Latest / Neck & Back Surgery Answers with Dr. Leonard Kibuule / Give Me 10 Minutes and I’ll Show You What Happens After Microdiscectomy Surgery

Transcript

Give Me 10 Minutes and I’ll Show You What Happens After Microdiscectomy Surgery · Neck & Back Surgery Answers with Dr. Leonard Kibuule

• 0:00
  SPEAKER_00: A lot of people are surprised by how quickly they can feel better after a microdyskectomy.
• 0:04
  SPEAKER_00: You may go home the same day, the leg pain can start improving very quickly, and within a couple of weeks, you may be wondering why you waited so long for the procedure.
• 0:11
  SPEAKER_00: Because when we take the pressure off the nerve, the change can be dramatic.
• 0:15
  SPEAKER_00: I know spine surgery can sound scary, but with a micro dyskectomy, most people are surprised by how manageable the recovery can be.
• 0:21
  SPEAKER_00: If you're considering a microdyskectomy and wondering what the first year actually looks like afterwards, let me talk you through it.
• 0:28
  SPEAKER_00: I'm Dr.
• 0:28
  SPEAKER_00: Leonard Kabuli and I'm an orthopedic spine surgeon here in Houston, Texas, and I'll show you what to expect from the day of surgery through the first few weeks, the return to normal activity, and what that disc may look like years later.
• 0:40
  SPEAKER_00: First, what is microdyscectomy?
• 0:42
  SPEAKER_00: Before we get into the recovery, let me make sure we're talking about the same procedure.
• 0:46
  SPEAKER_00: And microdyskectomy is usually done when part of a herniated disc is pressing on a nerve and causing symptoms like sciatica, numbness, or weakness.
• 0:52
  SPEAKER_00: We're not taking the entire disc out.
• 0:54
  SPEAKER_00: We are not automatically fusing anything.
• 0:56
  SPEAKER_00: The goal is much more targeted.
• 0:58
  SPEAKER_00: We make a small opening, find the nerve, and remove the piece of disc that is pushing against it.
• 1:02
  SPEAKER_00: The way I often explain it, it's almost like popping a pimple.
• 1:06
  SPEAKER_00: We make a small opening in the disc, some of the soft disk material comes out, and that bulging pressure on the nerve all of a sudden flattens down.
• 1:14
  SPEAKER_00: We don't remove the whole disc, we just remove the part of the disc that's creating the pressure.
• 1:18
  SPEAKER_00: It's a pretty incredible procedure.
• 1:21
  SPEAKER_00: So let's start with what the first day actually looks like, the day of surgery.
• 1:25
  SPEAKER_00: For a straightforward microdyskectomy, the procedure itself may take somewhere between 30 minutes to about an hour.
• 1:31
  SPEAKER_00: And in most cases, my patients are going home the same day.
• 1:34
  SPEAKER_00: That surprises a lot of people because they hear spine surgery and they picture spending several nights in the hospital.
• 1:40
  SPEAKER_00: That is usually not what we're talking about here.
• 1:42
  SPEAKER_00: You'll wake up with some soreness around the incision, and obviously you've just had surgery.
• 1:47
  SPEAKER_00: So I'm not going to tell you that you're not going to feel anything, but the symptoms people are usually paying closest attention to is the leg pain.
• 1:54
  SPEAKER_00: And for some patients, that improves almost immediately.
• 1:57
  SPEAKER_00: They stand up, take a few steps, and the shooting pain that they've been dealing with for the past few weeks is dramatically reduced.
• 2:03
  SPEAKER_00: For other patients, the nerve has been irritated or compressed for a lot longer.
• 2:07
  SPEAKER_00: So the recovery may take more time and may be more gradual.
• 2:11
  SPEAKER_00: That's especially true with numbness and weakness.
• 2:13
  SPEAKER_00: A nerve that's been compressed for a very long time may take longer to recover, so numbness or weakness may also take longer to improve.
• 2:21
  SPEAKER_00: But the pain can settle down very quickly.
• 2:23
  SPEAKER_00: And here's where I usually have to slow people down a little bit.
• 2:26
  SPEAKER_00: You may feel great pretty quickly, but the disc still needs several weeks for it to heal.
• 2:30
  SPEAKER_00: The first two weeks.
• 2:31
  SPEAKER_00: The first couple weeks are not about proving what you can do.
• 2:34
  SPEAKER_00: They're about letting your body recover from the procedure.
• 2:37
  SPEAKER_00: I want you to get up and move around.
• 2:39
  SPEAKER_00: I don't want you laying in bed for two weeks because you're afraid you may hurt your back.
• 2:43
  SPEAKER_00: Walking around the house is good.
• 2:45
  SPEAKER_00: Short walks are good.
• 2:46
  SPEAKER_00: Getting up regularly instead of sitting in one position all day is also good.
• 2:50
  SPEAKER_00: But I also don't want you feeling dramatically better on day four and decide that that means you can go move the furniture.
