What it is
Removal of the fragment of disc material pressing on a nerve root, through a small incision and usually under magnification. The aim is specifically the leg pain; it is not an operation for back pain.
Who it is for
People with sciatica from a confirmed disc herniation that matches their examination, who have not improved after six to twelve weeks of good non-operative care — or sooner where there is progressive weakness. Cauda equina syndrome is an emergency and is operated on urgently.
How it works
Through a small midline or paramedian incision, a window is made in the ligament between two vertebrae. Under magnification the nerve root is identified and protected, and the fragment compressing it is removed. Only the loose and protruding material is taken; the rest of the disc stays.
Recovery
Usually home the same day. Leg pain is often dramatically better immediately, though numbness can take longer to settle. Walking is encouraged from day one. Bending, lifting and twisting are limited for about six weeks to reduce re-herniation risk.
Risks and alternatives
Recurrent herniation, dural tear with leakage of spinal fluid, infection, bleeding, nerve injury, and persistent numbness or weakness where the nerve was compressed for a long time. Alternatives are continued non-operative care, nerve root injection, or a tubular or endoscopic approach to the same pathology.