When does a microdiscectomy need to be repeated for a slipped disc?Orthopaedic Surgery Sport Medicine Spine Health
I had a microdiscectomy for a herniated disc 1 year ago. Is there a chance that the procedure may need to be repeated? What are the typical situations in which I may need to undergo a second procedure?
Microdiscectomy is the standard surgical procedure commonly performed when a disc needs to be removed usually because it is endangering a nearby spinal cord or nerve (e.g. if patient has worsening sciatica pain in his leg unable to walk).
It combines both the advantages of physical removal of the herniated disc out of the spine (unlike radiofrequency discoplasty "injection") with minimally invasive approach reducing risk of collateral damage, pain, bleeding and infection because of a smaller incision wound, enabling patient rapid recovery (early return to home and work) after microdiscectomy.
With these benefits follow the disadvantage of not able to remove 100% of the disc (at least 10% may remain - ironically also helping to preserve some motion), unlike a larger fusion surgery which necessitates complete 100% disc (and motion) removal before implant insertion.
Hence 10% risk of a recurrent/relapse re-prolapse of the remnant disc anytime in the future is always made known to all patients during their consent process before their first microdiscectomy surgery.
A relapse of his old preoperative sciatica confirmed by a repeat mri of a recurrent same disc herniation will warn of this complication.
Similar to his first episode, a repeat discectomy or even fusion surgery is necessary if this second episode cannot be controlled by conservative treatment. The most important prevention is to make sure the wound and back/neck recover as much as possible after the first surgery and rehab postop spinal physio done for core strengthening after the first surgery.
An important recent development is the use of a newer endoscopic discectomy surgery as an alternative to microdiscectomy (can even be done by a pain specialist who is not even a surgeon!).
Because of a now even smaller endoscopic access, more and more cases of recurrent disc herniation necessitating a repeat surgery have been reported in USA so patients/doctors please beware !
Dr Fong Shee Yan
MBBS, FAMS, FRCS, MMed Ortho
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