• 2:56
  SPEAKER_00: If you have a desk job and you can work from home, that is usually what I prefer you do early on.
• 3:02
  SPEAKER_00: Give yourself a little room, a little time to recover.
• 3:05
  SPEAKER_00: At about two weeks, I want to see that incision in my office and make sure there's no redness or drainage and make sure the pain is under control.
• 3:11
  SPEAKER_00: I want to see what's happened to your symptoms and what we have tried to do to fix it.
• 3:16
  SPEAKER_00: Is leg pain better?
• 3:17
  SPEAKER_00: Is the numbness starting to change?
• 3:19
  SPEAKER_00: Is the strength coming back?
• 3:20
  SPEAKER_00: If all of that is moving in the right direction, we can start opening things up a little bit more.
• 3:25
  SPEAKER_00: And if this is helpful, subscribe to the channel.
• 3:27
  SPEAKER_00: I'll break down more of these spine surgery decisions, recovery timelines, and the questions I hear from patients every day so you can understand your options before you have to make that big decision.
• 3:38
  SPEAKER_00: Now, there's one thing I usually have to remind patients of at this point in time.
• 3:42
  SPEAKER_00: This is about two weeks into the recovery.
• 3:45
  SPEAKER_00: You may feel much better before that disc is ready for you to treat it as if nothing ever happened.
• 3:51
  SPEAKER_00: Why I still slow people down when they feel so good?
• 3:54
  SPEAKER_00: This is probably the part of the recovery people underestimate the most.
• 3:58
  SPEAKER_00: During a microdysquectomy, we remove the piece of disc material that came through and was pressing on the nerve.
• 4:04
  SPEAKER_00: But the area that the disc material came through still has to heal.
• 4:07
  SPEAKER_00: Your body has to form a little bit of scar tissue to seal down that area.
• 4:12
  SPEAKER_00: That takes time.
• 4:13
  SPEAKER_00: For most patients, I'm thinking in terms of roughly four to six weeks for that tissue to really mature enough so that I become comfortable with you increasing your activity.
• 4:22
  SPEAKER_00: And this is why the patients who feel incredible at two weeks sometimes need a little bit more convincing than the patients who still feel sore.
• 4:30
  SPEAKER_00: The person who feels sore is usually happy to take it easy.
• 4:33
  SPEAKER_00: The person who feels great starts thinking, Doc, I'm fine.
• 4:36
  SPEAKER_00: Why am I still restricted?
• 4:38
  SPEAKER_00: Because I do not want you turning on a very successful surgery into another discarniation because you gave the tissue two weeks to heal instead of six.
• 4:47
  SPEAKER_00: So during that window, I'm especially careful with heavy lifting, straining, repetitive bending, and the kinds of movements that put a lot of pressure through that part of the back.
• 4:57
  SPEAKER_00: You are not fragile, but you are healing.
• 5:00
  SPEAKER_00: And those are two very different things.
• 5:02
  SPEAKER_00: Once we get through the early healing period, I actually want the conversation to start moving in an opposite direction, weeks two through six.
• 5:09
  SPEAKER_00: Around the two-week point, I will often get patients started with physical therapy, not because the surgery failed to fix the problem.
• 5:16
  SPEAKER_00: The surgery took the pressure off the nerve.
• 5:18
  SPEAKER_00: Now we want to rebuild around that.
• 5:21
  SPEAKER_00: That usually means working on core strengthening, posture, movement, and getting you comfortable using your back again without either bathing it or doing too much too soon.
• 5:31
  SPEAKER_00: And I tell patients the same thing here that I tell athletes.
• 5:34
  SPEAKER_00: The goal is not to spend the rest of your life protecting your back.
• 5:38
  SPEAKER_00: The goal is to build a back that can tolerate normal life again.
• 5:42
  SPEAKER_00: So over those next several weeks, activity should gradually expand.
• 5:46
  SPEAKER_00: You walk a little bit further, you sit a little bit longer, you start doing more normal daily things.
• 5:52
  SPEAKER_00: You begin working your way back to normal exercise.
• 5:55
  SPEAKER_00: And if everything is going well, somewhere around a six-week mark or so, the recovery usually starts feeling much less like I just had spine surgery and more like I'm getting my life back.
• 6:05
  SPEAKER_00: But there's still one question I get all the time from active patients.
• 6:09
  SPEAKER_00: When can I really go back?
• 6:10
  SPEAKER_00: Not walking, not sitting at a desk.
• 6:12
  SPEAKER_00: When can I go back to golf, tennis, basketball, lifting, running, or whatever I was doing before this all happened?
• 6:19
  SPEAKER_00: When you can get back to normal activity.
• 6:22
  SPEAKER_00: For most uncomplicated microdyskectomy patients, by six to eight weeks, I'm becoming much more comfortable with a return to normal activity.
• 6:29
  SPEAKER_00: That does not mean everybody gets to the exact same green light on the exact same day.
• 6:34
  SPEAKER_00: Someone who sits at a computer for work is different from someone who moves heavy equipment all day.
