[Alan]

#6407

Dr. Corenman,

Quite impressive your microdisectomy procedure posted on YouTube.

I have been diagnosed with a 1cm extruded disc L5/S1 resulting in painful sciatica and some sensory nerve damage to my left foot. I am pursuing conservative treatment now; however, I want to keep my options open. My orthopedist is suggesting a steroid epidural to the S1 nerve and only pursue surgery as a last resort. He cautions me that microdisectomy is not as effective on extruded discs (as opposed to protruded discs).

What is your experience and knowledge about the effectiveness of MISS for extruded discs? What are the odds for success/relapse? Is there any patient preparation or recovery that can improve the odds of success? And what about other treatment methods such as laser?

Thank you.

[Donald Corenman, MD, DC]

#6409

With a 1 cm extruded disc at L5-S1 and conservative treatment, I assume you have no weakness of the calf muscles (you can perform a one legged heel raise 10 times on the unaffected and affected leg with equal ability). With weakness, I normally consider surgery first (see section on “When to have lower back surgery”).

Without motor weakness, an epidural injection will help with pain reduction. I use that injection along with therapy to help restore normal function.

I am surprised that your orthopedist thinks that surgery for extruded herniated discs is less surgically effective that for protruded discs as I think the opposite. In my opinion, surgically removing extruded discs is easier and more effective.

The MISS (minimally invasive spine surgery) title is really a misnomer. The procedure is almost the same as for a microdiscectomy (same size incision, same moving of the muscle insertion) but the results are generally not as good in my opinion. Instead of surgically starting right over the herniation, the procedure requires you to start about one inch off midline which causes a handicap from the start.

I have seen less success with the MISS procedure than the microdiscectomy procedure in the patients who have come from other institutions with failed procedures. Don’t let the title of the procedure lure you into complacency.

In my opinion, the laser has no place in the spinal canal. The energy from the laser can cause unintended harm to other structures. Most spinal surgeons use something called a bipolar cautery which is essentially a tweezers that can cauterize any structure that is held between the two points. This way, the surgeon can be sure that the only structure (small adhesion or inflammatory frond) to be cauterized is right between the blades of the bipolar forceps.

Look on the website for patient preparation and recovery information by surgery to answer your other questions regarding success of the procedure.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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