Lumbar Microdiscectomy Surgery

Everything You Should Know About Lumbar Microdiscectomy Surgery

Herniated discs frequently result in impingement of the spinal nerve and sciatica: pain that radiates from the back to the buttocks and down into one or both of the legs. When this occurs many seek relief in the form of lumbar microdiscectomy surgery. Microdiscectomy back is never considered a proper first response to sciatica but rather is only recommended after a patient has exhausted all other non-invasive treatments. This type of surgery is preferred for spinal disc herniation since it typically provides relief from sciatica without fundamentally altering the structure of the lumbar spine.

NHS Funding for Lumbar Microdiscectomy

At more than £13,000 microdiscectomy in the UK is an expensive procedure. There can be no doubt about that. In fact you could purchase a new Citroen C3 Hatchback for about the same price, and there aren’t many people who could do that without taking out an auto loan. The good news is that if you go abroad for your herniated disc operation you will likely be able to save 60% or slightly more and you won’t have to endure the interminable NHS surgical waiting lists. And the even better news is that, in many cases, NHS will pick up the tab for your overseas microdiscectomy.

NHS provides 2 potential funding routes when it comes to lumbar discectomy abroad: the “S2” route and the “EU Directive” route.

• The S2 Route – Many prefer to pursue the S2 route when it comes to funding their overseas microdiscectomy. This is because the S2 route does not require any upfront payment from the patient unless local custom calls for a co-payment of some kind. Even if that should be the case you have a decent chance of recouping any co-payment when you return to the UK after your surgery.
• EU Directive Route – The EU Directive route by comparison will require the patient to foot the cost of the surgery and then obtain reimbursement when they return to the UK after the procedure. While many would prefer not to have to pay upfront there is no denying the one major advantage the EU Directive route has over the S2 route: choice. With the S2 route you are confined to state sector treatments while with the EU Directive route you have your choice of state sector or private sector treatments.

Microdiscectomy Surgery: A Brief Description

Microdiscectomy is considered to be the most efficacious type of surgery for sciatica. It is the procedure to which all other types are compared to judge their effectiveness. Microdiscectomy success rates are in the neighbourhood of 95%; which is a very good neighbourhood indeed.

This type of back surgery for sciatica is typically performed under general anaesthesia with the patient lying face down on the operating table. In most cases the surgery will take anywhere from 1 to 2 hours, although the exact time will vary on a case by case basis depending on the physiology of the particular patient and their level of overall health. In most cases the microdiscectomy proceeds as follows:

• A small incision is created down the vertical axis of the lumbar spine. Usually this incision is about 1 to 1.5 inches in length.
• Special visualization instruments (including surgical microscope) are used that allow the surgeon to perform surgery under high magnification through small incision.
• The back muscles are lifted from the lamina of the spine and moved aside where they are held out of harm’s way during the procedure by means of a retractor.
• The membrane over the nerve route is removed to provide the surgeon access to the spine.
• In certain cases a portion of the facet joint is removed to A) relieve pressure on the pinched nerve and to B) facilitate access to the nerve root.
• It may also be necessary to create a tiny opening in the bony lamina in order to access the site of the nerve impingement.
• At this point the nerve root is also moved to the side, out of harm’s way.
• The surgeon is then able to access the herniated disc and remove any fragments of material that had been extruding from it and impinging the nerve.
• Once the offending material has been removed and adequate space created for the nerve root to assume a normal position free of impingement the retractor and any instruments are removed and the muscles returned to their proper position.
• The incision is then closed and sealed either by stitches or steri-strips and the patient removed to the recovery room.

Indications for Lumbar Microdiscectomy

As noted earlier microdiscectomy surgery is almost never considered a proper first course of treatment for a herniated disc. More conservative, non-invasive treatments such as physiotherapy, painkillers and behaviour modification often provide the time and conditions for the nerve impingement to correct itself. However, there are cases when surgery will be indicated.

• Failure of conservative methods – The most common reason your surgeon will ultimately recommend microdiscectomy surgery is because conservative, non-invasive techniques have been given ample time to work and have failed to relieve slipped disc symptoms. “Ample time” in this case is typically considered to be 6 to 8 weeks, after which surgery may be considered as a last resort.
• Loss of bladder or bowel function – In some more extreme cases a spinal disc herniation may produce a degree of pressure on the spinal nerve that affects bladder and/or bowel function. If this occurs urgent surgery is indicated.
• Progressive muscle weakness – If a patient experiences muscle weakness as a result of a slipped disc and that weakness gets progressively worse in spite of the application of conservative treatments lumbar surgery may be indicated.
• Intolerable radicular pain caused by disc herniation which cannot be controlled by conservative measures is an indication for expedited surgery

Contraindications of microdiscectomy

As any other surgery, microdiscectomy has a typical contraindications, or in another words situations when surgery cannot be performed for patient safety reasons. These include bleeding disorders, active infection elsewhere in body, being generally unfit for surgery etc.

