Microscopic or endoscopic surgical treatment preferred when a lumbar disc herniation compresses a nerve root and causes severe leg pain, weakness, or bladder/bowel control problems.
Indication
- Persistent low back and leg pain not responding to at least 6-8 weeks of conservative treatment (rest, medication, physical therapy, injection)
- Progressive weakness in the leg (foot drop, hip-leg weakness)
- Sensory loss or extensive numbness
- Cauda equina syndrome (sudden urinary/bowel retention, perineal numbness) — emergency surgical indication
- MRI showing significant nerve root compression by disc herniation consistent with clinical findings
- Severe mechanical low back-leg pain that significantly impairs quality of life
Preparation
- Lumbar MRI and dynamic X-ray evaluation when needed
- Anesthesia consultation, blood tests and ECG
- Adjustment of blood thinners with physician approval
- Fasting for 8 hours before the procedure
- Smoking cessation at least 4 weeks beforehand (for healing and infection risk)
How it's performed
- The patient is positioned prone; blood pressure, heart rhythm and oxygen levels are monitored
- General anesthesia is administered
- The correct disc level is marked using fluoroscopy or neuronavigation
- Depending on the technique, a small skin incision is made (microdiscectomy 2-3 cm; endoscopic 7-10 mm)
- The nerve root is freed and the compressing disc fragment is removed using a surgical microscope or endoscope
- After bleeding control, tissues are closed in layers
Post-procedure
- Discharge after same-day or 1-2 day hospital stay
- Walking is encouraged early; prolonged sitting and heavy lifting are restricted
- A 2-6 week physical therapy program for back and core muscles in the early period
- Return to desk work in 2-4 weeks on average; heavy physical work in 6-12 weeks
- Follow-up examinations are planned at weeks 2, 6, and at 3 months
Risks
- Nerve root injury (temporary or permanent numbness, weakness)
- Cerebrospinal fluid leak (dural tear)
- Wound or disc space infection (discitis)
- Recurrent disc herniation at the same or different level
- Persistent low back pain after surgery (failed back surgery syndrome)
FAQ
Does every lumbar disc herniation require surgery?
No. The vast majority of lumbar disc herniations improve with rest, medication, physical therapy and, when necessary, injections. Surgery is the last option, considered for weakness, bladder/bowel control problems, or prolonged pain unresponsive to conservative treatment.
Is microdiscectomy or endoscopic surgery better?
Both methods are effective; the choice is made according to herniation location and size, the patient's anatomy and the surgeon's experience. Endoscopic techniques can offer faster recovery with smaller incisions, but they cannot be applied to every case.
Can the herniation recur after surgery?
Recurrence at the same level has been reported at approximately 5-10 percent. Weight control, smoking cessation, proper lifting techniques and regular core muscle exercise reduce the risk.
When can I drive and start sports?
Short-distance driving is generally allowed after 2-3 weeks, and low-impact exercises such as walking and swimming after 4-6 weeks. Contact sports are started after 3 months with physician approval.
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