Surgery for disk herniations

Disk herniations come in all sizes and shapes and they cause all sorts of symptoms.  Some symptoms, such as leg pain, numbness in the legs, and muscular weakness can be improved with surgical treatment, whereas some symptoms, such as back pain, are less likely to improve.  The best candidates for a microscopic discectomy are people with a disk herniation that is causing significant nerve root compression and the patient wants the nerve root pain alleviated.  For example, here are a series of slides from a talk that I give on MRI anatomy of the lumbar spine that demonstrate the different types of disk hernations.  Click on each image to enlarge it to full size and to see the caption…..

This series of images should convince you that there are disk herniations in name only, and those that really need treatment (the fourth slide).  The surgical treatment of disk herniations is relatively controversial, because medical research has shown that if you wait long enough, most people with a disk herniation will improve without surgical treatment.  In fact, it is considered dogma in the US that surgical treatment of disk herniations does not change the LONG TERM outcome, but simply helps patients to get over their pain and return to work faster.  In my experience, most patients WILL get better with physical therapy, medical management, and selective nerve root blocks, and they are able to avoid surgical treatment if they are patient enough.  However, there are those patients that clearly do better with a microdiscectomy and they tend to have the following findings:

1. Their leg pain is worse than their back pain
2. Their pain has been present for at least 6 to 8 weeks without any trend towards gradual improvement
3. The disk herniation is large, a free or extruded fragment, and appears to be causing significant nerve root compression
4. They have tried a course of physical therapy, NSAIDs, and possibly a selective nerve root block and each time the pain has come back.

If most, or all of these criteria are met, then having a microscopic discectomy is a reasonable choice.  In my practice, A microscopic discectomy is always an outpatient operation.  The patient is typically able to return to work within 2 weeks, and back to basically completely normal activity by 6 weeks.

In this short video, I explain what happens in the course of a typical microscopic discectomy

And in this short video, I explain how I do an endoscopic discectony

Why choose Microscopic Surgery at Monterey Spine?

Working as a combined orthopedic and neurosurgical team, Dr. Gollogly and Dr. Dimitrov successfully perform more microscopic outpatient spine surgeries each month than any other team in California, setting us apart as a leader in outpatient microscopic spine surgery.

Here are some facts about our program in Monterey, California:

• Our dedication to outpatient microscopic spine surgery procedures has made us the busiest outpatient center in California.  A high volume of cases results in local expertise that helps hundreds of patients get back to their daily lives with less pain.
• Dr. Gollogly and Dr. Dimitrov focus on avoiding fusion surgery.  They believe that careful surgical craftsmanship will alleviate nerve root pain in the operating room and spinal stability can be achieved through careful physical rehabilitation.  This makes many fusion procedures unnecessary.
• With over 20 years of combined experience working together as a team, Dr. Gollogly and Dr. Dimitrov combine the expertise of neurosurgery and orthopedic surgery into one team that produces excellent results.
• These procedures are performed in an Ambulatory Surgery Center that is the nation’s leader in bundled payments.  As an “in network” facility with transparent pricing, Monterey Peninsula Surgery center delivers fantastic results at a reasonable price.
• 99% of patients who have surgery in Monterey report that they are “very satisfied” with their experience and would recommend it to a family or friend.

*Risk Factors for 30-Day Unplanned Readmission and Major Preoperative Complications After Spine Fusion Surgery in Adults: A Review of the National Surgical Quality Improvement Program Database.  Su AW et al., Spine (Phila Pa 1976). 2016 Oct 1;41(19):1523-1534.

microdiscectomy technique: a step by step explanation