Microdiscectomy Spine Surgery: Risks, Complications, and Success Rates

The vast majority of microdiscectomy surgeries are successful, especially in reducing or eliminating sciatica pain; however, complications can occur. In rare instances, these complications may be severe, and a small percentage of patients may require a second, revision surgery.

Potential Complications and Risks of Microdiscectomy

As with any form of spine surgery, there are a few potential risks and complications associated with microdiscectomy. The general complication rates for microdiscectomy are¹Dowling TJ, Munakomi S, Dowling TJ. Microdiscectomy. [Updated 2023 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555984/:

• 12.5% for traditional microdiscectomies
• 10.8% for microdiscectomies performed using minimally invasive techniques (percutaneous or endoscopic microdiscectomy)

Patient-related factors that may negatively affect the surgical outcome and success of the procedure include but are not limited to older age, obesity, lifestyle habits (such as smoking), and certain occupations (such as heavy manual labor).¹Dowling TJ, Munakomi S, Dowling TJ. Microdiscectomy. [Updated 2023 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555984/

Spinal factors such as a taller disc and the presence of degenerative changes in the facet joints may also be associated with a higher risk of complications.¹Dowling TJ, Munakomi S, Dowling TJ. Microdiscectomy. [Updated 2023 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555984/

Procedure-Related Complications of Microdiscectomy

Potential complications that may occur during the surgery range from minor issues that may be resolved during surgery to more serious complications that require additional interventions.

Procedure-related complications include:

Dural tear

Inadvertently nicking the spinal cord’s outer membrane (dura mater) may result in a dural puncture. This condition causes the cerebrospinal fluid (CSF) to leak out, decreasing CSF pressure in the brain and resulting in headache, nausea, and/or vomiting.²Erdoğan U, Akpinar A. Clinical Outcomes of Incidental Dural Tears During Lumbar Microdiscectomy. Cureus. 2021 Apr 8;13(4):e14360. doi: 10.7759/cureus.14360. PMID: 34079645; PMCID: PMC8159299.

A dural tear occurs in about 4% of microdiscectomy surgeries.³Butler AJ, Munakomi S, Donnally III CJ. Discectomy. [Updated 2023 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544281/

Risk factors for a dural tear include¹Dowling TJ, Munakomi S, Dowling TJ. Microdiscectomy. [Updated 2023 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555984/:

• A history of lumbar epidural steroid injections within 3 months of the surgery 
• Excessive traction on the nerve while exposing the herniated disc 

Rarely, untreated dural tears may carry a small risk of meningitis.³Butler AJ, Munakomi S, Donnally III CJ. Discectomy. [Updated 2023 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544281/

The leak does not change the results of surgery, but the patient may be asked to lie down for one to two days after surgery to allow the leak to seal. 

A procedure called “epidural blood patch,” where blood is withdrawn from the patient's arm and injected into the epidural space in the back (to create a blood patch) help control the symptoms of a dural tear. This procedure places pressure over the site that is leaking spinal fluid to stop the leak and in turn resolve the headache.

Nerve injury

Injury to one or more nerves may occur in about 1% to 2% microdiscectomies.¹Dowling TJ, Munakomi S, Dowling TJ. Microdiscectomy. [Updated 2023 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555984/ Depending on the severity, a nerve injury may cause transient symptoms or long-term complications.

Blood vessel injury

In less than 1% of microdiscectomy surgeries, a major blood vessel, such as the aorta, inferior vena cava, and iliac vessels may get injured. The L4-L5 and L5-S1 spinal segments are at a higher risk for these types of injuries.¹Dowling TJ, Munakomi S, Dowling TJ. Microdiscectomy. [Updated 2023 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555984/

Microdiscectomy Potential Risks and Complications

As with any form of spine surgery, there are several risks and complications associated with a microdiscectomy.

