Microdiscectomy: What to Expect During Herniated Disc Surgery

What Is Microdiscectomy?

Microdiscectomy (also called microdecompression) is a minimally invasive spinal surgical procedure to remove the portion of a herniated disc that is pressing on a nerve root or the spinal cord. It is the most commonly performed spinal surgery in the United States, with excellent success rates for leg pain relief (sciatica).

The procedure uses a microscope or magnifying lens to allow the surgeon to work through a very small incision, minimizing damage to surrounding muscles and tissues.

Why Surgery Is Performed

Your surgeon will recommend microdiscectomy when:

Conservative treatment (physical therapy, injections, medications) has failed after at least 6 weeks
You have progressive neurological weakness (difficulty lifting your foot, weakness walking)
You have severe, disabling radicular pain (sciatica) that significantly impairs quality of life
You have cauda equina syndrome — a rare emergency requiring immediate surgery

It's important to understand that microdiscectomy relieves leg pain more predictably than back pain. If your primary complaint is back pain without significant leg involvement, results may be less predictable.

What to Expect the Day Before Surgery

Pre-operative preparations:

Stop eating and drinking at midnight (typically NPO after midnight)
Continue most daily medications unless instructed otherwise by your surgeon
Stop blood thinners (aspirin, ibuprofen, warfarin) as directed — usually 5–7 days before
Arrange a responsible adult to drive you home and stay with you the first night
Prepare your home for recovery (see our recovery guide)
Shower with antibacterial soap the night before

Day of Surgery: Step by Step

Arrival and Check-In

You will arrive at the hospital or ambulatory surgery center (most microdiscectomies are outpatient procedures) 1–2 hours before your scheduled surgery time. You'll check in, change into a hospital gown, and have an IV placed.

Pre-Operative Area

A nurse will review your medical history and medications
The anesthesiologist will meet with you to discuss anesthesia and answer questions
Your surgeon may mark the correct surgical site on your back
Blood pressure, heart rate, and oxygen will be monitored

Anesthesia

Microdiscectomy is performed under general anesthesia (you will be completely asleep and feel nothing). Some centers may offer spinal anesthesia (numb from the waist down) for appropriate candidates. The anesthesiologist will discuss the best option for you.

Surgical Positioning

You will be positioned face-down (prone) on a specially padded surgical table that allows your abdomen to hang freely, reducing pressure in the lumbar spine and blood loss.

The Surgical Procedure (45–90 minutes)

Small incision: The surgeon makes a 1–2 inch incision in the midline of your lower back, centered over the affected disc level
Muscle retraction: Using a retractor, the surgeon gently moves the back muscles to the side without cutting them
Bone window: A small portion of the bony arch (lamina) is removed to create a window to access the nerve — this is called a laminotomy
Nerve protection: The nerve root is carefully moved aside under magnification
Disc removal: The surgeon removes the herniated disc fragment(s) pressing on the nerve, as well as any loose disc material from inside the disc space
Closure: The muscles are allowed to fall back into place and the incision is closed in layers with sutures or staples

Recovery Room (PACU)

After surgery, you'll be moved to the Post-Anesthesia Care Unit (PACU) for 1–2 hours. Nursing staff will monitor your vital signs and pain level. Most patients are awake and oriented within 30–60 minutes of arriving in recovery.

Discharge

Most microdiscectomy patients go home the same day. You will be discharged when:

Your pain is controlled with oral medications
You can walk safely with assistance
You can urinate (confirming bladder function)
Your vital signs are stable

Risks and Complications

Microdiscectomy has a very favorable safety profile, but as with any surgery, risks exist:

Recurrent disc herniation (5–15%): The most common complication; the disc can re-herniate
Infection (<1–2%): Wound, disc space, or deep spinal infection
Nerve damage (rare): Temporary or rarely permanent worsening of neurological symptoms
Dural tear (1–2%): A nick in the membrane surrounding the spinal cord, causing CSF leak; usually repaired intraoperatively
Blood clots (DVT/PE): Particularly in older patients or those with limited mobility post-op
Anesthesia risks: Rare but include allergic reaction, breathing problems
Failed back surgery syndrome: Persistence or return of symptoms

Discuss your specific risk profile with your surgeon before the procedure.

Hospital vs. Outpatient Setting

The majority of microdiscectomies today are performed in outpatient ambulatory surgery centers or as same-day hospital procedures. Inpatient hospital stays (one night) may be preferred for:

Older patients
Complex cases requiring additional procedures
Patients with significant medical comorbidities

What to Bring to Surgery

Photo ID and insurance cards
A list of all medications including over-the-counter and supplements
Comfortable, loose-fitting clothing (elastic waist sweatpants work well post-op)
Slip-on shoes (you won't want to bend over to tie laces)
Phone and charger
Leave valuables at home