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Microdiscectomy: Current role in Management of Prolapsed Disc



Low back pain is spreading as an epidemic in the current era. One of the most important reason for this is the change in lifestyle from active to sedentary and change in job profiles from outdoor jobs to sitting jobs. The problem that arises with bad posture and lifestyle is that the age related degeneration has shown a tremendous shift to 3rd decade where people of age 30-40 have started facing problems with their back.

One of the most common diseases of the back is a prolapsed disc disease where a part of the disc which has degenerated is thrown out of the normal disc. This portion of the disc starts to compress the nerves in the spinal canal which causes pain in the buttock and whole leg with numbness in the leg, a group of symptoms commonly known as Sciatica.

Majority of the patients who suffer from this disease have intractable pain that increases on prolonged sitting and standing. Around 80% of the patients will get a good relief in symptoms with a good conservative treatment after a period of 6 weeks to 3 months. Some of the patients suffering from this ailment may develop weakness in one of the muscles of leg or may have to strain while passing urine. All such patients along with the patients who do not get a good pain relief in 6 weeks are candidates for surgical intervention.

There are various procedures described in the literature for such an ailment. Currently, Microdiscectomy is the gold standard procedure for this disease. Microdiscectomy is a procedure wherein we remove the piece of the disc tissue which has been thrown out of the normal disc which is compressing the nerve root causing pain in the leg. This procedure uses the help of a microscope or magnifying loupes and a light source for better magnification and illumination.

This procedure is done under general anaesthesia preferably in prone position. We expose one side of the spine and make a small hole in the back bone, preserving all the important joints and ligaments in the back, to remove the disc fragment which is compressing the nerve. In this process, we remove all the pressure on the nerve root to relieve the patient off the leg pain.

This procedure is favored over the traditional open discectomy as this causes less bone resection, less bleeding, less chances of post-operative back pain and lesser chances of adjacent segment degeneration. A better magnification and illumination makes this procedure very safe. This procedure is still rated a better procedure than Endoscopic discectomy with lesser chances of a recurrence as per the literature.

Dr Sahil Batra
MS (Ortho), DNB (Ortho), FNB (Spine Surgery)
Adult and Pediatric Spine Specialist,
CareMax Superspeciality Hospital,
Jalandhar

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