenberg, 1994). Despite this, due to degenerative lesions of the spine, in the United States alone, more than 150,000 patients annually undergo discectomy and the same number of patients undergo other types of spinal surgery. Overall, between 20 and 70 patients with low back pain per 100,000 population per year undergo surgical treatment in Western countries (TAD Cadoux-Hudoson, 1996).

A difficult problem in surgical treatment is Failed Back Surgery Syndrome (FBSS). This syndrome describes conditions when, despite one or more spinal surgeries aimed at reducing pain, they remain at the same intensity, which reduces the patient’s quality of life and work activity.

The incidence of this syndrome ranges from 5 to 10% of all operations (Davis, 1994) to 15-50% (M.S. Gelfenbein, 2000) depending on the nature of surgical procedures, selection of patients, methods for assessing treatment results and tactics of postoperative management of patients . The highest percentage of FBSS is reported by American colleagues, where microdiscectomy surgery has become an outpatient procedure and the patient is discharged from the hospital on the day of surgery or the next day. One of the main reasons for the development of FBSS is the recurrence of a disc herniation at the same or adjacent level. After laminectomy, 15-20% of patients undergo reoperation due to recurrent hernia (Yumashev et al., 1984).

Microsurgical techniques have improved results and reduced postoperative hernia recurrences to 10-12% (Savenkov et al., 1997, Shcherbuk et al., 1999). However, even the use of endoscopic video monitoring during microdiscectomy does not completely avoid this complication, leaving about 4% of relapses (Shcherbuk et al., 1999). This is understandable, since no surgical intervention can stop the degeneration of spinal structures. Surgery is aimed only at eliminating local conflict. Probably, not only the correct selection of patients, the quality of the surgical intervention performed, but also a certain tactic of gradually increasing the load on the spine in the postoperative period, teaching the patient to move correctly, preventing overload of the spine and functionally stabilizing the operated segment, is important for the final result of treatment.

Material and methods

The results of surgical treatment in 55 consecutively operated patients were studied. Follow-up in the postoperative period was studied in 43 patients. This group included all patients who responded to letters with a follow-up period of 6 months or more.

The average age of the patients was 43.4±7.8 years (min 28, max 62), women - 20, men - 35. To select for surgery, all patients were examined using a modern neurological and neurosurgical diagnostic complex. Patients underwent a general clinical examination, neurological examination, magnetic resonance imaging (MRI) (37 patients), computed tomography (CT) (19 patients). In 31 cases, the diagnosis was clarified by positive myelography with functional imaging; in 6 patients, CT myelography was performed.

In 25 patients, the disc herniation was determined at the L4-L5 level, in 23 at the L5-S1 level, four patients had hernias at two levels L4-L5 and L5-S1, two patients at the L3-L4 level and one at L2-L3. In 23 patients lateralization was noted to the right and in 32 to the left. Upon admission, all patients complained of back and leg pain with a predominance of leg pain compared to back pain. In 40 of 55 patients (73%) and in 34 of 43 patients (79%) with a follow-up, weakness in the foot was observed, in 45 of 55 (82%) and 39 of 43 (91%) patients there was numbness in the area of ​​innervation of the affected root . Four patients had varying degrees of pelvic dysfunction.

All patients underwent microdiscectomy using the classical W. Casper technology using Aesculap instruments. Indications for surgery in 95% of patients were the ineffectiveness of complex conservative therapy in various neurological hospitals for at least 5-8 weeks from the onset of radiculopathy, and progressive weakness in the foot. On average, the duration of conservative treatment from the moment of the last exacerbation to surgery in the analyzed group of patients was 4.3 ± 3.6 months.

Only three patients were admitted to the clinic and underwent surgery in the acute period due to the development of cauda equina syndrome. In the postoperative period, all patients were trained in the method of alternative locomotion (Nekrasov A.D., 1999) in order to functionally stabilize the operated segment. The method made it possible to significantly expand the range of motor activity of patients and reduce the risk of neurological complications. The patient was allowed to get out of bed the next day after surgery. Discharge from the hospital was carried out after removal of the sutures. For a month, the patients did not put full load on the spine in a sitting position.

Long-term results of surgical treatment were monitored through a written survey of patients according to a questionnaire we developed

Results and its discussion

All 55 patients who underwent microdiscectomy were discharged from the hospital with significant improvement or recovery. At discharge, all patients responded that they were satisfied with the results of the operation. During surgery, fragments of disc herniation were found loose in the epidural space in 19 patients. In 4 cases, a rough adhesive periradicular process and ossification of the posterior longitudinal ligament were detected. In these patients, the duration of conservative treatment was 10±6 months.

It has already been noted in the literature that long-term ineffective conservative therapy contributes to the development of hypertrophic and ossifying processes (Musalatov, 1999). Less favorable outcomes of surgical treatment of lumbar disc herniations are shown in patients with a duration of leg pain exceeding 8 months (Nygaard et al, 1999).

At the time of discharge from the hospital, 49 (89%) patients demonstrated complete disappearance of leg pain, 6 (11%) patients noted significant pain relief, but some discomfort in the leg remained.

