Caspar microsurgical discectomy
When is this procedure indicated?
Patients with herniated discs have an indication for elective surgical treatment, when intense pain, resistant to medical therapy, has been present for at least 2 months or when there is a neurological deficit. It is rarely necessary to perform emergency surgery in case of cauda equina (complete/incomplete) syndrome or acute spinal cord compression.
How is it performed?
Lumbar microdiscectomy is performed with the patient in the prone or genupectural position. After radioscopic confirmation of the level, the skin is incised through a posterior median linear incision. The muscle fascia is opened and the paravertebral muscles are released. An autostatic retractor is used to expose the surgical space. A partial laminectomy and flavectomy is then performed to access the disc space. Through careful divarication of the nerve root, with the help of the operating microscope, the hernial fragment is removed. The procedure may be completed by partial discectomy (when indicated). The removal of dorsal hernia involves different surgical approaches (posterior, postero-lateral, lateral) depending on the level involved, with different technical difficulties and the need sometimes to perform arthrodesis. Cervical hernias, typically removed via an anterior presternocleidomastoid approach, with the patient in the supine position, involve a complete discectomy and placement of a cage filled with bone/bone substitute for interbody fusion and plating (placement of a plate) to stabilize the construct.
The patient is discharged on the first/second day. Patients have their first outpatient check-up 10 days after discharge, during which the stitches are removed, the dressing is applied, the medical therapy is checked and, if necessary, modified, and advice is given for the continuation of the postoperative course.
A second check-up is normally scheduled about 1 month later. On this occasion, if the patient's clinical conditions allow it, the rehabilitation program is started. A third and final outpatient check-up is scheduled about 3 months after surgery for final treatment evaluations. In cases of special need, outpatient audits are scheduled according to specific needs.
The possible specific and most common early complications of this surgery are: infections, hematoma formation, neurological lesions (nerve roots, dura mater, Cauda syndrome), peripheral nerve lesions (dysphagia, dysphonia), vascular lesions, visceral lesions (esophagus), herniated disc recurrence (in about 10% of lumbar hernia cases), early (within 30 days after surgery).
The possible specific and most common late complications of this surgery are: infections, recurrence of disc herniation, scar tissue formation, onset of disc degeneration (discopathy), junctional syndrome, iatrogenic instability, persistence of lumbar and peripheral pain symptoms.