Microdiscectomy, Microdiscectomy Recovery Times & Life After Microdiscectomy

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Welcome to the Back Pain Solutions Podcast – Microdiscectomy, Microdiscectomy Recovery Times & Life After Microdiscectomy

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Microdiscectomy, Microdiscectomy Recovery Times & Life After Microdiscectomy

As with many medical procedures, there have been advances is the surgical approach to back care. Spinal surgery once meant large incisions, long recovery periods and extended periods of rehabilitation. Fortunately, advances in surgical approach have improved the process making it less invasive. One such procedure is the microdiscectomy which is performed on patients suffering from a herniated disc, often with pain extended down the leg. During this surgery, a surgeon removes a portion of the disc to remove pressure on the spinal nerves exiting the spine which can be the source of pain. But how effective is this treatment? Is this a quick fix for patients suffering from back pain, with associated sciatic nerve pain and what are the longer-term outcomes following this surgical procedure?

In this episode we discuss the microdiscectomy and briefly outline the surgical approach to this treatment. We discuss the tissues that can be affected by the surgery and the potential collateral damage that can occur as a result of this procedure. We highlight why this approach is not a quick fix to the underlying problem such that an effective rehabilitation program post-surgery is fundamentally important to the long-term prognosis of your back health and the risk of recurrence of injury. Furthermore, we discuss the why many people consider this an early option in the treatment of their back injury without giving consideration for the active involvement they must play in their recovery. Finally, we touch on the recovery time and early exercises that can be expected post-surgery.

Some of the things you’ll discover:

• How the microdiscectomy is performed?
• Some of the risk factors involved in surgery of this type
• Why this procedure should not be considered a quick fix to the underlying problem
• What you should expect to do post-surgery in order to enhance the outcome of surgery
• Surgery success rates and recurrence rates
• Expected recovery time following surgery and what you can expect in the early stages of recovery
• Why an effective rehabilitation plan could help prevent the need for surgery and what you should expect from it

Show Highlights

When experiencing pain people want a quick resolution to their problem which is understandable. Unfortunately, as is often the case, people feel that surgery can provide a quick resolution to their problem. Whilst surgical advances allow for less invasive treatment options, and outcomes are considered more favorable, it does not mean it is a quick fix to the problem. If you simply go back to doing the things that you were doing preinjury then you should expect the problem to return! People fail to acknowledge that in the vast majority of cases the injury they experience is the result of repetitive, and consistent, aggravation of the underlying tissue. Good surgery will not solve for poor movement, and a lack of core strength so commit to solving these things if you want a healthier back!!

Episode Transcription

Unknown Speaker 0:00
When we’re young, we move with freedom and confidence with a great resilience to injury. But somewhere along the line we develop poor habits and become more vulnerable to back pain. Back Pain solutions features evidence based and practical advice to help you take back control of your health and get back to the activities you love. This is your guide to better back health through movement. So join us as we demystify some of the commonly held beliefs about back pain and build your confidence to a stronger back the smart way.

