Microdiscectomy Treatment Cost in India

The term discectomy means the cutting of disc. The procedure can be performed anywhere in the length of the spine starting from the lower back or lumbar region to the neck or cervical region. From the back of the spine or posterior side of the spine, the damaged disc is accessed via the path of muscles and bones. Exact access is established by the removal of certain parts of the lamina, the bone which makes the backside of the spinal canal which makes a roof over the spinal cord. Now the spinal nerves are moved and kept at one side. Depending upon the severity of the condition, one or more discs can be removed.

For performing a microdiscectomy, makes use of a very small skin incision and series of dilators and tubes will be used to maneuver their way through the muscles. These special instruments aid the surgeon to see and operate in a very limited space unlike an open technique where a large skin incision is made, and muscle retraction takes place for the direct viewing of the area. A microdiscectomy is a minimally invasive process, cause less disruption of the back muscles and brings down the recovery period significantly.

When the patients perform heavy labor in their day to day life or they are athletes or have spinal disability problems, a fusion may be done along with the surgical procedure for the stabilization of the spine. A combination of hardware like screws and plates along with a bone graft can connect two vertebrae together. In the healing procedure, the two vertebrae fuse into one piece of bone after some time. For a herniated lumbar disc, a fusion procedure is rarely conducted since it is usually not needed.

A patient is considered for discectomy when they have the following problems and symptoms:

• Herniated disc revealed in diagnostic tests
• Too much pain, numbness, and weakness in the leg or foot
• A condition called sciatica where leg pain is much worse than back pain
• No improvement in symptoms with medication or physical therapy
• Loss of bladder and control of bowel movement (cauda equina syndrome)
• No sensation associated in the genital area

Microdiscectomy is also helpful in treating leg pain or sciatica caused as a result of

• Bulging or herniated disc: It is the gel-like material within the disc that ruptures or bulges through a weak region in the surrounding wall or annulus. When this gel-like material somehow comes out and painfully presses in a nerve then irritation and swelling occur.
• Degenerative disc disease: Bone spur formation arises, and facet joints become inflamed as the disks wear out naturally. They dry out and slowly shrink away, as a result, lose their cushioning and stability properties. The disk spaces expand, and this can result in stenosis or disc herniation.

Some of the following tests are conducted to understand whether a patient requires a microdiscectomy

•         Magnetic resonance imaging or MRI
•         Computed tomography or CT scan
•         Myelogram is another fluoroscopy aided X-Ray which shows the condition of spinal cord

An anesthesiologist will talk to the patient and elaborate on the effects of anesthesia and risks associated. An intravenous line is placed in the arm to inject medications whenever required. The whole surgical procedure lasts for around 2 hours.

The patient is placed on the operating table on their back and is given anesthesia. Once the patient loses consciousness they are rolled on their stomach with the chest and the sides of the body held and supported by pillows. The region where the incision has to be made is cleaned and prepared.

The surgeon will pass a very thin needle through the skin to reach the bone and access the disc or the vertebra that is to be treated. In case of an open discectomy, the skin incision made at the back on the affected vertebrae is a big one and its length varies depending upon the number of vertebrae that has to be treated. The incision for one single vertebra treatment is around 1 or 2 inches long. The back muscles will be retracted on any one side for exposing the bony vertebra. In such a case an X-ray is taken for the verification of a correct vertebra.

But in the case of a minimally invasive microdiscectomy, a very small incision is made to any one side of the back.  For this surgery, a small stab entry is made in the skin close to the midline. Quite a number of large dilators are slowly made to pass, one after the other. In this way, a tunnel is formed by separating the muscles to reach the vertebra. Muscles are then made to dilate with the aid of increasing sizes of tubular retractors for making access to the spine easier.

Now with the lamina removed, the surgeon retracts the protective sac of the nerve root.  To locate the herniated disc the surgeon observes via a surgical microscope. The ruptured portion of the disc is next eradicated to bring about decompression of the spinal nerve root that is affected. However, the entire disc is not removed totally.  Any bone spurs or synovial cyst is removed that creates pressure on the nerve root.

In a single level lumbar, discectomy fusion is hardly ever performed. But then it may be required when there are other conditions like a recurrent disc herniation or spinal instability involved.

The retractors that keep the muscles in position are now removed and the skin incisions are sewn together with the help of staples and sutures. Steri Strips are placed across the incision to keep it closed securely in a sterile condition.

Presurgical tests are conducted a few days before the surgery. The patient is expected to discuss the medical history of allergies, bleeding troubles if any, previous surgeries or reactions to anesthesia and dyes in detail. All medications that the patient has been prescribed should be strictly adhered to and if the doctor asks the patient to quit certain medications that should also be followed. Apart from that, one must stop smoking, alcohol consumption and 2 or 3 weeks prior to the surgery.

On the morning of the surgery, the patient must take a bath with the prescribed antibacterial soap. Flat shoes must be worn with close backs. A list of medicines as prescribed should be carried and a family member should accompany the patient.

The surgery can be performed on an outpatient basis and in certain cases patient may be required to stay 1 or 2 days after the surgery. Some of the discharge instructions are as follows:

• Painkiller to be taken only when pain is unbearable
• Water consumption and high fiber food intake should be increased
• Non-steroidal anti-inflammatory drug sage should not be used if fusion has also taken place
• No long periods of driving
• No lifting of weights heavier than 10 pounds
• No bending or twisting at the waist
• Avoid sexual activities
• Visit the healthcare provider as per the schedules
• Attend the physical therapies for faster recovery
• Call the healthcare provider is swelling noticed at the incision, too much of pain or high fever observed

It takes 2 months to get back to normal life totally.

Some of the alternatives to microdiscectomy include spinal injections, medication, traction or physical therapy. But unfortunately, none of the above are as effective as microdiscectomy. However, it is still advised that patients talk to their healthcare provider in detail to understand what suits them the best since it is very important to explore noninvasive options before going for microdiscectomy. A lot of research work is in progress to find better alternatives to enhance the recovery time and make the procedure as noninvasive as possible. Techniques like laser technology are being cultured to see their effectiveness on the outcome of the procedure.

The cost of microdiscectomy ranges from $2800 to $4500 in India which is far cheaper compared to the USA and the quality of treatment is also at par with the best medical institutes in developed countries.