Motor disturbances decreased in 100% of cases, and in 65% they completely disappeared by the time of discharge. Somewhat worse results immediately after surgery were obtained with regard to back pain: 42 out of 55 (76%) and 32 out of 43 (74%) with follow-up patients stated the absence of back pain and in 20% the pain decreased significantly. However, 3 of 55 and 2 of 43 patients continued to complain of back pain. The latter had a duration of conservative therapy of more than 8 months and a periradicular adhesive process discovered during surgery. Sensory disorders completely disappeared in only 18% of patients and decreased in 61%. In 19% of patients they remained at the preoperative level and in one patient, where the epidural scar was excised, they worsened after reoperation.

In a group of 43 patients where postoperative follow-up was followed, four patients were observed for a period from 6 months to 1 year, more than a year to two years - 22 patients, and more than two years - 17 patients. Thus, the average postoperative follow-up period was 20±7.3 months. To the question: “Are you satisfied with the results of the operation?” 42 out of 43 patients answered “Yes.” Moreover, 40% of patients accompanied the answer with one or more exclamation marks. Only one patient, whose wound suppurated in the late postoperative period and serious social motivations to maintain the disability group arose, remained dissatisfied with the outcome of the operation when surveyed after 8 months.

71% of patients responded that the weakness in the foot had completely disappeared and 26% noted an improvement. It is important to note that 5 patients who had residual weakness in the leg upon discharge subsequently fully recovered movement.

25 (58%) patients were completely free from any pain, 36 (84%) did not experience pain in the leg and 28 (66%) did not experience pain in the back. Six (14%) patients had a low level of pain, which allowed them to perform any physical activity other than sports. 11(26%) patients reported attacks of pain in the leg or back, which were relieved by conservative therapy. One patient complained of severe pain in the leg and back, as well as increasing weakness in the foot, which was not detected during an objective examination.

Most authors report 90% satisfactory results after discectomy (Spangfort, 1972, McCulloch, 1989, Manucher, 1992, Kotilainen et al., 1993). However, only 50% of operated patients completely get rid of any symptoms of the disease (Spangfort, 1972). In a series of 100 operated patients, after a year, 73% of patients had pain in the leg and only 63% of patients had pain in the back (Lewis, et al, 1987), which is in good agreement with our data.

In our study, 34 (79%) patients continued to work in the same capacity without restrictions. Of the five patients who had a disability group before surgery, only one returned to work. In one case with the development of failed surgery syndrome, a higher disability group was established. Three other patients remained in the same group, although during a written survey they were satisfied with the outcome of the operation and noted a significant improvement in their condition.

Assessing the results of surgical treatment in the long-term period according to the scale proposed for this purpose (Pevzner et al., 1999, Davis, 1994, Dowd et al., 1998), we received 86% good, 12% satisfactory and 3% unsatisfactory results.

As can be seen from the table below, good long-term results of surgical treatment in periods from 0.8 to 10.8 years are observed from 68% to 95% and, accordingly, unsatisfactory results are given from 12% in 247 patients to only 1% in 50 patients (table .1).

Table 1

Long-term results of discectomy
Authors

Number of patients	Results %					Hernia recurrence, %
	Good		Satisfied.	Unsatisfactory
Davis	984	89,5	7,7			3	6
Pappas	654	76,3	15,5			6,8	3
Dowd	247	68,4	19,6			12	8,9
Pevzner	50	95	4			1	2
Krivoshapkin	43	86	12			3	0

Probably, the final results of surgical treatment depend not only on the characteristics of surgical tactics, but also to a much greater extent on the selection of patients in groups. It has been noted that psychological and socio-economic factors (significant excess weight, presence of disability before surgery, psychological instability, medico-legal problems) are strong negative factors that predetermine an unfavorable outcome of the operation (Finneson, 1995).

Conservative therapy is recommended in cases where a poor outcome from surgery is expected (Junge et al., 1995). In our series, we received an unsatisfactory result in the case of a confluence of all the above negative factors, having performed surgery due to a progressive neurological deficit and the patient’s insistence due to unbearable pain. In the group with preoperative disability, only one patient achieved a good result, in other cases only satisfactory results.

It is important to note that in the analyzed group of consecutively operated patients, two reoperations were performed. In one case, a revision of a festering wound was performed, and in another, repeated excision of the epidural scar in the early postoperative period was carried out in a patient who had been treated conservatively for a long time with numerous epidural blockades before surgery. There were no cases of reoperation due to hernia recurrence. We associate the latter with teaching patients the technique of alternative locomotion, aimed at functional stabilization of the lower lumbar segments after surgical treatment.

conclusions

1. Microdiscectomy, performed according to strict indications, is a highly effective method of treating discogenic radiculitis, bringing relief to patients both immediately after surgery and in the long-term period.
2. Long-term (over 8 months) ineffective conservative treatment and early transfer of patients to disability worsens the outcome of surgical treatment.
3. Teaching patients the technique of alternative locomotion helps to avoid relapses of hernias in the postoperative period.

LITERATURE

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