Microdisectomy or microdiscectomy is a spinal surgery to treat nerve nerves. In this operation, the surgeon will lift the cushions on the spine to reduce pressure on the spinal cord, so that symptoms can subside.
Not all nerve clamps (hernia nucleus pulposus) need surgery. There are sufferers whose condition improves after undergoing treatment with drugs and physiotherapy. In fact, most people with symptoms of hernia nucleus pulposus can heal by themselves after a few weeks.
Doctors generally only advise patients to do microdisectomy if symptoms do not subside after undergoing treatment and physiotherapy for more than 3 months. Microdisectomy is performed to prevent the symptoms from getting worse due to nerve clamps.
Objectives and indications of microdisectomy
Symptoms of a hernia pulposus nucleus can be pain, tingling, or weakness in the affected area. If it occurs in the neck, pain can spread to the shoulders and arms.
Whereas if a nucleus pulposus hernia occurs in the lower back, pain will radiate to the buttocks, thighs, and calves. This creeping pain is known as sciatica. The pain will be increasingly felt when sufferers cough, sneeze, or move the body to a certain position.
Doctors can treat nerve pain with medication and physiotherapy. Microdisectomy is only done if the patient feels pain for more than 3 months and treatment without surgery is unsuccessful.
Aside from the lack of improvement in sciatica, microdisectomy can also be performed when the symptoms of a nucleus hernia pulposus cause:
- Numbness or muscle weakness
- It's hard to stand or walk
- Loss of control of urination and bowel movements
Warnings Before Performing Microdisectomy
Microdisectomy is generally safe to do. However, doctors can recommend advanced surgical procedures if there are multiple pinched nerves in the patient. In addition, there is a possibility that nerve pain and pain in the affected area will reappear after surgery.
Immediately go to the hospital emergency room, both before or after surgery, if a pinched nerve causes the following:
- Symptoms of pinched nerve are getting worse so that it disrupts daily activities.
- Patients with bedwetting or difficulty urinating, or can not control bowel movements.
- Saddle anesthesia or numbness that continues on the inside of the thighs, the back of the legs, and the area around the rectum.
Preparation Before Microdisectomy
Before the microdisectomy procedure, there are several things that the patient needs to do, namely:
- Undergo a medical check-up, either a medical examination from a general practitioner or a specialist who treats other conditions the patient has, for example an examination by a cardiologist.
- Stop smoking since a few months before surgery, to prevent postoperative complications in the form of infection or the slow process of wound healing.
- Preparing blood from donors, to be used as backup blood if there is a lot of bleeding.
- Stop using certain drugs, such as aspirin or nonsteroidal anti-inflammatory drugs, because it can cause bleeding and inhibit the work of the anesthetic.
- Patients also need to inform the doctor if they are using herbal medicines or certain supplements when undergoing the examination.
The day before the microdisectomy procedure, patients need to be hospitalized so that doctors and nurses can prepare everything needed. Before the operation is performed, the anesthesiologist will also look at the patient's medical history and do a physical examination to determine the type of anesthesia to be used.
There are 2 types of anesthesia that can be used in the microdisectomy procedure, namely:
- General anesthesia (general anesthesia), which is an anesthetic that will put the patient to sleep during the microdisectomy procedure.
- Half body anesthesia, an anesthetic that keeps the patient awake, but half the body (from the waist down) will feel numb.
Don't forget to inform the anesthesiologist about your illness or medical condition. Also tell the anesthesiologist if you or your family have allergies or have experienced certain problems related to anesthetics.
Microdisectomy Procedures and Actions
Before the operation, the patient will lie down on his stomach. After that, the doctor will give an anesthetic. The anesthetist and medical team will monitor the function of the patient's vital organs during the procedure, including heart rate and blood pressure.
It usually takes 1-2 hours for the microdisectomy procedure to be completed. The following will be explained about the steps taken during microdisectomy surgery:
- The neurosurgeon or orthopedic doctor will make a small incision on the patient's back, just behind the problematic disc or cushion. During surgery, the doctor will use a special X-ray device to ascertain the location of the nerve
- After the incision is made, the surgeon will insert a wire-shaped device into the problematic spinal cord pads, then the doctor will insert a larger metal tube down the direction of the wire.
- Furthermore, metal tubes which are getting bigger and larger in size will be inserted right around the previous tube. This action is done to shift the body's tissue to reach the spine.
- After successfully reaching the inside of the spine, the doctor will remove all the wires and tubes, then with special microdisectomy surgery tools, including lights and microscopes, the surgeon will take a part of the cushions that pinch the nerves.
- Once it is sufficient, the surgical instruments will be removed from the patient's body, then the doctor will cover the incision with stitches and put a bandage to cover the patient's wound.
Recovery after microdisectomy
After surgery, patients are allowed to go home 24 hours after surgery. During the recovery period the patient will be required to take a physiotherapy program. Physiotherapy is done to increase the strength and flexibility of the muscles around the spine.
In the interim, patients also need to avoid some activities, such as sitting too long, lifting heavy loads, driving a vehicle, and bending the body. The doctor will also ask the patient to use a corset or spinal support for some time after surgery.
Most patients who undergo microdisectomy can return to their activities after 2 weeks. However, it takes about 1.5 months to fully recover.
The doctor can prescribe painkillers if the scars are painful. The pain that a patient feels is usually lighter than the pain due to a pinched nerve before surgery.
During the recovery period, the surgical wound will discharge. This condition is normal, but consult a doctor immediately if there is fever, severe pain, or pus from the surgical scar.
Complications and Side Effects of Microdisectomy
Microdisectomy is a procedure that tends to be safe and rarely cause complications. Even so, the risk of complications remains, including:
- An allergic reaction to the anesthetic
- Infection
- Excessive bleeding
- Blood clotting
- Cerebrospinal fluid leak or cerebrospinal fluid
- Spinal cord injury
- Nerve clamps occur repeatedly
- Fecal incontinence and urinary incontinence.
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