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This operation removes the part of your intervertebral disc which is compressing the nerve. There are three broad types: classic discectomy, microdiscectomy, and percutaneous discectomy. The main difference between them is the size of the incision. The choice depends on your situation. Although percutaneous discectomy is the least invasive, it is also the least effective for large herniations.
Surgical imaging technology has allowed surgeons to perform the complex procedures in a less invasive way (using smaller incisions). Surgeons can utilise microscopes, magnifying loupes, or endoscopes to see the spine in greater detail.
Surgeons often use surgical loupes; these are magnifying lenses worn like glasses. They are usually custom made for the particular surgeon.
Percutaneous discectomy is the least invasive and typically done as an outpatient procedure. The surgeon makes a small incision in the skin and, using X-ray technology and a needle, removes the troublesome disc material. This procedure is usually done when disc herniations have not ruptured, but bulged. This procedure is only suitable for certain patients and the long-term effectiveness of it has been called into question.
In microdiscectomy, the surgeon makes a small incision (usually around an inch or two long). Either tubular or blade-based retractors are positioned through the incision to push aside the muscle and soft tissue. A section of bone and ligament is then removed to expose the disc. Then a magnifying device (surgical loupes or a microscope) is used to investigate the damaged disc. Disc fragments are removed from the area surrounding the nerve. Some further removal of fragments within the disc space is done to reduce recurrence of herniation.
A standard discectomy uses a larger incision, but allows for better visualization of the tissue. Though in most cases, a microdiscectomy will provide the surgeon with sufficient visualization to do the job effectively. Furthermore, understand that in a discectomy the entire disc is typically not removed. The annulus (outer portion) and a part of the nucleus (inner portion) are left intact to support surrounding vertebrae.