This minimally invasive surgery for herniated discs is still the gold standard. I learned this technique in the 1970’s from a neurosurgeon who came to Dallas for a Laser Neurosurgery Workshop that I used to teach. (I am a founding member of the American Board of Laser Surgery, yet I have learned that the laser has no role in spinal surgery).

The procedure involves a tiny midline incision in the lower back, not cutting any muscle, just retracting it to the side, and using an operating microscope with built-in lighting and 3-D binocular vision to remove the fragments of herniating disc. If the nerve root in still under pressure, the nerve root canal can be opened up and basically everything done necessary to perform a procedure that has been done through large incisions since the 1930’s.

The operation is done with the patient asleep, lying on the stomach, and the skin and muscle is infiltrated with long-acting local anesthetic so they have almost no pain on waking up. Stitches are buried under the skin and dissolve after two months. Patients go home the same day, get up more each day, and are up full time in 3-7 days.

I did a survey of 200 patients and found that 85% reported excellent relief of pain, another 10% still had some back pain, and about 5% didn’t think the operation helped very much. So, back surgery doesn’t cure everyone and we always try conservative treatment first.

I have never had a patient die or be paralyzed. About one in 50 may get a torn dura requiring repair to prevent spinal fluid leak. Infection can still occur, but the infection rate where I work is only about one in 500. Of course, with any surgery a patient may die or have loss of bowel, bladder and ability to walk, so reading the operative permit may seem scary.

For patients with a herniated disc, this is the first choice for surgery. For a short summary, see: http://www.webmd.com/back-pain/discectomy-or-microdiscectomy-for-a-herniated-disc . Some instrument manufacturers have developed a tube to operate through and call the procedure automated percutaneous lumbar discectomy (APLD), but in my experience, the incision is the same size or larger and the exposure is more limited.

The percutaneous disc operations now being touted, wither with lasers or heat probes are not as effective in removing enough disc tissue, carry more risk of hitting the nerve, and don’t have as good outcome as microdiscectomy.