Microdiscectomy: A Modern Fix for Disc Herniation

What is microdiscectomy?

Microdiscectomy is a surgical procedure for the relief of pain and other symptoms that occur when a herniated disc in the spine presses on an adjacent nerve root. During the operation, the surgeon frees the nerve by removing small fragments of disc, bone and ligament.

Microdiscectomy is sometimes described as a minimally invasive spine surgery, because it requires only a small incision and the use of a microscope or surgical glasses, called loupes, to magnify the site where the injury has occurred. The surgeon also uses smaller tools and instruments to work in the restricted space of the spine. Microdiscectomy is a type of spinal decompression surgery, and the term microdecompression – which describes the surgical removal of any bone or ligament that is compressing a nerve – may also be used to describe the procedure. However, the term “microdiscectomy” is more specific to the removal of the fragment of herniated disc tissue that is causing the patient’s symptoms.

Because most patients will recover from a herniated disc without surgery, microdiscectomy is recommended only after conservative treatment, including physical therapy, cortisone shots, and other medication have been tried for a period of at least 6 to 12 weeks, without bringing relief. In some cases, motor weakness may be a reason to have this surgery sooner. Patients with cauda equina syndrome require immediate surgical intervention. This is a condition in which pressure on the nerves in the lower portion of the spine affects bladder and bowel function, but it affects less than 1% of people.

How does a surgeon perform a microdiscectomy?

Microdiscectomy surgery may be approached using one of three minimally invasive techniques to gain access to the herniated disc and nerve: a midline, tubular or endoscopic microdiscectomy.

Historically, a traditional discectomy required a large incision and involved removal of the entire disc. Today, with the availability of advanced techniques and equipment, almost all spine surgeons perform microdiscectomies. The procedure usually results in rapid, and sometimes immediate, pain relief.

Microdiscectomy techniques

  • A midline microdiscectomy, in which the surgeon makes a one to two-inch vertical incision in the back, lifts the surrounding muscles off the vertebrae, and uses instruments to hold apart the layers of tissue during the procedure.
  • A tubular microdiscectomy, in which the surgeon inserts a series of small tubes or dilators through a small incision to create a corridor through the muscle in which to operate, thereby causing less disruption to this tissue.
  • Endoscopic microdiscectomy (sometimes also known as microendoscopic discectomy), in which an even smaller incision is made and the surgeon employs a miniaturized camera and instruments; this approach also involves less disruption to surrounding tissues.

What are the benefits of a microdiscectomy?

Regardless of which particular microdiscectomy technique selected, the surgical goal is the same: to remove the disc fragment and any bone or ligament that may be compressing the nerve root. To do so, the surgeon creates a small window in the vertebra (a procedure also called a laminotomy) and pulls away the ligamentum flavum, the underlying tissue, to reveal the dura (the covering of the spine) and the nerve root. The herniated part of the disc is then removed to complete the nerve decompression.

Imaging techniques, including X-rays, are used before, and sometimes during, the surgery to ensure localization of the correct operative site.

While herniated discs may occur in almost any level of the spine, lumbar microdiscectomy – surgery in the lower portion of the back – is the most common site for this procedure.

How long does a microdiscectomy take?

On average, microdiscectomy surgery takes between 30 to 60 minutes to complete. However, because patients are given general anesthesia and must spend time afterward in the recovery room for a period of monitoring, the total time usually extends to about two hours.

In almost all cases, people undergoing microdiscectomy may return home the same day. Upon discharge from the hospital, patients are typically given a small amount of pain medication – including acetaminophen or small dose of opioid medication – and a muscle relaxant with instructions regarding postsurgical care and how to taper these medications appropriately. Special emphasis is given to symptoms that signal the need for immediate medical attention, including muscle weakness, change in bladder or bowel function, and extreme and unexpected back or leg pain.

What complications can occur with microdiscectomy?

During surgery, multiple safety measures are followed to control bleeding, prevent infection and avoid injury to any surrounding tissues. Rarely, a tear in the dura (the tissue surrounding the spinal nerves) may occur. The surgeon repairs this with a suture or a patch made of collagen.

What is the expected microdiscectomy recovery time?

Following a two-week period of rest to allow the soft tissues to heal, many patients feel well enough to return to work. However, microdiscectomy recovery typically requires a six-week period of modified activity and includes a course of physical therapy starting at week two or three.

