Lumbar discectomy is an operation that has been performed since the 1930’s and the surgical techniques have evolved and improved ever since. The most common indication for lumbar discectomy is a herniated lumbar spine intervertebral disc with compression of one, or more, lumbar nerve root. A high-powered surgical microscope is frequently used in conjunction with the procedure then described as a lumbar microdiscectomy. As with many operations, a number of variations to the technique can be utilised depending on the exact nature, and location, of the offending pathology.
The patient is positioned prone on an operating table with protective supports for the torso and legs. A posterior incision is made adjacent to the midline spanning the surgical level. Pre-operative x-ray screening is used to mark the intended surgical level immediately prior to surgery. The muscles of the lower back are dissected off the posterior components of the vertebral arch to expose the posterior aspect of the vertebral column on the
The correct surgical level is confirmed with the use of intra-operative x-ray. The space between two vertebrae is cleared of tissue and the posterior opening of the spinal canal is enlarged slightly to facilitate improved visualisation and access with surgical instruments. A high-powered surgical microscope is used to identify the involved nerve root and retract it away from the offending herniated lumbar disc. The herniated disc material is removed in order to relieve the compression of the nerve – it may be necessary to make a small incision in the posterior disc capsule in order to address a bulging disc.
Once the surgeon is satisfied with the decompression of the nerve root and haemostasis the retractor is removed and the posterior muscles are allowed to relax back into position. The muscle sheath is sutured to restore structural integrity. The skin is closed with resorbable sub-cuticular sutures and covered with an appropriate dressing.
Preparing for Surgery
Ensure that you know what surgical procedure you are having. It is important to understand the reasons for the operation as well as having a realistic expectation of the outcome. If you have any questions regarding your operation please do not hesitate to discuss these with Dr Crispin Thompson.
Ensure that you have received authorisation from your medical aid, including the authorisation number. Different medical aid providers and medical aid plans offer different levels of cover for surgical procedures. It is your responsibility to know what services are covered by your particular medical aid plan, including whether any co-payments are applicable.
Refrain from eating and drinking anything from 02h00 on the morning of your surgery, unless specifically instructed by one of our team members. Patient specific recommendations will be made depending on your specific circumstances.
Present yourself to the Mediclinic Milnerton reception area by 06h30 on the morning of surgery. You will be admitted onto the hospital administrative system by a member of the reception team before being shown to your bed on the ward. You will need to bring your identification document, your medical aid card and number and your authorisation number with you to the reception area.
Bring all your medication with you to the hospital so that the necessary in-hospital prescriptions can be accurately and appropriately formulated. The medication will need to be given to the ward nursing staff when you are admitted to the ward prior to surgery.
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