These images demonstrate the steps in a typical microdiscectomy procedure.
A 2 - 3 cm incision is made in the midline over the offending disc, the position being confirmed with an X-ray. A retractor is inserted to allow clear visualisation of the spine and the operating microscope is positioned.
A small portion of ligament (the ligamentum flavum) is removed to access the spinal canal.
The nerve root is gently retracted and the disc protrusion is easily seen.
The tissues over the disc protrusion (posterior longitudinal ligament and adhesions) are parted and the protruding disc fragments are identified.
A 2 mm rongeur is used to pull out the fragments from below the nerve, which is visualised and protected throughout.
Further fragments are then removed.
To check that the nerve root is free a small blunt hook is introduced into the spine...
..and the space around the root can be identified. Any further fragments of disc can be identified and removed.
At the end of the procedure gel is put around the nerve root to reduce the risk of scar formation.
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