Open discectomy is performed under general or epidural anesthesia, depending on the patient’s request or the location of the herniated lumbar disc, while the patient is in a prone position. A 2-4 cm incision is made on the skin. Then, the muscle tissue is stripped and a retractor is placed. A small window is made on the bone tissue behind the spine to access the connective tissue just beneath it, and then sometimes this tissue is removed and sometimes another small incision is made to see the thecal sac and the nerve root extending from it. Subsequently, the herniated part that increases the complaint of the patient by compressing on the nerve root is seen and removed. Afterwards, discectomy is performed by entering the disc area, where the herniation has occurred, and then the operation is completed after bleeding control.
Microdiscectomy (a surgical procedure performed by using a surgical microscope), involves a smaller skin incision and less amount of muscle tissue dissection. This enables the patient to experience a painless and more comfortable postoperative period. Performing the surgical operation by dissecting less amount of muscle tissue means LESS MUSCLE SPASM, i.e. LESS PAIN. The microscope used during the operation reduces the risk of complication by enabling the surgeon to have a magnified and very detailed 3-D view of the tissues.
I instruct my patients to stand up 6 hours after microdiscectomy. This early mobilization enables the patient to get through the night more comfortably and use the toilet without help. I use a digital PCA (patient-controlled analgesia) device prepared by my anesthesiologist friend for ensuring patients to get through the night without pain. This device regularly administers medications with considerably high analgesic properties to patients, and also enables them to get ADDITIONAL DOSES by pushing on its button when they feel pain. However, because of its digital features, the device adjusts the doses automatically and does not allow patients to take any additional dose after a certain dosage. In this way, patients are ensured to spend the night with maximum comfort. Patients are usually discharged 1-2 days after surgery. For the postoperative period, you can have a look at the section under the heading ‘Things You Wonder about the Postoperative Period of Cervical Herniated Disc Surgery’.