Microdiscectomy and Microendoscopic Laminectomy

Microdiscectomy
Microdiscectomy, also called microlumbar discectomy (MLD), is a very common minimally invasive surgical decompression procedure performed in patients with a symptomatic lumbar herniated disc. The operation consists of removing the portion of the intervertebral disc that is herniated and compressing a spinal nerve root. The procedure is performed from the back (posterior) with the patient on his or her stomach.

A 1- to 2-cm longitudinal incision is made in the midline of the lower back, directly over the area of the herniated disc. Special retractors and an operating microscope are used to visualize the region of the spine, with minimal or no cutting of the adjacent muscles and soft tissues. After the retractor is in place, an x-ray is used to confirm that the appropriate disc is identified.

A small amount of bone of the superior (above) lamina may be removed first to expose the disc herniation. The nerve root and neurologic structures are protected and carefully retracted so that the herniated disc can be removed. Surrounding areas are checked to ensure that no additional disc fragments are remaining. This procedure typically takes about 1 hour to perform.

Outcome
Numerous research studies published in medical journals show that 90-96% of patients have good or excellent results from microdiscectomy surgery. Most patients experience a rapid decrease in pain and return to normal function.

Microendoscopic Laminectomy
Microendoscopic laminectomy, also called microlaminectomy, is a MIS decompression procedure performed in patients with symptomatic, painful lumbar spinal stenosis. The operation consists of removing the large, arthritic bone spurs that are compressing the spinal nerves. The procedure is performed from the back (posterior) with the patient on his or her stomach.

A 2- to 3-cm longitudinal incision is made in the midline of the lower back, directly over the area of the spinal stenosis. Special retractors and an operating microscope are used to visualize the region of the spine, with minimal or no cutting of the adjacent muscles and soft tissues. After the retractor is in place, an x-ray is used to confirm that the appropriate spinal level is identified.

The surgeon will remove all or part of the lamina and may also perform a foraminotomy, where bone overlying the affected nerve is removed with a small drill. The nerve root and neurologic structures are protected and carefully retracted so that the bone spurs can be removed. Surrounding areas are checked to ensure that no additional bone or disc fragments are remaining. This procedure typically takes about 1 to 1 ½ hours to perform.

Outcome
Numerous research studies published in medical journals show that 86-95% of patients have good or excellent results from microendoscopic laminectomy surgery. Most patients experience a rapid decrease in pain and return to normal function.

American Association of Neurological Surgeons
Neurosurgerytoday.org
Minimally Invasive Spine Surgery, January 2009

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