Lumbar Microdiscectomy

Overview

Lumbar microdiscectomy is the most common and well-proven surgical treatment for lumbar disc herniations causing sciatica — radiating leg pain, numbness, or weakness that has not responded to non-surgical treatment. Using a surgical microscope for magnification and illumination, Dr. Basques makes a small incision (about 2–3 cm) in the lower back, gently retracts the paraspinal muscles, removes a small portion of the ligamentum flavum and lamina to access the nerve, carefully retracts the compressed nerve root, and removes only the herniated disc fragment. The healthy portion of the disc is left in place. Microdiscectomy has a 90–95% success rate for relieving sciatica and is the procedure against which newer techniques (including endoscopic microdiscectomy) are measured. Dr. Basques has extensive experience with both traditional microdiscectomy and endoscopic microdiscectomy and will recommend the best approach for each patient's specific disc herniation.

How It Works

Under general anesthesia, the patient is positioned face-down. Using intraoperative X-ray, Dr. Basques marks the exact disc level. A 2–3 cm incision is made in the midline or slightly off-center. The paraspinal muscles on the affected side are gently elevated. A tubular retractor or small self-retaining retractor is placed. Using the surgical microscope, Dr. Basques removes a small portion of the ligamentum flavum and lamina (laminotomy) to expose the compressed nerve root. The nerve root is carefully identified and gently retracted medially. The herniated disc fragment — which is compressing the nerve — is identified and removed with pituitary rongeurs. The disc space is checked to ensure no additional free fragments remain. The nerve root is confirmed to be free and no longer compressed. The retractors are removed, and the incision is closed with dissolving sutures. The procedure typically takes 45–90 minutes.

Benefits

Who Is a Candidate?

Ideal candidates have a lumbar disc herniation at L3-L4, L4-L5, or L5-S1 causing sciatica (leg pain, numbness, or weakness) that has not responded to 6–8 weeks of non-surgical treatment including physical therapy, anti-inflammatory medications, activity modification, and possibly epidural steroid injections. Candidates with progressive neurological deficits (worsening weakness, foot drop) or cauda equina syndrome (bowel/bladder dysfunction) need more urgent surgery. Dr. Basques evaluates MRI and clinical symptoms to confirm the disc herniation correlates with symptoms.

Recovery & Aftercare

Most patients go home the same day or after one night of observation. Walking begins immediately and is encouraged. Most patients notice significant or complete relief of leg pain right away. Light activities resume within 1 week. Return to desk work is typically 2–3 weeks. Physical labor jobs require 6–8 weeks. No heavy lifting, bending, or twisting for the first 4–6 weeks. Physical therapy begins at 4–6 weeks. Dr. Basques provides detailed activity restrictions.

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