Lumbar Disc Herniation Surgery

Transcript translated from Turkish (video audio remains in Turkish)

Hello everyone, I am Dr. Mehmet Levent Deniz, a specialist in brain, nerve and spine surgery. I will explain the microdiscectomy technique used in lumbar disc surgery.

Lumbar microdiscectomy remains the most common method for lumbar disc herniations requiring surgery in Turkey and many other countries. We perform the operation under general or spinal anaesthesia. After an approximately 3-centimetre skin incision, the muscles in the area are moved aside to reach the bone. Some bone is removed to reach the herniated disc tissue. After removing the ligaments beneath the bone, we reach the disc tissue that needs to be removed. The herniation is removed with microsurgical instruments, relieving the compressed nerve tissue.

The operation takes approximately 40 to 60 minutes. The hospital stay is one day.

I wish you all pain-free and happy days. Stay well.

What Is Lumbar Disc Herniation Surgery (Microdiscectomy)?

Microdiscectomy removes herniated disc tissue through an approximately 2–3 cm incision under a surgical microscope, relieving pressure on the nerve root.

Who Can Receive Lumbar Disc Herniation Surgery?

It is used for patients with pain that persists despite non-surgical treatment or progressive weakness or loss of bladder or bowel control. The vast majority of our patients with lumbar disc herniation improve non-surgically, but some need an operation.

• Treatment-Resistant Chronic Pain: Persistent lower back and leg pain that limits daily life and prevents walking and sleeping, despite medication, physiotherapy and algology procedures (interventional pain treatments) such as targeted treatment (epidural injection).
• Conditions Requiring Urgent Assessment: Foot drop (inability to lift the ankle upwards), progressive weakness or loss of bladder/bowel control (cauda equina syndrome) resulting from severe pressure on the nerve roots. Loss of bladder or bowel control requires emergency surgery; progressive weakness requires surgery without delay.

Microdiscectomy is one of the first surgical choices after non-surgical techniques in treating lumbar disc herniation. In some suitable cases, full-endoscopic lumbar disc surgery may be the first choice.

How Is Lumbar Disc Herniation Surgery Performed?

Microdiscectomy is performed through an approximately 2–3 cm incision under a surgical microscope, with general or spinal anaesthesia, and takes 40–60 minutes.

• Anaesthesia: General or spinal anaesthesia (numbing from the lower back) is used.
• Surgical Access: The operative area is reached through a small skin incision of approximately 2–3 cm.
• Stages: The deeper muscles are minimally detached and a very small amount of bone is removed to relieve the nerve. After passing the ligament tissue beneath the bone, the compressing herniated disc material is removed in a controlled manner with a clear microscopic view, freeing the nerve.
• Duration: Approximately 40–60 minutes.
• Hospital Stay: Our patients generally stay in hospital for 1 day after surgery.

What Is the Success Rate of Lumbar Disc Herniation Surgery?

Yes, in most patients: in sciatica lasting 4–12 months, leg pain on a scale of 10 fell to 2.8 at six months in operated patients, while remaining at 5.2 in those managed without surgery [4]. This is the standard operation for severe radiating leg pain that does not respond to non-surgical treatment.

Comparisons of operated and non-operated patients showed greater improvement in pain and daily functioning after surgery; this advantage persisted for 8 years [1, 2, 3, 7].

What Are the Risks and Side Effects of Lumbar Disc Herniation Surgery?

Microdiscectomy has a low complication rate: reported rates are 2.3% for tearing of the membrane around the nerves (dural tear), 2.1–3.5% for wound problems, 0.3–2.6% for nerve root injury, 4.4–5.1% for recurrent herniation at the same level, and 7.1–7.5% for repeat surgery for any reason [5, 6]. Microsurgical techniques keep these risks low.

🩺 Physician’s Insight & Clinical Experience

“As a spine surgeon, I should emphasise that despite all the new technologies, microdiscectomy remains one of the most widely used and extensively researched methods of lumbar disc surgery. The magnification and depth perception provided by a high-resolution microscope help protect nerve tissue with millimetre precision. It is the method spine surgeons most often use in clinical practice for patients in whom surgery is indicated. It is our fundamental, extensively studied method, aiming to reduce nerve injury risk by limiting intervention in surrounding tissues as much as possible.”

