Microdiscectomy

The discs between the bones of the spine act as cushions. Each has a tough outer ring and a soft, gel-like centre. With age, strain or a sudden movement, the outer ring can split and part of the centre can bulge or break through, which is called a herniated or slipped disc. In the lower back, this fragment often presses on a nerve root on its way to the leg, causing inflammation and the burning, shooting pain known as sciatica. Microdiscectomy removes only the fragment that is pressing on the nerve, together with any loose disc material that could slip out later. The word micro refers to the magnification: the surgeon works through a small opening using an operating microscope or, in the endoscopic version, a thin camera. The disc space is not replaced and no screws or implants are used, so the natural movement of the spine is preserved. It is the standard operation for a herniated lumbar disc.

Most episodes of sciatica from a disc herniation improve on their own within 6 to 12 weeks, as the inflammation settles and the body gradually shrinks the fragment. First-line care therefore includes pain relief, staying as active as comfort allows, physiotherapy and, in some cases, an epidural steroid injection around the nerve. Microdiscectomy is recommended when severe leg pain continues despite this care and an MRI shows a herniation that matches the symptoms, when pain is so intense that it cannot be controlled, or when muscle weakness, such as difficulty lifting the foot, is present or getting worse. A rare but urgent situation is cauda equina syndrome, in which a large herniation compresses the bundle of nerves serving the bladder, bowel and genitals, causing numbness in the saddle area or difficulty passing urine. This is a surgical emergency that needs treatment at the nearest hospital within hours, not a planned trip. Back pain without leg pain is usually not an indication for microdiscectomy.

Microdiscectomy is most often done under general anaesthesia. You lie face down on a padded frame that takes pressure off the abdomen, and an X-ray is used to confirm the correct level of the spine. The surgeon makes an incision of about 2 to 4 centimetres in the middle of the lower back, gently moves the back muscles aside and creates a small window in the bony arch of the vertebra, called a laminotomy, sometimes removing a little of the thickened ligament beneath it. Under the microscope, the nerve root is identified and carefully moved aside, and the herniated fragment is removed. The surgeon checks that the nerve is free along its path, controls any bleeding and closes the wound in layers, often with dissolving stitches. In the endoscopic version, the same steps are performed through a tube about 1 centimetre wide. A single-level operation usually takes about 1 to 1.5 hours.

Good candidates have leg pain that is worse than their back pain, an MRI showing a disc herniation that fits the pattern of their symptoms, and either persistent disabling pain after several weeks of non-surgical care or worsening nerve weakness. The surgeon will examine your strength, reflexes and sensation and review the MRI in detail; if scans are older or symptoms have changed, a new MRI may be requested. Before surgery you will have routine blood tests and, where needed, an ECG, and your medicines will be reviewed; blood thinners and some anti-inflammatory drugs are usually paused on medical advice. Smoking slows healing and is linked to poorer outcomes, so stopping before surgery helps. For international patients, the MRI images and report can usually be reviewed remotely before travel, so the surgeon can confirm that microdiscectomy is appropriate and the operation can be scheduled soon after arrival and an in-person examination.

Most people are up and walking within a few hours and go home the same day or the next morning. Leg pain often eases markedly soon after surgery, although some soreness at the incision and in the back is normal for a week or two. Walking is encouraged from the first day and gradually increased. Long periods of sitting, bending, twisting and lifting are limited in the first weeks while the disc wall heals. Desk work is often possible after two to four weeks, while physically demanding jobs may need 6 to 12 weeks. Driving is usually possible once you can sit comfortably and are no longer taking strong painkillers, often after one to two weeks. For travel, plan to stay about 5 to 7 days so the wound can be checked before the flight; on board, an aisle seat and short walks help. A physiotherapy programme then continues near home, with remote follow-up and clear advice on when to seek help.

Microdiscectomy is a well-established operation, and most patients with typical sciatica have good relief of leg pain. Like any spinal surgery, it carries risks. A small tear in the membrane around the nerves, called a dural tear, can occur and is usually repaired during the operation, sometimes with a period of bed rest afterwards. Other uncommon risks include wound infection, infection of the disc space, bleeding, blood clots and, rarely, injury to a nerve root that can cause new numbness or weakness. The most important long-term issue is recurrence: a minority of patients have another herniation at the same level, most often within the first year, and some of them need a second operation. Leg pain usually improves faster than numbness, and weakness may take months to recover or remain partly. Back pain from wear in the disc is less reliably helped. Staying active, keeping a healthy weight and following a core strengthening programme support long-term results.