Microdiscectomy for Lumbar Disc Herniation (Microsurgery)

Microdiscectomy is considered the gold-standard operation for lumbar disc herniation. Herniated disc tissue is removed through an approximately 2–3 cm incision under a surgical microscope to relieve pressure on the nerve root. It takes approximately 40–60 minutes; patients are usually discharged the following day and return to everyday life in approximately 2 weeks.

When Is Lumbar Disc Surgery (Microdiscectomy) Necessary?

Most of our patients with lumbar disc herniation recover with non-surgical methods, but some need an operation. Surgery is chosen in two main clinical situations:

• Treatment-Resistant Chronic Pain: Persistent lower back and leg pain that limits daily life and prevents walking and sleeping, despite medication, physiotherapy and interventional pain procedures 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.

Lumbar Microdiscectomy: Procedure and Stages

The operation is performed under an advanced surgical microscope in the following stages:

• 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.

Does Microdiscectomy Relieve Herniation Symptoms? (Success Rates)

Yes, in most patients. This is the standard operation for patients with lumbar disc herniation and severe radiating leg pain (sciatica) who do not respond to non-surgical treatment. In sciatica lasting 4–12 months, leg pain on a scale of 10 fell to 2.8 at 6 months in operated patients, while remaining at 5.2 in those managed without surgery [4].

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 Complication Rates of Microdiscectomy?

Thanks to microsurgical techniques, this operation has a low complication rate. Reported rates are 2.3% for tearing of the membrane surrounding 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].

🩺 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].

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 can climb stairs and walk short distances and are discharged.

When Can I Walk, Exercise and Resume Sexual Activity?

Gentle walks can begin the day after surgery. Resuming sexual activity is generally permitted after week 2. Swimming and light exercise can begin in week 4, and strenuous and competitive 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?

Serious neurological complications after microdiscectomy are rare, but the risk is not zero. A published systematic review reported a nerve root injury rate of approximately 0.3%; this does not directly mean the “risk of paralysis”. Microscopic magnification and visualisation help protect nerve tissue more carefully but do not eliminate risk [5].

Can a Lumbar Disc Herniation Recur at the Same Site?

In some patients, yes: recurrent herniation at the same level occurs in 4.4–5.1% [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 brain, nerve and spine surgery.

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 – Brain, Nerve and Spine Surgeon
• ⚠️ Medical Disclaimer: This page is for information only; consult your doctor for diagnosis and treatment.