Lumbar microdiscectomy with medial facetectomy. Techniques and analysis of results.

Lumbar microdiscectomy and medial facetectomy are safe and effective operative options in the treatment of symptomatic herniated lumbar discs in selected patients. We use this approach for patients with a lateralized intracanalicular disc herniation (rather than a broad-based disc rupture) without significant degenerative stenosis or a prior operation. The procedures can usually be performed easily and quickly with excellent illumination and visualization. The medial facetectomy component of the procedure allows early identification of the compressed nerve root and affords excellent exposure to the disc space without significant nerve root or thecal sac retraction. The results with microsurgical discectomy are good and the complications few. The limited incision and surgical dissection appear to minimize postoperative patient morbidity and may reduce the duration of the postoperative hospital stay. It is important that we not lose sight of the fact that the goal of lumbar disc surgery is to restore an individual's functional abilities and allow an expeditious return to daily activities as well as to work. Among carefully chosen patients, a skilled surgeon probably can achieve this goal using either standard or microsurgical techniques.