There are few specific situations when microdiscectomy is contraindicated despite present disc protrusion/herniation.

• Mild to moderate pain – In most cases mild to moderate pain, sciatica, tingling, numbness or loss of reflexivity is not considered sufficient justification to undergo lower back surgery. In cases like these your doctor will want to proceed through a series of more conservative treatment regimes, many of which has an excellent track record of success.
• Back pain – As stated above if a patient is primarily experiencing back pain as a result of a slipped disc in the back microdiscectomy surgery will almost never be indicated. This type of surgery is designed to alleviate sciatica (pain projecting down through the legs) and not back pain per se. While it is possible that this type of surgery will relieve back pain as well as sciatica the relief of back pain is not a measuring stick by which success is measured when it comes to a microdiscectomy.
• Discrepancy between clinical and radiological test results – If a patient has clinical test results that do not correlate with radiological findings it is unlikely that surgery will produce any benefits. It is therefore rarely recommended in such situations.

Pre-operative Exam

Before undergoing a slipped disc operation at Neuro Spine Riga you will participate in a pre-operative examination and assessment to determine your level of fitness for the procedure and to ensure the recommendation for surgery was indeed the correct one. You will have a general health check-up as well as blood tests to look for any mitigating factors that may have either been missed earlier or which have sprung up in the days since surgery was scheduled. X-rays or an MRI will be performed as part of this confirmation and assessment process and to provide the surgeon with any last minute information that may be helpful. You will typically meet the surgeon who is to perform the surgery during this pre-operative exam which makes it an excellent opportunity to air any lingering questions or concerns you may have.

Prior to Surgery

Since each patient is different each may be advised to approach the days prior to surgery in a slightly different way. In general though preparations for surgery in the days leading up to the procedure are fairly straightforward. If you are taking large amounts of aspirin to deal with pain associated with your herniated lumbar disc you will be advised to stop in order to reduce the potential for unwanted bleeding. If you are taking any other blood thinning medications you will be asked to stop taking them as well. Beyond that you will be advised to stop eating at least 6 hours prior to surgery, to stop drinking any fluids at least 3 hours prior to surgery and not to drink anything other than clear liquids in the days immediately preceding surgery.

Possible Complications from Spinal Disc Surgery

Any type of surgery carries with it the risk of complications. In the case of a microdiscectomy these complications can range from the relatively benign to potentially fatal. Here are some of the most common types of short and long term complications from bulging disc microdiscectomy surgery:

Potential Short Term Complications

• Dural Tear – The dura is a watertight sac that surrounds and protects the spinal cord. It is possible, although rare, that the dura could become torn during this type of surgical procedure. In such cases it is imperative that the tear be addressed quickly and effectively as any significant leakage of cerebrospinal fluid can potentially have a negative impact on your overall health. Rest assured however that the surgeons at Neuro Spine Riga are some of the best in Europe, are well aware of the possibility of a dural tear and know exactly what to do should one occur.
• Nerve damage – Nerve damage is another extremely rare but potential complication from this type of surgery. In the event of nerve damage patients will normally experience pins and needles as well as tingling or numbness in their back, buttocks and legs. As we said nerve damage is extremely rare but the possibility cannot be completely ruled out.
• Infection – Any time you open up the human body it becomes susceptible to infection. That said the infection rate for this type of surgery is considered to be very low, at somewhere around 1%. Most infections related to herniated disc surgery are relatively minor although more severe infections cannot be ruled out. In either case however infections related to bulging disc surgery typically respond well to antibiotic treatment.
• Bladder and/or bowel incontinence – Some types of anaesthesia are known to affect the prostate gland. Should this occur patients may discover they have a difficult time passing urine. In the event of this type of bladder retention the patient may be catheterised until the situation is able to correct itself. If the problem does not clear in a reasonable amount of time the patient will be referred to an urologist. In some cases analgesics may also cause constipation. This is a potential issue because it may result in pressure on the surgical site which could complicate recovery. OTC diuretics are usually helpful in alleviating this type of surgery related constipation.

