Microdiscectomy –
Outpatient Spinal Surgery

Phillip Porter, MD
Neurosurgery
The Brain & Spine Institute, Eau Claire

Almost everyone knows someone who has had a slipped disc or pinched nerve in his or her back. Low back pain is extremely common in our society, and as a result is one of the most frequent problems that neurosurgeons deal with. The discs of the spine act as cushions between the bones, and provide some degree of mobility. They are composed of tough outer fibers, called the annulus, and a softer inner core known as the nucleus. Straining one’s back by lifting or twisting the wrong way (at work or play) may cause a tear in the annulus, leading to bulging or herniation of the softer disc material. This may have two effects. Firstly, the tear and swelling cause local pain in the back. Secondly, the bulging part of the disc may press on one or more of the nerves that exit from the spine to go to the legs and provide movement and sensation (see MRI). This may result in pain shooting down the leg from the back or buttock, numbness or tingling, and weakness of the leg. The nerves most commonly affected make up the sciatic nerve – hence, the term “sciatica” for this pain. Similar problems may occur in the discs of the neck, causing neck pain and arm symptoms.

What you should know about disc problems in the lower back:

• Many back injuries may be avoided by proper lifting and bending techniques, staying fit and reducing the load on your spine by losing weight.
• The majority of episodes of low back pain will resolve within days to weeks using appropriate non-surgical treatments including rest, anti-inflammatory medications, physical therapy, local injections, etc.
• For those who do not improve, surgery may be an option.
• The best imaging for sciatica is an MRI.

The most appropriate patients for surgery are those with significant buttock or leg symptoms (pain, numbness, and weakness), rather than back pain alone. The primary goal of microdiscectomy (removal of the herniated or bulging disc material under an operating microscope) is to take the pressure off the pinched nerve. Most patients have immediate improvement in leg pain, while neurological recovery from weakness and loss of sensation may take some time. Although microdiscectomy remains the standard surgical treatment for this condition, there are many other operations offered for disc problems, ranging from fusion to disc replacement. All disc replacements that have been tried in the past have ultimately failed. Current designs look promising but are still under FDA trial.

Traditionally microdiscectomy has been performed on inpatients, with a length of stay from 1-4 nights in hospital. However, with modern techniques this is now being performed on an outpatient basis, with same-day discharge in greater than 90% of appropriately selected patients. Patients must be medically and neurologically stable, able to walk to the washroom and have discomfort controlled with oral pain medications to meet the criteria for discharge.

Outpatient microdiscectomy is achieved by attention to the following issues:

• Appropriate patient selection (absence of other major medical problems, reasonable length of drive home).
• Performing surgery early in the day to allow the maximal period of observation and assistance before discharge.
• The administration of potent intravenous anti-inflammatory agents and infiltration of the area of surgery with long-acting local anesthetic at the end of the operation.
• Excellent post-operative nursing care to attend to issues such as mobility and the relief of pain and nausea.

For more information on Outpatient Microdiscectomy, contact Dr. Phillip Porter at The Brain & Spine Institute» 715.858.1777.
Also visit www.sofamordanek.com/health-spinal.html or www.esurgeon.com/pporter/ for other spine-related questions.