A dural tear (cerebrospinal fluid leak) occurs in about 1% to 7% of microdiscectomy surgeries.⁴Kalevski S, Peev N, Haritonov D. Incidental Dural Tears in lumbar decompressive surgery: Incidence, causes, treatment, results. Asian Journal of Neurosurgery. 2010;5(1):54-59. The leak does not change the results of surgery, but the patient may be asked to lie down for one to two days after surgery to allow the leak to seal.

Other risks and complications include the following:

• Nerve root damage
• Bowel/bladder incontinence
• Bleeding
• Infection
• Possible buildup of fluid in the lungs that may lead to pneumonia
• Deep vein thrombosis, which occurs when blood clots form in the leg
• Pain that persists after the surgery

The above complications for microdiscectomy spine surgery are not common.

Postsurgical Complications of Microdiscectomy

Some patients may experience postsurgical complications during the recovery period. These complications can vary in severity and duration and may require additional medical attention or interventions.

Potential postsurgical complications include:

Infection

Postoperative infection can cause increased pain, redness, swelling, or drainage at the surgical site. The use of surgical microscopes, loupes, and headlamps has been associated with an increased risk of infection in microdiscectomy surgeries.¹Dowling TJ, Munakomi S, Dowling TJ. Microdiscectomy. [Updated 2023 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555984/

Failed back surgery syndrome

Recurrence of disc herniation and/or instability in the treated segment may result in failed back surgery syndrome –  a generalized term used to describe the condition where lower back pain persists or appears after spine surgery. 

An estimated 3% to 15% of microdiscectomy surgeries may eventually have failed back surgery syndrome within 10 years of the surgery.¹Dowling TJ, Munakomi S, Dowling TJ. Microdiscectomy. [Updated 2023 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555984/

Revision surgery may be needed in 7% to 10% of cases to manage failed back surgery from microdiscectomy.¹Dowling TJ, Munakomi S, Dowling TJ. Microdiscectomy. [Updated 2023 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555984/

Read about Failed Lumbar Decompression Back Surgery

Microdiscectomy Success Rates

The success rate for microdiscectomy surgery is generally high. Large-scale studies have shown good to excellent results for over 80% of people who had a microdiscectomy surgery.⁴Dohrmann GJ, Mansour N. Long-Term Results of Various Operations for Lumbar Disc Herniation: Analysis of over 39,000 Patients. Med Princ Pract. 2015;24(3):285-90. doi: 10.1159/000375499. Epub 2015 Mar 27. PMID: 25832729; PMCID: PMC5588202.

• Return to work: Around 80% of people typically return to work within 12 weeks of microdiscectomy surgery. Individuals with physically demanding jobs, such as heavy labor, may take longer to return to work.⁵Andersen MØ, Ernst C, Rasmussen J, Ankjær T, Carreon LY. Predictive Factors of Successful Return to Work Following Discectomy. Global Spine J. 2022 May;12(4):627-630. doi: 10.1177/2192568220960399. Epub 2020 Sep 24. PMID: 32969278; PMCID: PMC9109552.
• Return to play for athletes: In a study evaluating 558 professional athletes involved in high-impact sports, such as baseball and basketball, 80% to 90% of participants were able to safely return to play 20 weeks after a microdiscectomy surgery.⁶Overley SC, McAnany SJ, Andelman S, et al. Return to Play in Elite Athletes After Lumbar Microdiscectomy: A Meta-analysis. Spine (Phila Pa 1976). 2016;41(8):713-718. doi:10.1097/BRS.0000000000001325

In appropriately selected patients, surgery may help decrease pain faster and provide better quality of life improvements when compared to nonsurgical treatments.⁷Chen BL, Guo JB, Zhang HW, et al. Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis. Clin Rehabil. 2018;32(2):146-160. doi:10.1177/0269215517719952

There have been significant advancements in microdiscectomy technique and procedure, which have benefited patients with shorter recovery periods, less pain, and a higher success rate. 

Following postsurgical instructions, a comprehensive physical therapy program and home program, exercising and staying active as instructed, and maintaining a healthy lifestyle can positively affect the overall success of the surgery.

See Postoperative Care for Lumbar Microdiscectomy Surgery