Potential Long-Term Complications

• Deep Vein Thrombosis – Deep Vein Thrombosis or DVT is the result of patients being largely immobilized in the days following surgery. This type of immobility can potentially lead to the formation of blood clots in the legs. Thankfully there are common sense ways to prevent DVT with one of the best and most common being compression socks. Compression socks prevent the lower legs from swelling up and promote proper circulation. Keep in mind too that your surgeon may prescribe blood thinners for you in the days immediately following surgery in order to better prevent DVT blood clots.
• Pulmonary Embolism – Pulmonary Embolism (often referred to as “PE”) is related to DVT in that it’s the result of a blood clot or blood clots originating in the legs and migrating to the lungs. Should this happen it is vital to seek immediate medical treatment. Failing to do so could expose the patient to potentially fatal consequences. Keep in mind though that PE is considered rare; occurring in less than 0.1% of back surgery patients.
• Persistent back pain – It is important that a person who undergoes sciatica surgery understands that success is not measured by how effectively it relieves back pain, but by how effectively it alleviates pain that was projecting from the site of the bulging disc into the buttocks and down the leg of the patient. If you had back pain in addition to sciatica prior to surgery and you still have persistent back pain after surgery but the sciatica is gone, the surgery is considered successful. Other steps can then be taken to address the back pain if deemed necessary and appropriate.
• Relapse – While rare it is possible that symptoms of a herniated disc may return, along with sciatica. In most cases when this happens it typically occurs within the first 2 months following the initial procedure. If this should happen to you it is important that you contact the medical team as soon as possible after slipped disc symptoms reappear so that they can make a timely diagnosis and determine the best way forward.
• Degenerative Disc Disease – The spinal column is a surprisingly delicate thing and any injury could possibly lead to degeneration of the disc or discs involved. While degenerative disc disease is not something that is likely to happen following surgery for slipped disc it is possible. Although it usually takes years to develop.

Lumbar Microdiscectomy Recovery

This type of herniated disc treatment is intended to relieve sciatica in the patient’s lower extremities. The procedure itself has undergone constant refinement and improvement in recent years and as a result sciatica surgery recovery time is shorter, there is less surgery-related pain for patients to deal with after the fact and overall success rates continue to inch ever higher. While it’s likely that different surgeons will have slightly different ideas about how to approach the recovery process almost all such differences are a matter of degrees rather than deep fundamental disagreements over what works best. Virtually all those who practice microdiscectomy agree on the following guidelines for the recovery period:

• Avoidance of bending forward, long sitting and bending forwards for 3 weeks – as these activities are increasing pressure on discs in spine, it is important to avoid these postures/activities in order to give time to “freshly” operated disc to heal. It is very important to allow operated disc to heal without putting pressure on it as this reduces risk of recurrence of disc herniation.
• Physio exercises – deep spinal muscles are playing very important role in providing stability and strength of whole spine. As deep spinal muscles are stronger the load on spinal structures as intervertebral discs and intervertebral facet joints become lighter. Therefore building up paraspinal muscles after microdiscectomy surgery under guidance of physiotherapist is a paramount of importance to prevent recurrence and to prevent any other long term spinal problems.
• The importance of stretching – Scar tissue is an issue with most types of surgery and when scar tissue is allowed to form in the spine after lumbar surgery it can create a slew of brand new issues unrelated to the original reason for having the procedure. In order to stave off the development of scar tissue most surgeons today recommend patients engage in simple, low impact stretching exercises several times a day for 1 to 3 months after surgery (the time when most scarring occurs).
• Pain Management – Even if back pain was not an issue before surgery the fact that the patient has had their back opened up and operated on means there will be pain to manage in the post-surgical period. Although in most cases pain after surgery is very minor, most patients require some analgesia for few days post op.  Combination of Paracetamol and over the counter NSAIDs is sufficient in most cases. Stronger effect analgesia is rarely required.
• Walking – Walking is an excellent way to stay loose, build strength and maintain flexibility in the aftermath of slipped disc surgery. Patients will want to start out slowly in the wake of surgery but should build toward a goal of walking 2 to 3 miles per day after several weeks. Walking decreases the chance of developing scar tissue and is also a form of mild aerobic workout that benefits the entire body. After walking – particularly in the first few weeks following surgery – NSAIDs and ice can be helpful in alleviating discomfort and reducing any pain. Certainly if walking is producing substantial pain that seems to get worse the more the patient walks they should contact their medical support team and discuss the issue with them.
• Driving – Many people who undergo lumbar hernia surgery are eager to get back behind the wheel afterward. It may be that during the worst of their pre-surgery days they were unable to drive because sitting for any length of time was simply out of the question due to the pain they were experiencing. Now free of that pain they want to start driving again. But no one should rush back behind the wheel shortly after this type of surgery. That’s because in order to be a safe driver one must be able to respond appropriately in the event an emergency stop is required. People who underwent back surgery just a week or two earlier in all likelihood will not be able to muster the force needed to execute an emergency stop if they need to. Not to mention that driving requires sitting which is strongly not recommended for 3 weeks post op as explained earlier.
• Returning to work – How quickly one returns to work after microdiscectomy depends on their overall level of fitness and the type of work they do. If they were relatively young and in otherwise excellent shape before surgery for a herniated disc their chances of returning to work sooner rather than later are generally good. However, even if they were in excellent shape prior to surgery if they have a job that entails a lot of physical exertion they’ll need to make a graduated return to work form so as not to negatively impact their prolapsed disc surgery recovery time. Some in fact may have to content themselves with a reduced work load or undergo retraining to accommodate the new physical realities. Although such cases are typically the exception rather than the rule. As opposite – if your job doesn’t require severe physical input and can be done at standing table (to avoid sitting for 3 weeks) you may return to work just couple of days post op.