Physical therapists focus on helping patients strengthen core muscles and loosen stiff joints, as well as creating a home exercise program to help protect the spine. All patients are cautioned to ease back into their previous routines gradually, especially those whose work requires physical labor. Because sitting in a chair and leaning forward places pressure on the spine, people with more sedentary jobs also need to be attentive to their posture and take a short walk or do some gentle exercise every hour or so.

Patients who plan to resume driving after surgery must wait until they are pain-free, finished with any medication that causes drowsiness, and able to both shift their foot between pedals and turn in their seats easily and without pain. To test individual comfort, a practice drive in a parking lot or other safe space, in the company of another driver is recommended before returning to regular roadways.

Is a microdiscectomy painful?

Following surgery, most patients do well with a small amount of non-opioid pain medication and a drug that relaxes the muscles. While there is some discomfort associated with the surgical incision, many patients experience rapid relief of the pain caused by the herniated disc.

In patients who have experienced nerve compression and associated symptoms over an extended period, pain relief may take longer. When leg pain has been the primary symptom, the pain typically retreats up the leg over time. In addition, patients may experience muscle cramping or mild numbness or tingling after surgery which typically resolves with time.

Who is eligible for microdiscectomy?

Most patients with herniated discs that do not respond to a trial of medication and physical therapy over time, are eligible for a microdiscectomy. While the condition is usually seen in individuals aged 30 to 50, it does occur outside this age range.

Herniated discs are rare in children and young adults, who are more frequently able to recover without surgical intervention. Microdiscectomy may be appropriate for adults in their 80s or 90s, though they should be cautioned that there is an increased chance of medical or surgical complications in this population.

How successful is microdiscectomy?

Overall, microdiscectomy success rates are excellent, with many patients expressing a high degree of satisfaction with the outcome. Careful presurgical screening and evaluation, as well as patient commitment to maintaining good spine health following microdiscectomy, contribute to the success of the surgery.

It should be noted that some people with herniated discs are also found to have other issues in the spine that are causing nerve-related pain and disability. In such cases, additional procedures such as a laminectomy – removal of the lamina (bony roof over the spinal canal) in one or more vertebrae, may be required if it is felt that these issues are contributing to their disability.

Can microdiscectomy be used on a disc that herniates a second time?

In cases of disc reherniation, microdiscectomy can be performed for a second time on the same disc, often with good results. However, if herniation occurs in the same disc a third time, a different type of treatment will be recommended.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

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The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

 

Causes & Treatments for Fibromyalgia


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

 

What is Trigger Finger?

Article featured on MedicineNet

A trigger finger is a condition that can turn simple hand movements into a frustrating experience, often causing pain and discomfort. From gardening to repetitive motions, certain activities can put your fingers at risk. Learn about the causes, symptoms, treatments, and prevention tips to keep your hands healthy and functional.

 


A trigger finger is a “snapping” or “locking” condition of any of the digits of the hand when opening or closing. Stenosing tenosynovitis is the medical term for the trigger finger.

What causes trigger finger?

Local swelling from inflammation or scarring of the tendon sheath (tenosynovium) around the flexor tendons causes trigger fingers. These tendons normally pull the affected digit inward toward the palm (flexion). When they are inflamed, they tend to catch where they normally slide through the tendon sheath.

Usually, the trigger finger occurs as an isolated condition because of repetitive trauma. Activities such as gardening, pruning, and clipping are risk factors for trigger fingers. Sometimes, the trigger finger is an associated condition resulting from an underlying illness or medical condition that causes inflammation of tissues of the hand, such as rheumatoid arthritis.

Data presented at the 2005 American College of Rheumatology national meeting suggested that a majority of patients with rheumatoid arthritis have inflammation around the tendons of the palm that could develop into trigger fingers. The trigger finger most often affects the right or left index finger, the digits likely to pull the trigger on a gun.

What are the symptoms of trigger finger?

Symptoms and signs of trigger finger may occur when any of the four fingers of the hand attempts to flex closed while gripping. Instead of a smooth, continual closure, the digit hesitates, then snaps closed (causing a “trigger” effect), and is associated with a stiffness sensation of the digit. Symptoms and signs may occur in more than one digit.

When attempting to extend the digit, a similar hesitation may occur before it “snaps” into full extension. In severe cases, people must manually bring the digits into full extension or flexion because of the stiffness. The closure is frequently associated with pain at the base of the finger on the palm. Sometimes it’s possible to feel a tender nodule in the area of the inflamed tendon. There may be mild swelling in the affected area of the palm.

Triggering can also affect the thumb (trigger thumb, De Quervain syndrome), so many clinicians include the thumb in the diagnosis of the trigger finger.