Ben James 0:28
Okay, welcome back to the back pain solutions podcast Everybody with me, Ben James. And today on running solo. It’s just me today and I’m talking micro diskectomy. This is a come from a question from a Facebook group about how quickly after a micro diskectomy you can start exercise what is the general approach to rehabilitation, I guess after micro diskectomy so we’re going to talk about microdiscectomy. We’re going to talk about the procedure talk about Some of the things that we need to be aware of post surgery, to hopefully give you some insights about the surgical approach and about how you should expect to recover from such a surgical procedure. As always, head on over to the www dot smart strong.co.uk. website, take advantage of our free ebook there, where we’re really helping people to take back control and empower them to take ownership of their back health within the next seven days some really fundamental things that you can be doing to really take control of your back health and get back to the activities that you love. So micro diskectomy What does that involve? So, generally, if this procedure is going to be performed for people that are suffering from a disc herniation and likely that disc herniation is caused irritation of the nerve root and therefore, that classic distribution of of nerve pain down the back of the leg sciatica for one of a better term, and as that disc bulges as the nuclear material within the disc bulges, it starts to compress the nerve root and in compressing the nerve root causes irritation inflammation of the nerve root and that’s where we get the resultant classic sciatica type pain. Now with a micro diskectomy to procedure effectively involves cutting out that that element of disc bulge that material and in doing so hopefully takes the pressure off the nerve root and resultant reduction of pain down the leg. So let’s talk a little bit about the surgical procedure First of all, and then some of the guidance, post surgery and just when Maybe you should consider going down that route. Because, as with any surgical technique, there are always where it risks and it’s a one way street. Once you’ve gone down that road of surgery, you can’t go back. So some of the things to consider and some of the things to look out for and potentially do before taking that option. So, with a micro diskectomy, you’re going to be under the guidance of a spinal surgeon, for sure. And generally, depending on when you’re likely on that list, if you’re in the morning, you might even be out of hospital on the same day. If you’re later in the list and it’s in the afternoon, then perhaps you’ll have to stay overnight just to be monitored post surgery. So you’re going to be lying prone on a surgical table and ultimately, the surgeon needs to get into the back To the desk. So, generally, you’re going to be under fluoroscopy. So that’s a type of X ray so they can see the level of the disc herniation where they’re targeting the surgical procedure, then a small incision is going to be made in the back, probably less than an inch to be fair, vertical incision, likely to the left right of the spine depending on where the herniation is, and then they’ll likely use some form of tubular dilators to get through the tissue and through the muscle, potentially having to separate the muscle but sometimes certainly with the erector spiny, they might be able to push those muscles to the side, but they’ll use some tubular donor dilators to increase the size of that hole as it were, so that they can then get the surgical tools in To the disk, so there are tissues that you’re going to have to get through that you’re going to have to cut through to reach the disk. And based on the the spine and the anatomy of the spine, there, there may need to be some kind of drilling of bone. So as you stack vertebrae on top of each other, you get a bit of a V shape of bone, called the lamina coming out in the back, and within that whole sexual your spinal cord, and then it tapers off back into your spine as process and that’s what you can feel down the middle of your back. Now, the orientation of those spinous processes those lamina are kind of in an inferior direction, so they angled down so if you imagine vertebra stacked on top of one another, quite often, the bone itself is going to prevent those surgical instruments getting straight through that incision to the desk. And so they may need to just use probably a bone burger just to drill away and shave away the bone on the lamina. So then it creates that access point, not always the case, but quite often that will be required. And at that point, they’ve now got access to the disk and there they can use small surgical instruments to cut away that herniated element of disk and then remove the instruments and suture. So in simple terms, that is how a micro diskectomy is performed. Generally it’s going to be under a general anaesthetic. And once you wake up, job effectively done or is it and this is the key point because first and foremost, there are the There are some risks. And obviously we can catch the nerve root, which is definitely what we want to avoid because that’s, that’s not going to lead to a positive outcome and those also scar tissue that we want to consider. So we’ll talk about those things a little bit. But really, the the ideal approach post surgery is to kind of get you up and about relatively quickly and you’ll be under the guidance of the occupational therapists physiotherapists, no doubt in terms of the guidance in what you do post surgery and that is likely to change slightly depending on where you have that operation. So there will always be different protocols or slight modifications of protocols in terms of how surgeons like the kind of post surgical approach to take place. So there will be slight