Microlumbar discectomy.

Microlumbar discectomy is one of the debatable topics of spine surgery. The most important question is “Can we decrease the unsatisfactory results with microsurgery?” If we lock at the literature, we can see the successful results with microsurgery. There is no doubt microsurgery helps some parameters such as short operation time, minimal tissue damage, short hospital stay and in many cases short rehabilitation duration before the job (1). But in some literature findings in overall results there are no big differences between the discectomy with microsurgery and microdiscectomy (2). The important question is which factors effect on the unsuccessful results? Are these patient’s history, neurological examination and MRI evaluation? When the patient tells his/her history, two points is remarkable. The first point is the previous low back pain before the extremity pain. The patient gives at least two, three or more sudden low back pain attacks or complains constant back pain in daily life as least amount one year. The second point is the sudden onset history of low back pain and leg pain. Examination can show a mild to severe neurological deficit either one side or both side. Neurological deficits of the patients strongly effect our decision under a perspective of medical to surgical treatment. In patients with L5 radiculopathy, weakness of the extensor hallucis longus muscle can be seen. L5 sensory loss can be detected on the sensory examination of the gluteus muscles. The patient may have sciatic pain and show step page on affected side. Gluteus medius muscle can also be weak in patients with L5 radiculopathy. In this situation, the patient shows disordered walking pattern on the affected side. Pelvis may glissade when the patient tries to walk. A discrete mapping of L5 dermatome may be possible on sensory examination of the patient. In patients with S1 radiculopathy, the strength of the triceps surae group can be decreased and ankle Jerk is diminished. Additionally, the examination of the foot shows the weakness of its posh. The patient has sciatic pain and complains to drag the foot along the ground while walking. Upper lumbar disc herniations are rare and it would expect weakness in the quadriceps muscle. Knee jerk is diminished and the patient complains discharge feelings of affected knee while walking. On sensory examination, there may be a discrete mapping of L4 or upper nerve roots. Sciatic or femoral tension signs are seen in most individuals who present with lumbar disc herniations. The development of MRI technology is the corner stone of the diagnosing of lumbar disc disease. We can see the annular rupture of the disc on MRI. The localization and size of annular rupture are important. Wide based annular tear and laxity of posterior annulus can easily be diagnosed in MRI scans and it is related to severe low back pain attacks even in the absence of nerve root compression findings. A little tear including all layers of annulus is always better than laxity of wide based annulus.