Diagnosis of trigger finger

Primary care doctors, including general practitioners, family medicine physicians, and internists, commonly diagnose the trigger finger. Specialists who treat trigger fingers include orthopedic surgeons, sports-medicine doctors, plastic surgeons, hand surgeons, and rheumatologists. Occupational therapists and physical therapists can be involved in the care of patients with trigger fingers.

Health care professionals diagnose trigger fingers based on the history of “snapping” sensation that the patient experiences, as well as noting in the physical examination that there is tenderness and nodular irregularity of the involved flexor tendon in the palm. Typically, the nodule is not visible but can be felt in the palm. There can be contracture of the affected digit into a bent position.

What are the treatments for trigger finger?

Stretching, ice, and anti-inflammation treatments can be helpful. Oral anti-inflammatory medications may be helpful.

The quickest and most effective treatment is a local cortisone injection into the tendon sheath around the affected tendon. Most patients will respond well to the steroid injection . A trigger finger can recur after a period of normal function.

When a trigger finger persists after two steroid injections and is not responsive to the above nonsurgical treatments, consider surgical procedures to release the tendon sheath and/or remove the inflamed or scarred tissue. Trigger finger surgery is usually a permanent cure for this condition.

Initially, people can treat trigger fingers at home with remedies including cold packs, resting, and over-the-counter medications, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. Massaging the involved area of the palm gently followed by a cold pack application can be helpful. Take care to avoid reinjuring the strained tendon in the palm.

What is the prognosis of trigger finger?

The prognosis of the trigger finger is excellent. Nearly all patients recover completely after medical professionals administer cortisone injections and the tendon again glides freely through the tendon sheath. Sometimes it may be necessary to get repeat injections. Surgical treatments may be necessary for rare instances.

Is it possible to prevent trigger finger?

People can prevent trigger fingers by avoiding activities that strain the finger flexor tendons in the palms of the hands.

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The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

 

Does a Herniated Disc Need Surgery to Heal?


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

 

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The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

 

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The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

 

Causes & Treatments for Arch Pain

Article featured on Sydney Heel Pain

Arch pain can be the result of one or a combination of conditions that develop in the sole of the foot. Patients will often describe a tightness, pulling, strain, burning or ripping sensation through the mid arch of the foot, in front of the heel but behind the ball of the foot.

The pain in the arch can come on suddenly as in a one off day of increased walking or a sporting event, or progressively over a period of time as in walking in inappropriate shoes. Arch pain can be present every day and can be consistently present, in that it interferes with day to day activity. It will often feel worse in bare feet or thongs or flat and flimsy shoes such as ballet flats.

In extreme cases the pain can be excruciating and can cause burning and throbbing in bed at night. The soft tissue in the arch can be torn and this can be detected via ultra sound or MRI.

Conditions Causing Arch Pain

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ARCH PAIN TREATMENT

It is important to assess and diagnose which part of the foot is affected and causing the pain. Physical examination is usually sufficient but in complex cases the patient can be referred for ultra sound imaging. An MRI is not usually necessary.

It is also important to determine whether or not the ligament, fascia or tendon has been torn as this will determine which treatment path to take. If the tissue is not torn, then it is important to determine what has caused the condition so that these contributing factors can be resolved. Factors such as footwear, exercise or even stretching techniques are common contributing factors.

If there are bio mechanical issues affecting the patients foot then these need to be addressed also. Orthotics can be arranged and shoes can be changed. Strapping can be applied to the foot and in extreme cases an immobilisation boot can be used.

Shock wave therapy can applied to the foot which can stimulate blood flow and accelerate healing in addition to relieving pain. Correct stretching techniques must be instructed and followed.

TREATMENT OPTIONS

  • Strapping
  • Orthotics where necessary
  • Footwear changes
  • Shock wave therapy
  • Stretching
  • Immobilisation boot

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

 

Walking or Running: Which Is Better for Your Health?

Article featured on Healthline

Walking and running both provide several health benefits. The best option for you depends on your health goals, mobility, and personal preference. Read on to learn more about both options. Walking and running are both excellent forms of cardiovascular exercise. Neither is necessarily “better” than the other. The choice that’s best for you depends on your fitness and health goals.

If you’re looking to burn more calories or lose weight fast, running is a better choice. But walking can also offer numerous benefits for your health, including helping you maintain a healthy weight.

Keep reading to learn more about the benefits, risks, and the types of walking and running that fit your health goals.

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The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, foot and ankle conditions, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic and podiatric surgeons in Portland Oregon, contact OSM today.

Phone:

503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm