As with any form of spine surgery, there are several risks and complications associated with a microdiscectomy.
A dural tear (cerebrospinal fluid leak) occurs in about 1% to 7% of microdiscectomy surgeries. The leak does not change the results of surgery, but the patient may be asked to lie down for one to two days after surgery to allow the leak to seal.
No surgery is without risks. General complications of any surgery include bleeding, infection, blood clots, and reactions to anesthesia. If spinal fusion is done at the same time as a discectomy, there is a greater risk of complications. Specific complications related to a discectomy may include:
Deep vein thrombosis (DVT) is a potentially serious condition caused when blood clots form inside the leg veins. If the clots break free and travel to the lungs, lung collapse or even death is a risk. However, there are several ways to treat or prevent DVT. Get up and out of bed as soon as possible so your blood is moving and less likely to clot. Support hose and pulsatile stockings can keep the blood from pooling in the veins. Drugs, such as aspirin, Heparin, or Coumadin, may also be used.
Lung problems. Lungs need to be working their best after surgery to provide tissues with enough oxygen to heal. If the lungs have collapsed areas, mucus and bacteria build up can lead to pneumonia. Your nurse will encourage you to breath deeply and cough often.
Nerve damage or persistent pain. Any operation on the spine comes with the risk of damaging the nerves or spinal cord. Damage can cause numbness or even paralysis. However, the most common cause of persistent pain is nerve damage from the disc herniation itself. Some disc herniations may permanently damage a nerve making it unresponsive to decompressive surgery. In these cases, spinal cord stimulation or other treatments may provide relief. Be sure to go into surgery with realistic expectations about your pain. Discuss your expectations with your doctor.
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Other risks and complications include the following:
One of the most common complications is an infection where the incision was made. It can usually be treated successfully with antibiotics.
There’s a risk of developing a blood clot after lumbar decompression surgery, particularly in your leg. This is known as deep vein thrombosis (DVT).
DVT can cause pain and swelling in your leg and, in rare cases, may lead to a serious problem called a pulmonary embolism. This is where a piece of the blood clot breaks off and blocks one of the blood vessels in the lungs.
The risk of developing a blood clot can be significantly reduced by staying active during your recovery or wearing compression stockings to help improve your blood flow. Read more about preventing DVT.
There’s a risk of a dural tear occurring during all types of spinal surgery, including lumbar decompression surgery. The dura is a watertight sac of tissue that covers the spinal cord and spinal nerves.
If the tear isn’t identified and repaired at the time of surgery, it can lead to cerebrospinal fluid (CSF) leaking after the procedure.
Your surgeon will be aware of the risk of a dural tear, and if it does occur they will close the tear with stitches. In most cases, the repair is successful and no further problems or issues arise. However, further corrective surgery may be required in a small number of cases.
During lumbar decompression surgery, there’s a risk of accidental damage to the lining of the nerve, which can lead to the leakage of cerebrospinal fluid (CSF).
If this is discovered during the operation, it will be patched and repaired. However, small leaks can sometimes only become apparent after the operation, causing problems such as a headache and the wound to leak. Further surgery to repair this may be needed.
As you’re positioned face down during lumbar decompression surgery, you’ll be resting on your forehead and chin while the operation is carried out.
The anaesthetist will check regularly to make sure this isn’t causing any problems, but many people will wake up with a slightly puffed up face. In some cases, a red sore can develop over the forehead or chin, which could last several days.
Some patients who have lumbar decompression surgery will develop new numbness or weakness in one or both legs as a result of the operation.
Paralysis is an uncommon, but serious, complication that can occur as a result of lumbar decompression surgery.
Nerve injuries and paralysis can be caused by a number of different problems, including:
As with all types of surgery, there’s a risk of dying during or after lumbar decompression surgery, although this is rare. A blood clot, a bad reaction to the anaesthetic and blood loss can all be life-threatening.
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Most people can return to their usual activities around 4 weeks after herniated disc surgery. People who follow a rehabilitation program after surgery may experience a shorter recovery time and better mobility.
On your surgery day, you will report to the surgical center or hospital at an assigned time. Your doctor should give you pre-op instructions to follow. Be sure you follow these instructions carefully; eating or drinking before your surgery will be prohibited.
When you arrive, your surgical team will take your vital signs and start and IV line. Your doctor will meet with you to see how you are doing and to review the surgery one last time. Then, you will be brought to the operating room, and general anesthesia will be administered.
When you wake up in the recovery room you will be sleepy and a bit disoriented. Your doctors will check on your vital signs and your neurological status and treat your pain. He or she will also check your surgical incision for any signs of infection or problems. When you are more awake you may be transferred to a hospital room or another quieter recovery area.
If you have had a minimally invasive microdiscectomy, the goal will usually be to get you back home. First you will get out of bed and sit in a chair or walk to the bathroom.
As you feel better, you can begin walking up and down the hospital corridor. You will be given some food. If you can walk with your pain controlled, urinate, and keep food down, usually you can go home. IF you have had an open microdiscectomy typically you will be admitted overnight for observation regardless of your progress.
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While at home, you will need to be cautious about your movements. Be sure to maintain proper posture when sitting and standing, and avoid heavy lifting or frequent forward bending. You must protect your back so that it can heal properly.
You will be encouraged to slowly increase your activity level during the first week of recovery after surgery for a herniated disc. Walking is a great exercise after surgery as it helps to improve aerobic endurance and promote circulation in your body.
During the week following surgery, you will be expected to slowly increase your activity level while providing moderate protection for your back by avoiding bending, lifting and slouched sitting. You should continue to remain out of work during the first week of your herniated disc surgery recovery time.
Slowly increase your activity level and watch your incision for redness, swelling or discharge which may be signs of infection. By the end of the first week, you should visit your doctor who will check your incision and monitor your symptoms.
During the three week period in the herniated disc surgery recovery time, you should consider returning to work if your job is sedentary. If you work in an office, you should be aware of proper posture and work to maintain a neutral position for your spine while sitting or standing.
If your job requires heavy work, your doctor may recommend remaining out of work for a few more weeks.
Continue increasing your walking and activity tolerance with a goal of returning to everyday light activity by the end of three weeks. You may begin a light course of physical therapy if you need to, but some patients who undergo minimally invasive spine surgery enjoy a rapid recovery with no need for formal post-operative rehabilitation.
You should feel close to fully recovered after surgery by the fourth week. At that time you can slowly get back to your normal day-to-day activity with a full return to high intensity activity by the sixth to eighth week.
If you are facing surgery for a herniated disc, you should find a trusted neurosurgeon who can help guide you through the recovery process. Understanding what to expect after surgery can help you focus on your complete recovery and help you quickly and safely return to your previous level of function and activity.
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Read more about: Herniated disc surgery success rate
While it’s hard to quantify success in terms of surgical recovery (due to different lifestyles and activity levels of individual patients), a consistent 80-90 percent microdiscectomy success rate has been reported in numerous studies. This correlates with the ability for the patient to eventually return to most if not all of their previous activities.
Paralysis is an uncommon, but serious, complication that can occur as a result of lumbar decompression surgery. with a herniated disc, the capsule cracks or breaks, and the nucleus squeezes out. This can irritate the spinal cord or nearby nerves, causing weakness and numbness in the arms or legs. A severely herniated disc can cause paralysis.
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