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L5/S1 Microdiscectomy

Overview

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Learn the L5/S1 Microdiscectomy surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the L5/S1 Microdiscectomy surgical procedure.

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.

Surgical Steps

Welcome to the surgical steps quiz.

This tests your ability to recall the correct order in which the key steps of an operation should be performed.

There will be various legitimate variations in this order but the quiz doesn’t reflect this.
Your reference point for the steps quiz is just our operative technique.
It’s one starting point in helping you to learn the technique.

  • You simply “drag & drop” the boxes containing the descriptions of the steps into the order you think fits and submit for marking.
  • If you get it correct first time you will be presented your certificate at the end of the quiz.
  • If you need to do more work on the steps you access your marked version by clicking the“re-sit the quiz” button.
  • This will show the steps you ordered correctly highlighted in green and the incorrect ones in red.
  • The correct green steps are fixed and won’t move.
  • The red steps move differently after your initial attempt and swap locations with the step they are dragged and dropped onto .
  • Finally resubmit the quiz once again.
  • The quiz will let you keep going until you get all the steps in the right order.
  • The correct green steps are fixed and won’t move.
  • The red steps move differently after your initial attempt and swap locations with the step they are dragged and dropped onto .
  • Finally resubmit the quiz once again.
  • The quiz will let you keep going until you get all the steps in the right order.

COURSE PROGRESS

Surgical Steps

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