Discectomy vs Microdiscectomy: Key Difference Between Discectomy and Microdiscectomy

By - Zahin Ibnat

The spinal column, otherwise called the backbone of our body is composed of spinal cord, spinal vertebrae and discs. Spinal discs are situated between every vertebra of your spine and go about as pads to secure your spine.

Problems of spinal disc may sometimes require surgery. Discectomy and Microdiscectomy are the two most common surgeries done to repair herniated or ruptured disc. But these days microdiscectomy are preferred over discectomy as it involves minimally invasive procedure.

Through extensive development of medical science, minimally invasive surgeries these days also uses laser in some cases. These advanced technologies have made it easy for us to get rid of disc problems and attain relief from pain occurring due to nerve compression.

What is Discectomy and Microdiscectomy

Discectomy

Discectomy is a surgical procedure which involves evacuation or removal of part or whole of the spinal disc. This surgery is generally done as a treatment of herniated (bulging, prolapsed or slipped), fissured or degenerated spinal discs. A herniated plate or disc compress the nerves that dissipate from the spinal cord or sometimes also gives pressure against the entire spinal cord. It can soothe nerve pressure and agony brought about by a herniated plate. This type of surgery generally requires 1-2 hours.

Discectomy is a typical however significant medical procedure with huge dangers and expected intricacies. You may have less intrusive treatment alternatives. Consider hearing a second point of view pretty much the entirety of your treatment decisions prior to having a discectomy.

Microdisectomy

Microdiscectomy, otherwise called micro decompression, is one of the most widely recognized minimally intrusive surgeries of spine. The primary objective of microdiscectomy is to ease the compression off your nerves to diminish your back torment.

A microdiscectomy is commonly viewed as the best quality level for eliminating the herniated bit of a disc that is pushing on a nerve, as the technique has an extensive history and numerous spine surgeons have broad mastery in this methodology. Hence, as this surgery requires an experienced medical team, discectomy cost can range from $15,000 to $50,000 which is higher in comparison to many other surgeries.

Let’s look into the main differences between a discectomy and microdiscectomy surgery:

Types of Discectomy and Microdisectomy

Types of discectomy

Discectomy are of four types according to the position of the disc in the body:

• Cervical discectomy: The cervical area is the one around your neck. Withdrawal of a disc from this area means removing a disc from the cervical spine and is called cervical discectomy.
• Thoracic discectomy: Thoracic area refers to the front and back of your chest. Withdrawal of a disc from the middle portion of the back I,e the thoracic spine is called the thoracic discectomy.
• Lumber discectomy: Lumber area is the one around the abdominal region between the diaphragm and the sacrum. This area is often called lower spine. Withdrawal of disc from the lumber spine is called lumber discectomy.
• Sacral discectomy: Sacrum is located in your pelvic region. Withdrawal of a disc from the sacral spine located in between your hipbones is called sacral discectomy.

Discectomy based on aggressiveness and removal of disc material:

• Aggressive discectomy: In this kind of discectomy very few disc nucleus are retained and all of the free disc fragments are removed. It also includes removal of some materials which are situated inside the disc.
• Limited discectomy: Here only the free disc fragments are removed which are found inside and around the disc hole.

Other types:

• Open discectomy
• Microdiscectomy
• Endoscopic discectomy
• Percutaneous discectomy
• Laser discectomy

Types of Microdiscectomy

According to the position of the spinal disc:

• Cervical Microdiscectomy: When microsurgical tools and microscope is used to withdraw a part of disc situated in the cervical spine, then this surgery is called cervical microdiscectomy.
• Lumber Microdiscectomy: This minimally invasive surgery is done to a part of herniated disc in the lumber region which is continually irritating the nerve root.

Other types:

• Endoscopic or keyhole microdiscectomy
• Tubular microdiscectomy
• Mini-open microdiscectomy

Discectomy and Microdiscectomy: Why are they done?

Specialists may prescribe a discectomy as a treatment of particular state and disease of the spine. Generally, doctors consider the option of discectomy only when the other less risky treatment options are not able to cure the spine problem effectively.

