Lumbar Microdiscetomy | Spine Specialist

An Overview of Lumbar Microdiscectomy

The lumbar microdiscectomy procedure is designed for a herniated disc in the lumbar spine. It is quite simple. A small incision is made midline over the spinous process at the level of the herniation. The multifidi muscle is moved to the side and held with a retractor. The edge of the lamina (the back bottom of the vertebra) is exposed and identified with x-ray.

A small burr is used (like a dremel for those mechanically inclined) to take off about 3-4 mm of bone on the side of the lamina. Don’t worry as you won’t miss it. There is a thick ligament under this called the ligamentum flavum. It is a vestigial ligament (one that might have served a purpose in prehistoric times but does not now). A portion of it is removed and the nerve root is exposed.

The nerve root is about the diameter of your little finger. The root is neurolysed from the herniation. This means that the very sticky herniated disc material is carefully pulled away from the nerve and any small adhesions are disengaged. The nerve is gently rolled to the side, exposing the herniation itself or the hernia sac if the hernia material is encapsulated.

The herniation is removed. Sometimes there is one large fragment and other times multiple small fragments. There is always a tear in the back wall of the disc that allowed the herniation to exit from. That hole is probed with a small grabbing device (a pituitary) and any loose fragments still in the disc are removed. The disc is then irrigated to wash out any other loose fragments. A small probe is used under the nerve to make sure there are no hidden fragments.

At the end of the procedure, the nerve should be resting undisturbed in its normal anatomic position and should be able to move about 1 cm. A Valsalva maneuver is done to make sure there is no leak of fluid from the nerve sac (very rare) and the incision is closed.

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(Please keep reading below for more information on this treatment.)

A question should come to you now. “Why don’t you repair the tear in the back of the disc to prevent future herniations?” The answer comes from the discussion of the anatomy of the wall of the disc (discussed elsewhere in this web site). There is no blood supply to the disc so there is no opportunity to heal. Just like a tear of an ACL ligament in the knee won’t heal, the disc wall will not repair itself. The tear is permanent. This is why there is about a 10% chance of recurrent herniations from the original tear in the disc. A recurrent herniation can occur with previous surgery or even if there has been no surgery at all.

For more information on lumbar microdiscectomy, please contact spine surgeon and back pain specialist Dr. Donald Corenman at his Vail, Aspen, Denver and Grand Junction, Colorado area office.

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(Click to Enlarge Image) This is an axial view (top down) of a herniated disc at the level L5-S1. You can notice that the nerve root on the right side (this is a bottom up view) is compressed by the herniation (white arrow).

Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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Lumbar Microdiscectomy

An Overview of Lumbar Microdiscectomy

Are you a candidate for lumbar microdiscectomy?

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About the Author: Donald Corenman, MD, DC