Lumbar Microdiscectomy With and Without Annular Closure

When a herniated disc is pinching a nerve and the leg pain won’t let up, a microdiscectomy can often correct the problem through an incision about an inch long, and most patients go home the same day. For some patients, Dr. Grunch adds annular closure to help keep the disc from herniating again.

What Is a Lumbar Microdiscectomy?

A lumbar microdiscectomy, sometimes called a lumbar discectomy, is a minimally invasive surgery that removes the piece of a herniated disc in the lower back that is pressing on a spinal nerve. It is the most common surgery for sciatica, the sharp, burning or electric pain that travels from the lower back into the buttock and down the leg.

Between each pair of bones in your spine sits a disc, a rubbery cushion with a tough outer wall (the annulus) and a soft, gel-like center (the nucleus). When a weak spot or tear forms in that outer wall, some of the soft center can push out and press on a nearby nerve. That’s a herniated disc.

The “micro” in microdiscectomy means the surgery is done through a small incision, using a microscope or magnification to see the nerve and disc clearly. Dr. Grunch removes only the loose or herniated fragment and leaves the rest of the healthy disc in place. The bones, joints and stability of the spine are left intact, and no fusion is needed.

Annular closure with Barricaid: helping the disc stay put

Removing the herniated fragment takes pressure off the nerve, but it leaves an opening in the disc’s outer wall where the herniation came through. In some patients that opening is large, and a large opening raises the risk that more disc material will push out again later. This is called a recurrent herniation, or re-herniation.

For these patients, Dr. Grunch can add annular closure to the microdiscectomy using the Barricaid device. Patients with a smaller opening usually do well with a microdiscectomy alone. Barricaid is a small, flexible implant that is placed during the same surgery, through the same incision. It acts like a patch over the opening in the disc wall and is held in place by a small anchor in the vertebra next to it. In a large randomized clinical trial, patients with large openings in the disc wall who received Barricaid had fewer re-herniations and fewer repeat surgeries than patients who had a discectomy alone.

Watch two short videos in which Dr. Grunch explains how a disc re-herniates after surgery, how annular closure works, and why she uses Barricaid for the right patients, plus an overview of the technique from Barricaid:

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From Dr. Grunch: Lumbar disc herniation and microdiscectomy: how to prevent re-herniation with an annular closure device

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From Dr. Grunch: Why use the Barricaid for a microdiscectomy? Two cases of re-herniation

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From Barricaid: Barricaid® Annular Closure Technique Explained (YouTube)

To learn more about the device, visit Barricaid’s patient information on herniated discs.

Who Needs a Lumbar Microdiscectomy?

Most people with a herniated disc start with non-surgical care. A microdiscectomy is usually recommended when:

• Leg pain from a pinched nerve (sciatica or lumbar radiculopathy) hasn’t improved after about six weeks of good conservative treatment
• The pain is severe enough that it keeps you from working, sleeping, walking or living your life
• You have weakness in the leg or foot, such as foot drop, numbness that is getting worse, or trouble standing on your toes or heels
• Your MRI shows a herniated disc that matches your symptoms and exam

Microdiscectomy works best for leg pain, not back pain alone. If most of your pain is in your back, Dr. Grunch may look at other causes, such as degenerative disc disease or discogenic back pain.

Call 911 or go to the nearest emergency room if you have new numbness in the groin or inner thighs, trouble controlling your bladder or bowels, or weakness in both legs. These can be signs of cauda equina syndrome, a surgical emergency.

Treatments to Try First

Many herniated discs improve with time. Before recommending surgery, Dr. Grunch will usually make sure you’ve had a fair trial of:

• Activity changes staying active and walking while avoiding heavy lifting and the positions that set off your pain
• Medications anti-inflammatory medications, short courses of oral steroids or nerve pain medications
• Physical therapy exercises to calm the nerve, strengthen your core and improve how you move
• Epidural steroid injections anti-inflammatory medicine delivered near the irritated nerve, which can ease pain while the disc heals

When these don’t bring lasting relief, or when a nerve is losing strength, surgery can often correct the problem. Waiting too long with significant weakness can make full nerve recovery less likely, so Dr. Grunch will be honest with you about timing.

How a Microdiscectomy Is Done

A microdiscectomy usually takes about an hour per level. Here’s what happens, step by step:

1. 1Anesthesia: You’ll be fully asleep under general anesthesia and positioned face down on a padded frame.
2. 2A small incision: Using X-ray to confirm the exact level, Dr. Grunch makes an incision about an inch long in the middle of your lower back.
3. 3Gentle access: The back muscles are gently separated rather than cut, and a small tube-shaped retractor holds them aside. A small window of bone and ligament is opened to reach the nerve (this part is called a laminotomy).
4. 4Freeing the nerve: Under magnification, the nerve is gently moved aside and the herniated disc fragment is removed. Any other loose pieces of disc are cleared away so the nerve has room again.
5. 5Annular closure (when needed): Dr. Grunch measures the opening in the disc wall. If it is large, the Barricaid implant is placed to close it and help prevent re-herniation. If it is small, this step is skipped.
6. 6Closing: The muscles fall back into place, and the skin is closed with dissolvable stitches and skin glue.

