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The traditional way of treating the herniated disc with surgery is to perform a laminotomy and discectomy. The term laminotomy means “make an opening in the lamina”, and the term discectomy means “remove the disc”. The term microdiscectomy refers to the same procedure as the laminotomy and discectomy but utilizes a microscope, smaller tools and instruments, and a smaller incision. The advantage of microdiscectomy over the traditional approach is that there is less damage to the normal parts of the spine during the operation which may translate into faster recovery.
This procedure is performed through an incision down the center of the back over the area of the herniated disc. Once the incision is made through the skin, the muscles are moved to the side so that the surgeon can see the back of the vertebrae. X-rays during surgery may be required to make sure that the correct vertebra is chosen. A small opening is made between the two vertebrae where the disc is ruptured. This allows the surgeon to see into the spinal canal. The term laminotomy (make an opening in the lamina) comes from the fact that usually a small amount of the bone of the lamina must be removed. This is to make room to see into the spinal canal and to allow room to work.
Once this is done, the surgeon moves the nerve roots out of the way to see the intervertebral disc. The surgeon locates the disc material that has ruptured into the spinal canal and removes it. This removes any pressure and irritation on the nerves of the spine. Using small instruments that fit inside the disc itself, he also removes as much of the nucleus pulposus material still inside the disc as possible. This is done to prevent any remaining disc material to herniate again after the operation.
After the procedure is complete, the muscles of the back are returned to their normal position around the spine. The skin incision is repaired with sutures.