Getting back to normal in the wake of a microdiscectomy will take some time but the process can be aided by working closely with your medical support team. They’ll help devise an exercise regime which will help you retain flexibility, ward off scar tissue and get back to work as quickly as is possible. Just remember that the impulse to be completely sedentary in the days and weeks following surgery while understandable, is not an approach that will lead anywhere good.

Cost Comparison Chart

When you decide to have your microdiscectomy at Neuro Spine Riga you’ll benefit from the expertise of our surgical and support staff, modern surgical theatres outfitted with the latest and best technology and the affordability of our procedures when compared to costs in other European cities. Below is a cost comparison chart that should illustrate this point.

As the chart should makes clear the cost of having your microdiscectomy in Latvia at Neuro Spine Riga is a fraction of what it costs to have the same back disc surgery either in London or Dublin. In fact the procedure is so affordable that even if your application for reimbursement from NHS is declined you will likely be able to afford to have the procedure anyway. In addition you will not be subjected to the seemingly endless waiting lines that are a fact of life for those who depend on the NHS. You can instead be in Riga having this life-altering procedure in a matter of days or weeks after first contacting us rather than the months or even years you may have to wait for the NHS.

Note: The above prices reflect the average price you are likely to pay in the various cities as of the time of this writing. Some clinics/hospitals will charge more and others slightly less and you will need to contact specific facilities in order to get exact numbers.

Why So Many UK Residents Choose Riga

There are a number of different cities in Eastern and Northern Europe where highly trained professionals offer microdiscectomy and other surgical procedures for less than you will pay in Western European cities. Many UK residents choose Riga over other locales not just for the affordability but because the city itself is one of the long hidden gems of European culture and tradition. Riga had the unfortunate luck to spend much of the 20th century shunted away behind the iron curtain. But in the past 25 years the city has reclaimed its rightful place at the heart of the European narrative. The city centre itself has been designated a UNESCO World Heritage Site and draws tourists and academics from near and far to marvel at the native Jugendstil and priceless Art Deco buildings. The city today also plays host to many important EU offices and has been the site of a number of important world-class sporting events as well.

Each year more than 5 million people pass through Riga International Airport and hundreds of thousands more arrive by cruise ship. What all these people discover is a vital, engaging place populated by some of the best educated, friendliest, most resilient people anywhere. Many UK and Irish residents who come to Neuro Spine Riga for their surgery wind up returning again and again as visitors just to bask in the wonder of the place.

Conclusion

If you are tired of the endless queues you encounter when dealing with the NHS and would like to have your lumbar microdiscectomy back disk surgery sooner rather than later and for less rather than more, Neuro Spine Riga is here to help. Our surgical team is one of the most experienced in all of Northern Europe, our support staff are knowledgeable, friendly and multilingual and our facilities are equal to or better than anything you’ll find in London, Dublin, Paris or Berlin. The icing on the cake is that there is a decent chance NHS will reimburse you for having your surgery in Riga. Give our UK patient coordinator a call today to learn more and set yourself on a path to sciatica relief.