Image from: https://phg.eu/treatment-2/spine/microdiscectomy

Your physician may consider surgery as the only cure option for your spine in case you are having the following problems:

• Leg pain or back torment or feebleness or insensibility that doesn’t improve with different treatments in about a month and a half or more. Physical therapy, anti-inflammatory drugs and rest are considered as other treatment options for your spine problems.
• Issues with strolling and performing other every day works.
• Cauda equine syndrome which includes bowel or bladder control loss, weakness in legs and sensibility loss at the genital area.

Procedure of Discectomy and Microdiscectomy

Image from: https://www.shimspine.com/minimally-invasive-discectomy-vs-microopen-discectomy/

Discectomy Procedures

1. Open discectomy

• At the start of the surgery the specialist will make a surmised two to four inch cut in the skin over the problematic portion of the spine.
• Muscle tissue is taken out from the bone above and beneath the definite affected disc. The retractors are used to hold the skin and muscle aside from the work site so that the specialist has a lucid view of the vertebrae. Sometimes, removal of ligaments and bone may be required for gaining access to the affected discs. In  this case the surgeon remains careful about safeguarding the nerve tissues.
• When the specialist can envision the vertebrae, disc and other encompassing structures, he will eliminate the part of the disc that is distending from the wall of the disc along with some other disc pieces that may have been removed from the disc. This is frequently done under amplification.
• No material is utilized to supplant the disc tissue that is taken out.
• The cut is then shut with stitches and the patient is taken to the post-operative room.

2. Endoscopic discectomy

• In this type of discectomy at first a probe is inserted in the upto the affected disc by giving a small skin incision.
• Next, an endoscope including a camera and light are entered through the probe.
• Then the surgeon is able to see the certain area on a monitor.
• Other necessary instruments are also inserted through the endoscope.

3. Percutaneous discectomy

• In this case, a needle puncture is done on the skin in order to insert a percutaneous probe.
• Then the disc tissue is evaporated or burned through laser or extracted using a needle.
• This process takes about 30-45 minutes on average.

4. Laser discectomy

This process includes use of laser beam for both penetration and herniated disc operation. But this is still under research.

Microdiscectomy Procedures

1. Endoscopic microdiscectomy in lumber region

• To fix a lumber disc with herniation, your specialist usually makes a 1 cm cut in your back side.
• Here, they do not cut your back muscles rather move them aside under x-ray guidance and make a way for entering the endoscope. In this case microscopes and other special retractors are used.
• The endoscope allows proper identification of the problematic disc, nerve and other structures.
• Your specialist may have the necessity to eliminate a little portion of the facet joint (a joint which associates one vertebra to another one situated next to it) and conceivably the lamina (the bone situated at the rear of the vertebra).
• They’ll also eliminate the membranous layer over the nerve roots to get to your spine.
• In the wake of pulling aside the nerve root, your specialist would then be able to see the plate or disc and eliminate the herniated parts by using grasping/biting instruments along with some dental type instruments.
• This permits the spinal cord to regain its typical position. At long last, the specialist moves back the muscle and nerves to their original position and shuts the incision.
• The area is then cleaned with antibiotics which are sterile and contains water.

2. Endoscopic microdiscectomy in cervical region

To fix a herniated cervical plate, your specialist first gives a little incision in the rear of your neck to get to your cervical spine. Rest of the procedure resembles lumber microdiscectomy.

3. Tubular Microdiscectomy

• Utilizing fluoroscopic direction, a guidewire is entered across the skin and also paraspinous muscles to reach at the spinolaminar intersection which needs to be decompressed.
• A 2.5 cm incision is given in the skin to allow arrangement of dilators with successively expanding diameter.
• The tubular retractor is put in the course of the last dilator.
• Then, the dilator is taken out and the retractor stays set up and is balanced out by connection to an pliable arm assembly.
• A laminotomy is made with ordinary apparatuses (Kerrison rongeur, motorized burr), and the disc piece is taken out by visualizing with endoscope or microscope.

4. Mini-open Microdiscectomy

This procedure is almost same as the open discectomy. But in this case smaller incisions are given and special surgical devices are used to see the spine.

