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Lumbar Surgical Decompression (Laminectomy, Partial Discectomy and Microdiscectomy)

Sciatic pain is generally caused by inflammation of one or more nerve roots triggered by disc material displaced from the intervertebral disc and/or by narrowing of the bony tunnel for the nerves.



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In addition, pressure onto the nerves may originate from the facet joint (the hinge on either side of the vertebra) which may become thickened by osteoarthritis.

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Removing the displaced disc material (microdiscectomy or partial discectomy) and/or enlarging the size of the tunnel for the affected nerve (laminectomy, foraminotomy/rhyzolysis) does have generally a high probability of relieving the nerve pain, generally felt in the buttock, thigh and leg extending below the knee.

This operation is carried out through an incision in the middle of the lower back, which may vary depending on the size of the patient and the levels to be operated on, from only 1.5cm to 5.0cm.

 

The operation is generally performed using a microscope and/or magnifying loupes (special glasses) to allow for safe visualisation and handling of the nerves.



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The operation requires a general anaesthetic.  The patient is positioned prone lying over a padded frame to avoid direct pressure onto the abdomen.

Most operations for a single disc prolapse (microdiscectomy) should take less than an hour to be completed.

During the procedure, the nerve involved is identified, protected and any disc material causing inflammation of the nerve removed to assure good function of the nerve afterwards.

 

Bleeding is controlled using a bipolar diathermy and at the end of the procedure, special gels and/or membranes (Duragen) may be used to prevent scarring which may tether the nerve to the adjacent tissues.



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Apart from the general risks of any operation performed under general anaesthesia, this type of spinal surgery may expose the patient to a risk of nerve damage which may lead to increased weakness and numbness in the leg and/or in rare cases, bladder or bowel dysfunction.
 
There is also a risk of damaging the membrane (Dura Mater) covering the nerve with secondary leak of cerebro-spinal fluid (CSF) (Dural tear) which may require the patient to spend extra time in hospital and/or take special medications.  This is an infrequent complication in first operations and/or younger patients.
 
The risk of CSF leak (Dural tear) increases with repeat operations and/or in older patients.  The risk of complete paralysis following lumbar spine surgery is very low and quantifiable at less than 1/1000 (similar to the risk of dying in a car accident in Australia).
 
Most patients with disabling leg pain are likely to experience immediate relief of their leg symptoms when they wake up after the anaesthetic.  Post operatively, the patient is encouraged to stand up and walk the day after and in most cases, following simple uncomplicated single level disc surgery, he/she may be discharged the day after the operation.
 
Post discectomy patients should not sit for prolonged periods (over 1 hour) for approximately two weeks and should, therefore, not drive for that period.  They should also not perform any tasks which may involve repetitive forward bending and/or heavy lifting (over 10kg) for approximately six weeks.  All patients are encouraged to commence a gentle mobilisation and muscle strengthening program within two weeks of the surgery and are reviewed routinely by a Physiotherapist prior to their discharge from hospital. 
 



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