• 6:38
  SPEAKER_00: A recreational golfer is different from somebody trying to deadlift 400 pounds.
• 6:43
  SPEAKER_00: So the return depends on a lot on what normal means for you.
• 6:48
  SPEAKER_00: But if the incision has healed and your strength is coming back and the leg symptoms are settling down and you have gone through some rehabilitation, this is usually where I'm not trying to keep you on the sidelines anymore.
• 6:58
  SPEAKER_00: In fact, if you're doing well at six or eight weeks, I may tell you that it may be time for you to go back to most normal activity.
• 7:05
  SPEAKER_00: Because if you're doing well, I don't see you coming back to see me just because you've had surgery.
• 7:09
  SPEAKER_00: The whole point of the operation was to get you back to work, back to exercising, back to your family, and back to whatever you were doing before the nerve pain began.
• 7:18
  SPEAKER_00: Now, if you are somebody who loves heavy lifting, I will have a separate conversation with you.
• 7:22
  SPEAKER_00: There are certain movements, especially very heavy deadlifts and repeated heavy straining, where I may tell you that just because you can do it, it doesn't mean that it's the smartest thing for you to do on a regular routine time.
• 7:34
  SPEAKER_00: You've already had a problem at this disc once, so I want you to be thoughtful about how much stress you keep putting yourself through.
• 7:40
  SPEAKER_00: That doesn't mean you stop training.
• 7:41
  SPEAKER_00: It means you train with a little more respect for what happened.
• 7:45
  SPEAKER_00: And that brings us to the part people usually care about once early recovery is behind them.
• 7:49
  SPEAKER_00: What happens months later, three to six months later?
• 7:51
  SPEAKER_00: By three months, if everything has gone well, I really don't want you organizing your life around the fact that you've had a microdyskectomy.
• 7:57
  SPEAKER_00: At that point, the incision is old news.
• 8:00
  SPEAKER_00: The early healing period is behind you.
• 8:03
  SPEAKER_00: You should be moving more normally, exercising more normally, and getting back in the things that were taken away from you before the operation.
• 8:10
  SPEAKER_00: This is also the point where fear can become a bigger problem than the surgery itself.
• 8:15
  SPEAKER_00: Some people feel so much better that they never think about their back again.
• 8:19
  SPEAKER_00: Other people become afraid that one wrong bend is going to blow the disc out yet again.
• 8:24
  SPEAKER_00: And if you start avoiding everything because you're afraid you're hurting yourself, you could lose strength, conditioning, mobility, and confidence.
• 8:30
  SPEAKER_00: That is not where I want your next six months to be after a successful operation.
• 8:36
  SPEAKER_00: I want you to be smart about your back, but I don't want you to be scared of it either.
• 8:40
  SPEAKER_00: The bigger question by this point is usually not, am I healed?
• 8:44
  SPEAKER_00: It is, is this disc going to give me another problem later?
• 8:48
  SPEAKER_00: What does the disc look like a year later?
• 8:50
  SPEAKER_00: Once you've had a disc herniation, that disc is not exactly the same as it was before.
• 8:55
  SPEAKER_00: The outer fibers that normally help contain the disc material have been disrupted.
• 8:59
  SPEAKER_00: And with a microdysquectomy, we've removed some of the material that it came through.
• 9:03
  SPEAKER_00: So no, the disc does not go back to being brand new.
• 9:06
  SPEAKER_00: But that does not mean that you should expect another surgery either.
• 9:10
  SPEAKER_00: A lot of people have one herniation, get it treated, recover, and never have a significant problem after that again.
• 9:16
  SPEAKER_00: Can it herniate again?
• 9:17
  SPEAKER_00: Yes, it can.
• 9:18
  SPEAKER_00: There is still disc material at that level, and a recurrent herniation is possible.
• 9:23
  SPEAKER_00: That is one reason I'm careful during those first several weeks while the area is healing.
• 9:28
  SPEAKER_00: After that, there's no way to predict with certainty who will have another problem and who will not.
• 9:32
  SPEAKER_00: Genetics plays a role, the condition of the disc matters, and activity and age also matter.
• 9:39
  SPEAKER_00: But by a year after the procedure, most people are back to work, exercise, travel, and the things they enjoy.
• 9:45
  SPEAKER_00: They're not sitting around every day wondering when their back is going to hurt again.
• 9:49
  SPEAKER_00: If you're considering a microdyskectomy right now and you want another opinion on whether it is the right procedure for you, my team at Premier Orthopedics and Spine Health can help you sort through that.
• 9:59
  SPEAKER_00: You can find the information to schedule an evaluation or second opinion in the description below.
• 10:04
  SPEAKER_00: And if you're watching this because you've had a herniated disc and you're still trying to figure out whether you actually need surgery in the first place, watch my video on when herniated disc and sciatica really require surgery.
• 10:15
  SPEAKER_00: I'll walk you through the signs I look for and when it still makes sense to wait and when waiting can start working against you.