Microdiscectomy
Microdiscectomy is a microsurgical disc removal technique performed through a posterior approach under the operating microscope to relieve a herniated disc fragment pressing on a nerve root. It is most often used in the lumbar spine, and less commonly the cervical spine, to reduce radicular pain.
Останнє оновлення: 2026-06-08
Definition
Microdiscectomy is a technique performed from the posterior aspect of the spine in which a disc herniation compressing a nerve root is removed with the aid of an operating microscope. It uses a smaller skin incision and limited tissue dissection compared with open discectomy. The magnification and illumination provided by the microscope allow detailed visualization of the nerve root and the herniated material. The method is one of the most widely accepted reference techniques for disc herniation in modern spine surgery.
Indications
Microdiscectomy is considered in patients with persistent radicular pain from a disc herniation demonstrated on imaging (usually MRI) and concordant with clinical findings. It is generally offered to patients who have not responded to an adequate trial of conservative treatment (medication, physical therapy, activity modification). Earlier surgical evaluation may be appropriate for progressive motor deficit, uncontrolled severe pain, or cauda equina syndrome. The indication relies on the symptoms matching the anatomical location of the herniation.
Procedure
The procedure is usually performed under general anesthesia with the patient prone. After the target level is confirmed with fluoroscopy, a small midline incision is made and the paraspinal muscles are retracted in a limited fashion. Working under the microscope, the surgeon enters through the interlaminar window and performs a limited laminotomy and flavum excision when needed. The nerve root is gently retracted and the free or protruding disc fragment compressing it is removed; the intervertebral space is inspected when required. After confirming that the nerve root is decompressed, hemostasis is achieved and the layers are closed.
Advantages and Limitations
Microdiscectomy is a well-defined technique supported by long clinical experience and an extensive literature; microscopic magnification allows safe visualization of neural structures. It can offer a smaller incision and less tissue damage than classic open discectomy. However, some dissection of the posterior muscle and ligament structures is required, and the corridor used may be wider than in endoscopic techniques. In marked canal stenosis, significant instability, or multilevel pathology it may be insufficient alone and may need to be combined with other methods.
Recovery and Risks
Recovery time varies by patient; many patients mobilize early, but return to heavy activity is gradual. Possible risks include infection, bleeding, dural tear and cerebrospinal fluid leak, nerve root injury, and recurrence of the herniation at the same level. Pain may not resolve completely or may partly persist. No outcome is guaranteed; the decision is individualized by considering the patient's clinical status, imaging findings, and expectations together.
Джерела
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1257.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011:2919.
- Weinstein JN, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the SPORT randomized trial. JAMA. 2006.
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