variations but generally, you’re going to be open about quite quickly because These days, it’s it’s a much more proactive approach to rehabilitation. And that’s goes for any real orthopedic surgery, largely, we want to get things moving as quickly as possible. So walking is probably going to be advised and in the early stages of your recovery, and alongside some other exercises potentially, but generally, you’re looking at a four to six week, recovery time. So between that time, the likelihood is going to take things a little bit easy. And here’s the irony, because a lot of the guidance, post surgery in that early stage of recovery is avoid bending the spine. Avoid twisting the spine. So effectively any thing that can aggravate a disk, anything that a disk doesn’t really like or enjoy, you know, clearly that makes sentence if you’ve just had surgery on a desk, but the irony there is that these are the things we should be doing anyway. And the big question for me at this point is, have you had that guidance prior to any surgery? Have you had guidance on the daily routine, and a daily movement, advice, an exercise that supports what the spine and what those discs ultimately want to do or not want to do? Because repetitive flexion repeated flexion and twisting particularly, are detrimental to disc health. And if you’ve been doing those things for a number of years, that’s likely what’s caused your disc irritation very rarely Is it a result of a significant trauma. It’s it’s a repetitive action that leads to disc herniation. So if you have haven’t had that guidance, pre surgery, if you haven’t had that guidance on movement and what things you should be avoiding doing to support that disc in healing itself naturally, then for me, that’s something that you really need to reflect on before going down this surgical route. Because what we say is a one way path. Now, this the outcomes and the success rate, if you look at the evidence seems to be between 85 to 95%. Now, that’s pretty good. But clearly, they’re a proportion of the population that have these surgical treatments that don’t respond. Now. The likelihood is that those that don’t respond, are simply going back to the things that they were doing previously that caused the problem in the first place. Because this isn’t a treatment that is just going to prevent back problems in the future. And I think this is the another key point. The surgery alone is not going to solve your problem. Because if you go back to doing the things that you did before that caused the problem, then the problem is going to come back, whether it’s that disk or another disk, the problem is likely to come back. If you don’t change the things you’re doing, and that involves better movement. It involves spine hygiene and it involves building core strength. So don’t think that surgical approach is a quick solution, because it’s not and any surgeon is going to tell you that the rehabilitation is just as important. So if you haven’t done that rehabilitation, pre surgery, if you haven’t had the effective advice, pre surgery, then I would definitely recommend that you seek out somebody that can give you that information and can support an effective rehabilitation plan. First, if needed. The surgical route is there. But we want to avoid it in as many cases as we can. And the frustrating and the sad fact is people just aren’t getting the advice they need to take ownership of their back health and avoid chronic pain and potentially surgical procedures as a result. And so, really think about that before you go down this route, the options there. But if you have that treatment, and you go back to doing the things you did before, then the chances are it’s going to come back and actually, if it does come back, then the recurrence is much higher. So the likelihood of you getting again is then up to 15 to 20%. So, yes, you could have another procedure, but then your risk of reoccurrence is higher again. So A lot of things to really think about there before going down this, this surgical route. Now, generally, if you’re going to get a reoccurrence, it’s going to occur probably on average, around the three month mark. Sometimes it’s directly afterwards, sometimes it’s years later. But again, the reason it’s coming back is likely because you’re just not following the spinal hygiene advice, the exercise advice, the core strength advice that you need to be following in order to build a better back. Because surgery alone, as I say, and reiterate, isn’t just a quick solution. That means you don’t have to take an active approach yourself, because that is going to be a bad, bad approach for you to just think that that is going to solve your problem. So the other things we want to consider post surgery are the risk of scar tissue because if you’re cutting through tissue to get to the desk, Then there is that risk of, of scar tissue formation. And particularly, we don’t want that scar tissue to adhere to the nerve root. Because then as you’re moving that that nerve root isn’t passing through the tissue, the surrounding tissue as smoothly as it should be. And if it comes in different to other tissue because of scar tissue, then you can get a lot of aggravation of that nerve root and the same sort of symptoms in terms of leg pain. So nerve flossing would be another exercise that you’re likely to be given and if not, then it is something that you should be given, in my opinion to ensure that that nerve root is being cared for and can move through those tissues effectively. And that’s something that you’re going to want to do quite quickly post surgery just to make sure that those tissues don’t get the opportunity to form scar tissue around that that nerve root. So nerve flossing keeping you back in a neutral spine would be something that that would be really