Lumbar Microdiscectomy for the Treatment of Lumbar Disc Herniation & Sciatica

Lumbar discectomy and lumbar microdiscectomy constitute the same procedure aimed at removing the disc (typically a portion of the disc) between the vertebrae, because it has shifted posteriorly and entered the nerve space (canal), causing compression, pain, and serious symptoms. In essence, microdiscectomy is an advanced, minimally invasive surgical procedure in which Neurosurgeon Alexandros Blionas specializes, applying both techniques with excellent results to date in the treatment of intervertebral disc herniation, following careful selection of treatment and technique. As he maintains:

With indiscriminate application of surgery to all patients, the success rates from discectomy are closer to 60%. This figure alone confirms the importance of Physician Al. Blionas applying his pioneering (within the top 1% of the international medical community) service for the absolutely careful selection of treatment for each individual patient, using the advanced Artificial Intelligence (A.I) system CLAUDE FABLE, based on personal as well as the most recent and valid scientific data. The patient is not only fully informed about the data for each treatment option based on their personal medical characteristics and knows in advance what to expect, but also has access in minimal time to invaluable scientific knowledge drawn from thousands of scientific data points.

When is discectomy performed

The reason discectomy is performed is the attempt to eliminate the symptomatology, which primarily includes weakness, numbness, and pain (sciatica, i.e. leg pain that originates from the lower back and travels toward the leg). Discectomy is generally performed:

• when these symptoms are severe and do not resolve with other methods
• when significant muscle weakness is present.

Effectiveness of surgery

For the patient, discectomy surgery means a one-day hospitalization or simply a few hours at the hospital and 1 small skin incision in their lower back. The patient can return to their activities after very few days, provided they avoid lifting weights and prolonged driving for 3–4 weeks. It should be noted that patients with disc herniations should generally avoid lifting heavy weights, as they may have problems in the future with other discs as well.

Regarding how “good” the surgery is, the patient should expect an effectiveness in the range of 60–90%. These percentages refer to the likelihood of symptoms being reduced by more than 50% six months after surgery.

The key question is how the patient can approach 90% rather than remaining at 60%, which seems particularly low. With careful patient selection and especially by preferring patients with chronic symptoms and/or who have already unsuccessfully tried pharmacological and conservative treatment, we can achieve rates close to 90%. Therefore, the most important factor is the careful and correct selection of patients. Further questions arise that must concern both the physician and the informed patient, with scientific evidence as the primary criterion:

Questions regarding the “aggressive” and “conservative” strategy

An extremely important technical element relating to the surgical rationale of discectomy is the amount of disc that is removed. Some surgeons remove the entire disc (aggressive strategy), while others remove only the portion that is causing compression (conservative strategy).

The aggressive method has the advantage of reducing the likelihood of recurrence (the disc herniating again), however its disadvantage is that if no hardware is placed to support the spinal column in the surgical area, it is very common for instability to develop in the area and/or for the vertebrae to come into contact with each other. The result is typically low back pain that develops after a number of years.

The conservative method, although accompanied by higher recurrence rates, does not carry the above risk. Theoretically, we could place hardware in all patients and perform aggressive discectomy, however the problem is that the insertion of hardware constitutes a considerably more complex surgery, with complications and a more difficult recovery for the patient, and is therefore rarely the ideal solution.

In conclusion, the method of partial disc removal has prevailed, which carries a small risk of recurrence. In the event that recurrence does occur, it is not certain that it will cause nerve compression, as the surgical procedure also has the additional goal of increasing the space through which our nerves travel.

The procedure

The main methods by which the above procedure (disc removal by microdiscectomy) is performed are either through a very small 1–2 cm incision (minimally invasive), or through a larger 3–4 cm incision (discectomy). The bones and ligaments that obstruct access to the disc are removed to enable safe disc removal and additionally to create space behind the nerves, so that as mentioned previously, should the disc re-herniate in the area it will not cause significant compression due to the additional space.

Differences in final effectiveness between the two methods (classic discectomy and minimally invasive microdiscectomy) do not exist based on scientific evidence. It has been demonstrated, however, that microdiscectomy is clearly superior primarily in terms of complications as well as the recovery period. A clear, fundamental, and indisputable difference is cosmetic, as the minimally invasive method involves smaller incisions that are less visible on the patient’s skin, as well as reduced complications and a shorter recovery period.