This animation from Spine-health shows how a lumbar microdiscectomy is performed:

Revision Surgery for a Recurrent Herniation

Most people have lasting relief after a microdiscectomy. In a small percentage of patients, another piece of the same disc pushes out later, usually within the first year. This is called a recurrent herniation, and it can bring back the same leg pain. Other people continue to have symptoms after surgery because of scar tissue, a disc fragment that was missed, or narrowing that wasn’t fully treated the first time.

Revision disc surgery treats these problems. Dr. Grunch starts with a careful review of your symptoms, your exam and a new MRI, usually with contrast so scar tissue can be told apart from new disc material. Depending on what she finds, the options include:

• A repeat microdiscectomy the new disc fragment is removed through the same small incision. Working through scar tissue takes extra care, and the risk of a spinal fluid leak is somewhat higher than with a first surgery.
• Annular closure for patients with a large opening in the disc wall, closing it can help lower the chance of yet another herniation.
• Fusion if the disc has herniated several times, has collapsed, or the level has become unstable, a lumbar fusion may give the most lasting result.

Dr. Grunch regularly sees patients who had disc surgery elsewhere and are still in pain. If your symptoms came back after surgery, a second opinion can help you understand why and what can be done. Learn more about failed back surgery syndrome.

Benefits and Risks

Why Choose Dr. Betsy Grunch for Your Lumbar Microdiscectomy

• Duke-trained Dr. Grunch completed her neurosurgical residency and a spine research fellowship at Duke University School of Medicine, one of the top neurosurgery programs in the country, where she received the Spine Young Investigator Award.
• Minimally invasive by design Minimally invasive spine surgery is one of her signature areas. She works through the smallest opening that will safely do the job, so you can get back on your feet sooner.
• Experience you can count on She has been in practice since 2013 and performs 400 to 600 surgeries a year, more than 5,000 procedures over her career.
• Protecting your result She offers annular closure with Barricaid for patients at higher risk of re-herniation, to help keep the disc from herniating again.
• Second opinions and revisions She regularly sees patients who had spine surgery elsewhere, including those with a recurrent herniation.
• A teacher at heart As “Ladyspinedoc,” she is known for explaining spine conditions clearly. You’ll leave your visit understanding your MRI and every option in front of you.

What to Expect

Before surgery

You’ll meet with Dr. Grunch or one of her physician assistants to review your MRI, your exam and your goals, and to decide together whether a microdiscectomy is right for you. Our team will coordinate any pre-operative testing, review your medications (including blood thinners you may need to pause) and walk you through the day of surgery so nothing is a surprise. Before your surgery, please read our preparing for minimally invasive lumbar discectomy sheet (PDF). If you smoke or use nicotine, stopping before surgery lowers the risk of complications and re-herniation.

Procedure day

You’ll arrive a couple of hours before surgery to check in and meet the anesthesia team. The operation itself usually takes about an hour. Most patients walk the same day and go home that afternoon or evening with a responsible adult to drive them.

Recovery timeline

• First days: Leg pain is often much better right away. Some soreness in the low back and around the incision is normal, and a mild sore throat from the breathing tube usually clears within a week. Ice the incision twice a day for 20 minutes during the first week.
• Walking: Walk 30 to 60 minutes a day, broken into 10- to 15-minute sessions, and try not to sit for more than 30 minutes at a time.
• First six weeks: No bending at the waist, no twisting and no lifting more than 10 pounds. That includes household chores, yard work, golf and lifting young children or grandchildren.
• Two weeks: Your first follow-up visit is about two weeks after surgery. Many people with desk jobs are back at work around this time.
• Six weeks and beyond: Most patients return to normal activities, including exercise. Jobs that involve heavy lifting may take longer.
• Several months: Numbness, tingling and strength can continue to improve as the nerve heals.

Caring for yourself at home

• Your incision The stitches dissolve under the skin, and the skin glue falls off on its own. You may shower the day after surgery without scrubbing the incision. Don’t use ointments or creams, and don’t soak in a bath, hot tub or pool for six weeks.
• Medications Take pain medication with food and avoid alcohol while taking it. A daily stool softener helps prevent constipation. Blood thinners such as aspirin, warfarin, Xarelto or Plavix are held after surgery until Dr. Grunch’s team tells you to restart them.
• Driving You may drive once you are no longer taking narcotic pain medication. You can ride as a passenger before then.
• Smoking Smoking slows healing. Ask our office if you would like help quitting.

Watch Dr. Grunch’s tips for recovering from spine surgery:

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Video: 6 Tips for Your Recovery From Spine Surgery, from Dr. Grunch on her Ladyspinedoc channel (YouTube)

Call the office at 470-293-9800 if you have a fever over 101°F, redness, warmth or significant drainage from the incision, calf pain or swelling, constipation that medication doesn’t relieve, new trouble controlling your bladder or bowels, or back or leg pain that is worse than before surgery. Call 911 for chest pain or shortness of breath.

Download your patient instructions

Print these sheets or save them to your phone so you have them before and after surgery:

• PDFPreparing for surgery: Minimally Invasive Lumbar Discectomy
• PDFRecovery and home care: Minimally Invasive Lumbar Surgery

You’ll find instructions for other procedures on our Patient Resources page.

Every patient heals differently. Your exact timeline will depend on your symptoms, your job and your overall health.

Frequently Asked Questions

Take the First Step Toward Relief

This page is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. Please talk with your own doctor about your symptoms. If you have bladder or bowel changes, groin numbness or rapidly worsening weakness, call 911 or go to the nearest emergency room.