Discectomy and Microdiscectomy: Post-Surgery Managements

Post-surgery days bring a change in your day to day life and calls for some caution which you need to follow until complete recovery. Let’s take a glance at them:

• Few hours after surgery a patient may be allowed to go home but this strictly depend on the condition of the patient. Some patients are also recommended to stay for 24 hours in the hospital for observation.
• First 2 weeks, the patient feels intense pain. At this time opiods are given in combination with certain NSAIDs (non-steroidal anti-inflammatory drugs). But opiods are prescribed only for 2 weeks and after that for long term pain management, NSAIDs, acetaminophen and muscle relaxants are prescribed.

In initial few days, pain and fatigue is very severe. So, an accompany is required for helping with basic household chores and cooking.

• If a person has diabetes or is suffering from reduced skin sensitivity at the site of surgery, then heat or ice therapy can be given for 15-20 minutes at a time and a minimum gap of 2 hours should be maintained between consequent therapy.
• Generally after 2 weeks light works can be resumed.
• Within 6 weeks most people get completely recovered by 6 weeks and can return to their daily routine, office or school.
• In case a person need to do strenuous labor, he should wait for 6 more weeks I,e upto 12 weeks to resume his activities.

Discectomy and Microdiscectomy: Risk of surgery

Risk of Discectomy

Though medical science has made immense development, some risks are still there. Following is the list of side effects and risks of surgery:

• Infection
• Headache, confusion and nausea which are basically side effects of anesthesia
• Blood clot and bleeding
• Cerebrospinal fluid leakge
• Blood vessels or nerve damage
• Sometimes even surgery fails to relief the symotoms
• Disc herniation recurrence

Risk of Microdiscectomy

Initial risks:

• Numbness or feebleness due to nerve injury
• Leakage of spinal fluid can result from tear of dura matter.
• Pulmonary embolism or deep vein thrombosis
• Bleeding following surgery
• Infection
• Pneumonia

Long-term complications:

• Bladder or bowel control loss
• Erectile dysfunction
• Continuation of the numbness of leg
• Nerve pain
• Symptoms may exaggerate
• Further surgery like disc replacement or spinal fusion might be required due to surgery failure

Discectomy and Microdiscectomy: Difference Between Certain Surgeries

1. Endoscopic discectomy vs Microdisectomy

2. Microdisectomy vs Laminectomy

Conclusion

Though surgeries can be terrifying sometimes, these are the ultimate way to get of our pains for good. Back and leg pains work as an obstruction in our daily activities and also keeps us irritated. A chronic pain due to bulges disc is definitely hard to tolerate. (Know more about spinal disc problems and pain from Dr. Dryer on annular tears and annular bulge).

Now-a-days, surgeons are more experienced and many advanced instruments have emerged which makes the spine surgeries more reliable. In case you are having a severe problem, consult your doctor regarding the surgeries and also go through the risks and complications following the surgery. However, a proper permanent solution to your herniated or bulging disc problem can make your life happy and healthy as before.

The FAQs About Discectomy and Microdiscectomy

Q. Is Microdiscectomy a major surgery?

Answer: Generally, every surgery concerning the spine is counted as major surgeries. This is because spinal column is one of the most important and sensitive structure if our entire body framework. But the surgeries done are minimally invasive. So, major surgery does not necessarily mean that the procedure needs to be long with big cuts.

Q. What is the success rate of discectomy?

Answer: Success rate of discectomy is 90-95%. 5-10% of people have a chance of recurrent disc herniation.

Q. Should I have a lumber discectomy?

Answer: If you are suffering from long term back pain along with leg weakness which does not go away with medications, then you can consult your doctor regarding discectomy. This relieves the nerve compression and relives pain in your leg and buttock area.

Q.  How much you should walk after discectomy?

Answer:

• By day 4: 5 minutes at a time, upto 6 times a day
• By 2^nd week: 10 minutes at a time, upto 4 times a day
• By 3^rd week: 15 minutes at a time, 3-4 times per day
• By 6^th week: 30 minutes at a time, twice per day

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