Microscopic Spine Surgery

How Dr. Salman Falak performs the operation

The operation is done under general anaesthesia with the patient lying face down on a padded frame. The level is confirmed on X-ray before the incision, which is small, usually only a few centimetres long, and placed directly over the affected disc. The muscles are moved aside with a small retractor and a little bone is removed where needed. Antibiotics are given at the start of the operation. The microscope is then brought in.

Under magnification, Dr. Salman Falak gently moves the nerve root aside and removes the herniated fragment or the thickened ligament. He then checks that the nerve is free along its course. The wound is closed in layers and covered with a small dressing. The operation itself is not long for a single level, and most patients stay in hospital for a night or two.

Benefits and what to realistically expect

The microscope is the reason this operation has been the standard way of treating a slipped disc for decades. Magnification and good light mean the nerve is seen clearly and handled gently, and the incision stays small. Wound pain is usually manageable with ordinary painkillers and walking starts the next day. The scar fades to a fine line over time.

Leg pain from a pinched nerve often eases quickly, and many patients notice the difference in the leg as soon as they wake up. Numbness and weakness improve more slowly, over weeks to months, because the nerve has to heal, and a badly squeezed nerve may not recover fully. Pain felt in the back itself, from a worn disc, may persist, because the operation frees the nerve and leaves the worn disc in place. Dr. Salman Falak goes through these expectations before surgery so that nobody is surprised afterwards.

Who is a candidate, and when surgery is not advised

Microscopic surgery suits a wide range of disc and nerve problems: a single-level herniation, a large or calcified fragment, a disc piece that has broken off and moved, or spinal canal narrowing at one or two levels. It is also the usual choice when a problem is too big or too awkward for a keyhole tube. Compared with endoscopic spine surgery, the incision is a little longer and so is the stay, but the surgeon has a wider view and more room to work. Dr. Salman Falak performs both and recommends whichever fits the MRI. Age by itself is not a bar, and fitness for anaesthesia matters more.

Surgery is not advised when the scan does not explain the symptoms or when pain is mild and improving. In the early weeks of a first attack most surgeons wait, because many herniations shrink on their own. A spine that is unstable needs fixation as well as decompression, and that is a different operation.

Before surgery: tests and preparation

A recent MRI of the lumbar spine is essential, and patients outside Lahore can send it on WhatsApp for an opinion before they travel. Dr. Salman Falak examines the patient to match the MRI with the symptoms, and may ask for standing X-rays to rule out instability. Routine blood tests and an ECG are done, and the anaesthetist reviews the patient. Blood thinners are paused on medical advice and diabetes is brought under control. Smokers are asked to stop, because smoking slows wound and nerve healing. On the day, patients come fasting and bring every old report and scan.

Recovery and follow-up

Patients are helped out of bed and walk the day after surgery, sometimes the same evening. Discharge is usually within a day or two once pain is controlled and the wound is dry. At home, short walks several times a day are encouraged. Sitting is kept to short spells at first, and bending and heavy lifting are avoided for the first few weeks. Office work commonly restarts within a few weeks, and physical work later, with the exact timing set at follow-up. A fever, a wet dressing, new weakness in the leg or trouble passing urine should be reported the same day.

The first review is at the Lahore OPD, where the wound is checked and stitches are removed if needed. Patients from other cities can take later follow-ups by video consultation, and a photo of the wound can be sent on WhatsApp, or they can come to the weekly OPDs in Gujranwala and Phool Nagar. Exercises to strengthen the back and core muscles begin once the wound has healed.

Where the surgery is done

Microscopic spine surgery is performed in Lahore. Dr. Salman Falak consults at Sharif Medical City Hospital in Jati Umra on Raiwind Road, and also at Life Hospital in Bahria Town and Doctor Care Hospital in Al Kabir Town. The operating hospital is chosen with the patient. On Fridays he holds an OPD at Gujranwala Medical Complex on G.T. Road, and on Tuesdays in Phool Nagar, so patients from those areas can be assessed near home. Anyone further away can start with a video consultation and come to Lahore once, for the operation itself. The aim is one journey for the operation and no wasted trips.

Risks and how they are kept low

The risks of microdiscectomy and microdecompression are well known and uncommon: wound infection, a tear in the membrane around the nerves with a leak of spinal fluid, injury to a nerve root, bleeding, and a repeat herniation of the same disc later on. Paralysis is extremely rare in lower back surgery, because the spinal cord itself ends above the levels usually operated on. A few patients have persistent pain despite a technically good operation. Repeat herniation is more likely in smokers and in people who return to heavy lifting too early.

Dr. Salman Falak reduces these risks with careful patient selection, X-ray confirmation of the level, gentle handling of the nerve under magnification, antibiotic cover and close attention to wound care. Every risk is discussed openly before consent.

Related conditions and procedures

A slipped disc in the lower back is the commonest reason for microscopic surgery, and the full picture of that operation, with the open and keyhole options, is on the lumbar disc herniation surgery page. Patients with pain running from the buttock down the leg can read about sciatica and what eases it before surgery is considered. When a disc problem comes with instability or a fracture, screw fixation may be combined with the decompression. Send your MRI on WhatsApp and Dr. Salman Falak will tell you whether microscopic surgery is the right step.