rblockMemberMay 14, 2012 at 8:11 amPost count: 8
I am considering a second microdiscectomy from a recurrent herniation and am researching my options. I am wanting to understand the different techniques available. I don’t think I’m interested in an endoscopic procedure.
1. Are there varying degrees of minimally invasive specifically with the traditional microdiscectomy? Ie. use of microscope, cutting the muscle vs. moving the muscle, etc.
2. Or are all microdiscectomy procedures created equal?
Lastly, any wisdom you can give me in choosing a surgeon would be helpful.. (is it better to use a local surgeon or travel? Orthopedic vs neuro?
Thank you for your time.Donald Corenman, MD, DCModeratorMay 14, 2012 at 8:43 pmPost count: 8465
I generally do not endorse the endoscope as this device restricts the surgical view unnecessarily. The term minimally invasive is really a marketing term and not really a technique that by itself is beneficial. The term microdisectomy simply means that the surgery is accompanied by an operating microscope. The use of this tool in my opinion is vitally important as the field is illuminated perfectly, the surgical assistant sees exactly the same image as the surgeon and there is no parallax (distortion) in viewing the surgery.
The surgeon is all important in regards to the surgical procedure. What is his or her skill level? How many has he or she done? What are the success rates? What are the complication rates? What are the rehabilitation procedures? If you don’t do perfectly, does the surgeon continue to follow-up to help or are you left on your own?
There are great and not so great spine surgeons (orthopedists who have completed a fellowship in spinal disorders) and neurosurgeons. I wish I had a list of those you should choose from but I don’t.
Dr. CorenmanrblockMemberMay 15, 2012 at 3:30 amPost count: 8
Being this will be my second microdiscectomy, I’m assuming there will be scar tissue “in the way”. Is the procedure in any way different from the first procedure (ie. larger incision)?
Also, in the microdiscectomy do you have to cut the muscle to gain access or can you move the muscle out of the way?
Appreciate your time.Donald Corenman, MD, DCModeratorMay 15, 2012 at 8:33 amPost count: 8465
In a “minimally invasive” surgery, the muscle is stretched and portions of the muscle are removed. In a minimal incision microsurgery (microdiscectomy), the insertion of the muscle is moved and then sutured back again. In either case, the muscle is manipulated and retracted. This muscle, the multifidus is a minor muscle that does not change the structural integrity of the spine. The major spinal muscles (the erector spinae) are not touched during this surgery.
The incision size should not change in size but there is about 3mm more bone that should be removed from the lamina (one tenth of an inch) to safely follow and free the nerve root.
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