beneficial. And in simple terms, if you imagine sitting upright, keeping that back straight, let’s say the pain and the discomfort was down your left leg and it’s the left side of your lower back of a desk in your lower back that’s being treated, then imagine straighten in your leg. And as you point your toes, you bend your head forward, you flex your head forward, and simultaneous, you you then dorsiflex your foot, you bring your toes towards you, and you extend the head backwards. What that’s going to do is help flush the nerves because the nerves passing into your lower leg, go into the nerve root into your spinal cord. your spinal cord runs up all the way to the brain so it’s attached from your brain right the way down to your toes. So if you move your head and foot together, then you’re pulling that new Effectively through the tissue, and it’s called nerve flossing for that reason. So that’s something that really should be a consideration. And if you’ve undergone surgery and you haven’t been given that advice, then definitely ask your physiotherapist your surgeon about that. Because we want to avoid any scar tissue around that nerve root for sure. So there is going to be an active approach to your recovery. And so thinking about that pre surgery is the key take home here for me today. Because, again, if you’ve not been given that advice, then why not try that approach first, to see if effective rehabilitation effective movement effective exercise can prevent the need for surgery and in many cases, often it will. It’s just the bad advice out there and the wrong approaches and not leading you to success and therefore you’re having to go Go down this route of surgery to alleviate what is quite an uncomfortable symptom of leg pain, particularly alongside back pain. So completely understandable why people want to go down that approach to get rid, get rid of this discomfort, but sad that they’re not getting the advice that could help prevent that surgery in general. So, really, from a rehabilitation point of view work with, we’re looking at the same things that we would be looking at, if you hadn’t gone down that surgical route. So we’re avoiding those movements that aggravate the disc, we’re looking at building core stance, we’re keeping that spine in neutral, we’re learning to brace the spine, so that ultimately, we’re protecting the back and we’re allowing those discs to heal. So whether it’s surgery or not surgery, we have to do those things to allow that diff to heal. So it’s healing with or without surgery. So it shouldn’t be a big surprise that the advice is to try and avoid it. In the first place, don’t just assume that that diskectomy will solve your issue. And I go again, on labor in that point, but really, really important, really important because surgery isn’t a shortcut to recovery, you still need to modify your lifestyle, to support that back in the long term. spinal hygiene is essential. core strength is still important, these are non negotiable, for long term back health and resilience because you don’t want it to come back. And if you don’t take that advice, then the issue is likely to return. So if you’re looking for a short Road to Recovery than surgery is certainly not the option. You know, do do the work first, and then use surgery as a backup for the small percentage of people that can’t get better with conservative care. So hopefully, that gives some indication to the listeners to those people that are considering surgery and if you’re suffering from significant discomfort, and you’ve been suffering for a while, then it’s understandable why you would just think I want that. I want that discomfort to be cut away completely I can empathize with that because I’ve suffered from low back pain myself, it is not a nice experience. But if you know the things you do, you should do to manage your pain, then you really can feel in control and empowered to get back to the activities that you love in a conservative way. So the surgery is non invasive. The outcomes are pretty good in terms of surgical treatment. But it is a one way street, there are risks. And there are definitely things that we want to do effectively first, before going down that route. So hopefully, that is clear. You will take an active approach to recovery whether you’re undergoing surgery or not. Not so expect to do some exercises and ensure you adhere to those exercises, if you’ve already undergone this surgical approach because if you don’t do that, then as I said, the reoccurrence rate is, is pretty significant. So head on over to the website where you’ll get some ideas of some of the exercises you can do to build that core strength to move correctly to support your spinal hygiene before going down this route of surgery, because if you can do that, then clearly that’s the best option. And then you have a fallback option if required to head on over to www dot smartstore dot code at UK have a read of our ebook. And as I say there’s some great advice in there on some of the exercises that you can be doing some of the fundamental things that you can do to support your back health and hopefully, as a result, avoid any need for spinal surgery at this time, so www got smart strong.co.uk and, as always, thank you to the listeners that are posting reviews and sending these emails. We appreciate it. Any questions that you want answered on the show, then give us a shout. We’re happy to talk about them and to help answer your questions. And as always head on over to iTunes, give us a rating give us a review. It helps to share the message and share the help and advice that we are trying to put out to the world to support that back health. So thanks again for listening. And we’ll see you on the next show.

Transcribed by https://otter.ai

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