Microlumbar Discectomy (MLD)

A microlumbar discectomy (MLD) is an out-patient procedure that can be performed using minimally invasive spine surgery. It is a type of surgery in which the lumbar spine is approached through a small incision in the back. The name of the procedure is derived from:

• Micro (small)
• Lumbar (lower back)
• Discectomy (removal of the protruding portion of the disc)

Traditionally, open spine surgery involves cutting or stripping the muscles with good blood supply away from the spine. Now I perform an MLD using minimally invasive spine surgery, a treatment that involves a small incision and muscle dilation. The muscles surrounding the spine are gently separated instead of cut. This minimally invasive approach preserves the surrounding muscle and blood supply and minimizes scarring. Before your surgery date, you will undergo a pre-operative medical evaluation and surgical risk assessment by the hospitalist group where your surgery will take place. You will be instructed to stop taking weight loss supplements, herbals, aspirin, non-steroidal medications and anti-coagulants several days prior to surgery to help reduce blood loss.

Why is a MLD performed?

To remove a portion of the disc that is placing pressure on your spine and/or nerve root.

Radiating leg pain, numbness, tingling or weakness, also called ‘sciatica,’ can be caused by a bulge or rupture of the small cushion (disc) between your lumbar vertebra in the lower back. If the symptoms do not respond to other non-surgical measures, such as ice/heat, medications, physical therapy or spine injections, then a microlumbar discectomy may be required. It is one of the most commonly performed spinal procedures. It is 95 percent successful in relieving leg pain from a herniated disc.

During the procedure, you will lie face down on the operating table. X-ray equipment is used in the operating room to visualize the spine. A small incision is made in the skin of your back over the disc to be treated. The muscles surrounding the spine are then dilated with a dilating tube to allow access to the area of herniation. A microscope and light source provide visualization. A laminotomy might be used. This is where a small portion of the bone of the spine (the lamina or “roof” of the spine) is removed to access the disc herniation. The offending portion of the disc is then removed, freeing up the spine and/or nerve root. The incision will then be closed in layers, leaving behind only a small scar or scars.

After Surgery

To ensure a successful outcome, it's important to understand the post-operative care after a microlumbar discectomy before you even have the surgery.

Pain medication: You will go home after surgery with a prescription for pain medication. Usually, about four to six hours after surgery, the lidocaine that was used to numb the surgical site wears off, and you may start to feel a new post-op “incisional” pain. This is normal, and you may take your pain medication for this. Most patients notice immediate relief of the pain they previously had down their buttock or leg. Others require a few weeks for their nerve root to heal after being compressed for so long, so remember to keep realistic expectations. Please remember that narcotic pain medications cause the intestines to move more slowly, which allows more time for your body to reabsorb water from your intestines. This can cause your stool to become dry and hard, thus causing constipation. Take an over-the-counter stool softener (Colace, Miralax, Senekot-S, Dulcolax or Milk of Magnesia) while you are taking narcotic pain medication and drink plenty of fluids. Your pain medication may contain an ingredient called acetaminophen or APAP. That is the generic name for Tylenol. Keep track of how many tablets you take a day and do not exceed 4,000 mg of acetaminophen in a 24-hour period. Excessive use of Tylenol causes liver damage. You may also be given a prescription for Ketorolac for pain. This may be taken along with your narcotic pain medication but only for five days.

Wound Care: For the first 24 hours post-op, do not remove your dressing. Keep your incision clean and dry. There will be sutures at the top and bottom of your incision that will be painlessly removed at your first post-op appointment. At times, I choose to use “skin glue” called Dermabond that does not require external sutures. If you feel the edges of this clear coating, do not peel or pick. It will come off over time. There may also be strips called Steri-strips. Please leave these in place, even if they begin to curl up at the edges. They will be removed by me or my assistant at your first post-op appointment. Once you no longer notice drainage on the dressing, you don’t need to wear a dressing. Some patients, however, prefer keeping a dressing on for the first two weeks to avoid friction from the waistband of their pants. Do not apply any ointments, peroxide or betadine to the incision, as these may inhibit new skin cell growth and delay complete healing of your incision.

Bathing: No tub bathing or swimming for six weeks, but you may shower two or three days following your surgery. Let water run over the incision, while turning away from the full force of the stream, pat it dry and then let it air dry.

Nutrition: Drink a can of Boost or Ensure nutritional supplement at each meal until you are eating three regular, nutritious meals per day. Proteins are the building blocks of healing.

Initial Activity at Home:

• No bending, twisting, stooping or lifting over five to ten pounds for at least six weeks after surgery.
• Sleep on your back or side with pillows under or between the knees.
• First week: Walk short amounts in the house every 10 to 15 minutes. Stairs are okay as tolerated. Office work and driving are permitted after one week, but do not drive if you are still taking narcotic pain medication.
• Third week: You should be able to walk up to a half mile per day in divided doses.
• Fourth week: You should be able to walk up to one mile per day in divided doses.
• Sixth week: Return to moderate duty work.
• Third month: Return to heavy duty work and be able to walk up to three miles per day.

Use good body mechanics (always bend with your knees to lift or to pick something up from the floor). Physical therapy may be prescribed for you later in your recovery, depending on your progress. You may return to driving when you are completely off narcotic pain medications and are able to quickly step on the brake without pain.

Follow-up: Your first post-op appointment will be about two weeks after surgery; however, if you have concerns prior to this date, I will see you back sooner as needed. The tiny suture knots at each end of your incision will be painlessly removed and X-rays may be taken. Subsequent follow-up appointment intervals will be based on how you are progressing.