What is a microdiscectomy?
Microdiscectomy is a form of discectomy — an operation in which a herniated disc, which is compressing on a nerve, is removed to relieve the pressure on the nerve. It is called a microdiscectomy because the surgery is carried out under microscope visualisation and is usually performed as a minimally-invasive procedure.
Every discectomy has two stages. The first is to remove a small amount of bone covering the spinal canal. This is called a laminectomy. In some situations, only part of the bone is removed, it is then called, a laminotomy. The second stage is the discectomy, ie, removing the fragment of disc material which is compressing the nerve.
How a microdiscectomy differs from an open discectomy
A traditional open discectomy is performed through a midline incision over the back. This may measure up to 5 cm for a single level. The muscle is lifted from the bone, the laminectomy is performed, the nerve or the spinal cord is retracted, and the herniated disc material is removed.
A microdiscectomy reaches the same disc through a smaller incision (about 2 cm). Rather than lifting the muscle away, the surgeon uses a muscle-splitting approach, whereby a tube, or tubular retractor, is passed between the muscle fibres and docked onto the spine. The laminotomy and the discectomy are then performed through that tube, under the microscope.
The short-term advantages of microdiscectomy over open discectomy include less blood loss, faster recovery, less post-operative pain and shorter length of hospital stay.
However, over the long term, there is no difference between the two techniques. In peer-reviewed research comparing minimally invasive and open approaches to lumbar decompression, functional outcomes at 6 and 24 months were found to be similar (Minimally Invasive Compared With Open Lumbar Laminotomy, The Spine Journal).
When is a microdiscectomy recommended?
A microdiscectomy is usually recommended when a disc herniation causes symptoms which are significant enough to affect quality of life. In practice, that most often means:
- Severe buttock and leg pain from a compressed nerve, sometimes associated with numbness or weakness in the affected part of the leg.
- An MRI scan of the lumbar spine will then be done, in order to confirm the presence of nerve compression from a herniated disc.
Surgical decompression becomes urgent when there are warning signs of serious nerve involvement:
- Severe weakness in the leg or foot.
- Pain severe enough to limit walking or daily function.
- Loss of bladder or bowel control — a pattern known as the cauda equina syndrome.
If any of these is present, the nerve or spinal cord needs to be decompressed without delay.
Please seek medical attention immediately, do not wait.
What happens during the procedure?
The operation is performed under general anaesthesia and usually takes around an hour. Through a small incision in the back, the surgeon passes a tubular retractor between the muscle fibres and docks it onto the spine. Working under the microscope, a small opening is made in the bone covering the spinal canal, and the fragment of disc pressing on the nerve is removed. The small wound is then closed. Many patients are able to go home the same day or after one night.
Recovery after a microdiscectomy
| Stage | Typical guide |
|---|---|
| Same day | Walking, often discharged within 24 hours |
| 1–3 weeks | Light activity and desk work resume |
| ~6 weeks | Heavier lifting and sport reintroduced gradually |
These are general guidelines only. Your surgeon will give you advice tailored to your recovery, including when to resume driving and work.
Other minimally invasive approaches to a disc herniation
Minimally invasive discectomy is not the only minimally invasive operation available. Apart from microdiscectomy through a tubular retractor, the disc fragment can also be removed endoscopically — through a smaller tube that carries a camera and a working port, with the surgery performed under continuous irrigation. Endoscopic discectomy has its own variations, including uniportal and biportal techniques, and can approach the spine either between the laminae or through the foramen. Endoscopic discectomy will be covered in more detail on its own page.
Open discectomy, microdiscectomy and endoscopic discectomy all have the same aim: to remove the part of the disc which is compressing the nerve. The choice of the most suitable approach for you will depend on your anatomy and imaging scan results. The options, benefits and risks will be discussed with you before any decision is made.
Frequently asked questions
Is a microdiscectomy a major operation?
A microdiscectomy is one of the less invasive spine operations. It is usually performed through a small muscle-splitting incision using a microscope, most often with a tubular retractor, and often as day surgery or a short overnight stay. As with any operation it carries risks, which your surgeon will discuss with you beforehand.
How long does recovery after a microdiscectomy take?
Many people walk on the same day and go home within 24 hours. Light activity and desk work often resume within one to three weeks, with heavier lifting and sport reintroduced gradually over about six weeks on your surgeon's advice. Recovery varies between individuals.
Will a microdiscectomy fix my back pain?
A microdiscectomy is aimed mainly at relieving leg pain (sciatica) from a compressed nerve, rather than back pain itself. Your surgeon will explain how the operation is likely to help you, based on your symptoms and scans.
References
Discuss your symptoms with Dr Tow
Mount Elizabeth Orchard · Mount Elizabeth Novena