Frequently Asked Questions

What Is Microdiscectomy, and How Is It Performed?

Microdiscectomy is surgery for lumbar disc herniation in which herniated disc tissue is removed under a surgical microscope through an approximately 2–3 cm incision.

What Is the Success Rate of Microdiscectomy?

For sciatica lasting 4–12 months, leg pain after microdiscectomy fell to 2.8 out of 10 at 6 months, compared with 5.2 in the non-surgical group [4]; the advantage of surgery persisted for 8 years [3].

How Long Does Lumbar Disc Herniation Surgery Take?

It takes 40–60 minutes, less than one hour.

How Long Must I Stay in Hospital After Surgery?

Patients are generally discharged the following day.

Does Microdiscectomy Have Risks or Side Effects?

Yes, but they are low: reported rates are 2.3% for dural tear, 4.4–5.1% for recurrent herniation at the same site and 0.3–2.6% for nerve root injury [5, 6].

When Can I Return to Work After Microdiscectomy?

Most of our patients with desk jobs return after approximately 2 weeks (10–14 days); for heavy physical work, this is 4–6 weeks.

When Can I Get Up After Microdiscectomy?

Our patients can get up and start walking approximately 4–6 hours after surgery. By the following day, they are able to climb stairs and walk short distances and are discharged.

When Can I Walk, Exercise and Resume Sexual Activity?

Gentle walks begin the day after surgery. Sexual activity generally resumes after week 2. Swimming and light exercise begin in week 4, and strenuous sports after month 3 following a check-up.

Are Stitches Used, and Will There Be a Scar?

Cosmetic (dissolvable) stitches are generally used, so there is no need to have them removed. Because the incision is very small (an average of 2–3 cm), the scar is barely noticeable once healing is complete.

Is There a Risk of Paralysis During Microdiscectomy?

No, paralysis is not an expected outcome after microdiscectomy; serious neurological complications are rare. A reported nerve-root injury rate is approximately 0.3% [5].

Can a Lumbar Disc Herniation Recur at the Same Site After Microdiscectomy?

Yes: recurrent herniation at the same level occurs in 4.4–5.1% of patients [5, 6]. Weight control and lower back exercises reduce this risk.

Which Specialist Performs Microdiscectomy in Istanbul?

One of the physicians performing microdiscectomy in Istanbul is M. Levent Deniz, MD, a specialist in neurosurgery.

How Much Does Lumbar Microdiscectomy Cost?

As treatment costs vary according to the patient and hospital conditions, a definite fee can only be determined after examination and review of imaging.

References

1. Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA. 2006;296(20):2441-2450. PMID: 17119140. PubMed
2. Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2008;33(25):2789-2800. PMID: 19018250. PubMed
3. Lurie JD, Tosteson TD, Tosteson AN, et al. Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976). 2014;39(1):3-16. PMID: 24153171. PubMed
4. Bailey CS, Rasoulinejad P, Taylor D, et al. Surgery versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months. N Engl J Med. 2020;382(12):1093-1102. PMID: 32187469. PubMed
5. Bombieri FF, Shafafy R, Elsayed S. Complications associated with lumbar discectomy surgical techniques: a systematic review. J Spine Surg. 2022;8(3):377-389. PMID: 36285095. PubMed
6. Shriver MF, Xie JJ, Tye EY, et al. Lumbar microdiscectomy complication rates: a systematic review and meta-analysis. Neurosurg Focus. 2015;39(4):E6. PMID: 26424346. PubMed
7. Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical vs Nonoperative Treatment for Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial (SPORT) Observational Cohort. JAMA. 2006;296(20):2451-2459. PMID: 17119141. PubMed

• 👨‍⚕️ Author and medical reviewer of this content: M. Levent Deniz, MD – Neurosurgery Specialist
• ⚠️ Medical Disclaimer: This page is for information only; consult your doctor for diagnosis and treatment.