Spinal intervertebral discs are the body’s “shock absorbers,” allowing the back to be strong, highly flexible, and resilient. Disc degeneration and herniation are common back problems leading to surgery. A microdiscectomy is an outpatient surgical procedure performed under anesthesia to remove all or part of a herniated disc.
The type of surgical technique used during microdiscectomy, and the type of herniation, may increase one’s risk for reherniation afterwards. If back and leg pain from disc problems return after surgery, your surgeon will need to determine where the pain is coming from and take the necessary steps to treat the problem. As a patient, knowing the telltale signs of reherniation after microdiscectomy surgery will help ensure that you get the care you deserve.
Why Would I Need Microdiscectomy?
A discectomy, sometimes called a percutaneous discectomy or lumbar discectomy, involves removing the herniated portion of the intervertebral disc (the nucleus pulposus) that is pressing on the nerve or spinal cord. Removing part or all of the offending disc helps address pain, numbness, weakness, balance issues, or mobility problems.
A microdiscectomy is a minimally invasive version of the surgery that can be performed on various parts of the spine. For example, your surgeon may perform a lumbar microdiscectomy to remove the herniated portion of a lumbar disc in your lower back. During a microdiscectomy procedure, the surgeon uses a microscope and laser to remove part of the nucleus pulposus through a small incision (less than 2 inches).
Common Signs of Reherniation
A reherniation after microdiscectomy may occur in the immediate postoperative period, a few weeks to few months after the surgery, or within years following the surgery. In some cases, a reherniation might present in the form of back pain up to two years after a microdiscectomy. When that happens, patients may experience symptoms that are very much like the original complaints of disc herniation.
As a patient, there are five classic symptoms to watch for:
- Back pain at the site of surgery
- Intermittent or continuous back pain that occurs with and without movement
- Pain with coughing, sneezing, or bearing down
- Radiating pain from the back or buttock down into the leg or foot
- Numbness and tingling in the leg or foot, accompanied by weakness in the legs and reduced reflexes in the knee or ankle region
When experiencing recurrent disc reherniation, a patient might also report pain in a different location, intensity, or related to physical activity. These differences may be due to compression at another site or a nerve root tethering to epidural fibrosis.
Note: Reherniation does not occur with total discectomy because the entire disc has already been removed. In the case of recurrent back pain accompanied by sciatica (pain radiating down the back of the leg) after total discectomy, another disc may have become herniated.
How is Recurrent Disc Herniation Diagnosed?
Once you start experiencing recurring back pain, your surgeon must determine if the pain is being caused by reherniation or an acute flare-up. The best way for them to diagnose the problem is through physical examination findings correlated with imaging studies (MRI, CT scan, X-rays, etc.).
During the physical exam, your surgeon may look for pain during specific movements and perform a power/sensory examination of your lower extremities. They may also recommend a diagnostic nerve root injection in cases when an initial clinical diagnosis is not evident.
Common Risk Factors that Can Lead to Reherniation
What causes reherniation after microdiscectomy surgery? As was mentioned earlier, the type of surgical technique used during the initial procedure and type of herniation strongly influence whether or not there will be a recurrence.
For example, the incomplete removal of herniated disc material or inadequate closure of a significant gap in the annulus may lead to reherniation. Similarly, a thinned-out and stretched- out annulus place the patient at higher risk for reherniation, along with a wide incision of the annulus during surgery. Yet another reason why a patient may experience pain in their lumbar region is reherniation after laminectomy.
Laminectomy is surgery that creates space by removing the lamina, the back part of the vertebrae that covers your spinal cord. Also known as “spinal decompression surgery,” laminectomy enlarges your spinal canal to relieve pressure on the spinal cord or nerves and is typically performed on patients with severe symptoms or those with symptoms that are worsening dramatically.
Other possible causes
A spine injury may also lead to recurrent disc herniation, such as those caused by rigorous sports activities or motor vehicle accidents.
In addition to those resulting directly from the surgery itself or a spine injury, these lifestyle choices can increase one’s likelihood for reherniation after microdiscectomy:
- Poor posture
- Heavy physical activity within the first few weeks
- Diabetes mellitus
As you can see, patient compliance plays a major role in ensuring a healthier, more complete recovery after undergoing a lumbar microdiscectomy procedure.
How Common is Reherniation After Microdiscectomy?
Over 200,000 lumbar discectomies are performed in the United States each year, most of which are microdiscectomies. Based on follow-up studies, recurrent lumbar disc herniation only occurs in roughly 10% of all microdiscectomy patients.
The management of a re-herniated disc is much like the primary disc prolapse. Your surgeon will start with conservative treatment options in the form of pain medications, physical therapy, and activity modification. If those don’t do the trick, an epidural steroid injection may also be given to manage the symptoms. In some instances, it may become necessary to pursue surgical management in the form of repeat microdiscectomy.
How to Prevent Reherniation After Microdiscectomy
Here are some reherniation-prevention tips for microdiscectomy patients:
- Lift the right way. When lifting heavy objects, keep your back straight and use your knees to lift rather than your back. Better yet, get someone to help you.
- Adjust your sleep posture. Sleeping on your stomach or flat on your back puts significant stress on your spine. The best posture for someone with back pain is lying on their side in the fetal position.
- Watch how you sit and stand. Poor posture while sitting or standing can put excessive pressure on your back. Sit with your back straight, not slouched or bent over. Don’t stand for extended periods without putting one foot up on something and alternating feet every few minutes.
- Stop jogging. Jogging is not recommended when you have disc herniation. Instead, take up walking, swimming, or another low-impact form of exercise.
- Make positive lifestyle changes. Minimize your risk for reherniation by not smoking, watching your weight, and eating a balanced, back-healthy diet. If you have diabetes, practice good blood glucose management.
How The Spine Center Can Help
At The Spine Center, we’re dedicated to providing you with high-quality, personalized back and neck care. We strive to offer efficient and professional services to our patients, delivered with integrity and honesty in a cohesive, family-like environment. We have a solid commitment to excellence in diagnosing and treating spinal injuries and conditions spanning all age groups.
As fellowship-trained physicians with over 50 years of experience treating spinal conditions, we offer patient recommendations for treatment, including conservative care, non-operative treatment, and sophisticated, customized surgical solutions. Our physicians serve as innovators in technology, actively participate in national and international research studies, and are at the forefront of medical knowledge. If you or a loved one suffer from back or neck pain, call The Spine Center today at (847) 698-9330 to schedule a consultation.