L5/S1 Microdiscectomy surgical technique
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Lumbar disc prolapse is a common condition which can cause lumbar nerve root compression and result in lower limb radiculopathy.
Everyone develops degenerative disc disease over the course of their life, with the lower lumbar discs generally being effected earlier than the upper lumbar discs. The vast majority develop a degenerative broad based bulge that does not cause any neural compression. However, some people will develop a focal prolapse or herniation which can cause nerve compression. The most common location for a disc herniation is paracentral, which is located within the spinal canal, and causes compression of the traversing nerve root in the lateral recess. Less common locations for disc herniation include central, foraminal, and far lateral.
The incidence of lumbar disc herniation is between 0.5% and 2% and is most common in people in their fourth and fifth decades of life. It can sometimes be related to a specific incident involving heavy lifting or bending, but there is often no specific causative factor.
The lower limb radiculopathy caused by the neural compression can be severe and tends to be felt in the dermatomal area of the compressed nerve. The vast majority of disc prolapses do resolve spontaneously over time and this can generally take between 3 and 12 months. As such, most patients will be able to follow a non-operative course of treatment using analgesia and activity modification. Steroid injections around the nerve may help with pain relief during this time.
For those patients who cannot tolerate the pain despite non-operative measures or those who have a progressive neurological deficit, surgery may be beneficial.
Lumbar microdiscectomy is one of the most common spinal procedures performed and doctors managing spinal patients should be familiar with the management of lumbar disc herniation, the treatment options available, and the principles of a lumbar microdiscectomy.
Acknowledgement and thanks to Mr Simon Hughes FRCS (Tr & Orth) for providing a number of the images of this surgical technique.
Author: Mr Stephen Morris FRCS (Tr & Orth).
Institution: The Avon Orthopaedic centre, Southmead hospital, Bristol, UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
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