What is METRx Discectomy/Decompression?
METRx discectomy/decompression is a minimally invasive surgical procedure performed using the METRx (Minimal Exposure Tubular Retractor) system to treat problems of the spine. The procedure involves using microscopic or endoscopic techniques to access and remove a herniated disc in the spine to relieve pressure on the compressed nerves.
A traditional open discectomy/decompression surgery involves making a long incision along the spine, cutting large bands of muscle tissue, and then retracting or pulling surrounding muscles to each side, so the surgeon can clearly see the vertebrae of the spine requiring treatment.
Discectomy/decompression with METRx system involves using fluoroscopic imaging guidance to make a small incision over the vertebrae to be treated and then employing a series of segmental dilators and tubular retractors to gradually separate the muscles and create a portal or tunnel through which the discectomy/decompression surgery is performed.
Advantages of METRx discectomy/decompression surgery include:
- Minimal muscle trauma
- Small surgical cut
- Minimal blood loss
- Minimal postoperative pain
- Fast recovery
- Short hospital stay
- High patient satisfaction
Indications for METRx Discectomy/Decompression
METRx discectomy/decompression surgery is indicated for:
- Herniated discs, which most commonly occurs in the lumbar spine
- Lumbar spondylolisthesis
- Lumbar and cervical stenosis
- Degenerative disc disease
- Laminotomy (partial excision of the thin bony plate of the vertebra)
- Medial facetectomy (removal of the facet joint that guides the movement of spinal bones)
- Foraminotomy (expanding a foramina or bony opening to allow clearance of nerves)
- Nerve root retraction
Preparation for METRx Discectomy/Decompression
Pre-procedure preparation for METRx discectomy/decompression will involve the following steps:
- A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
- You should refrain from alcohol or tobacco at least a week before and 2 weeks after surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- You will be placed on a special diet prior to surgery and laxatives may be used to clean out your bowel.
- You may be instructed to shower with an antibacterial soap the night prior to surgery to help lower your risk of infection after surgery.
- Arrange for someone to drive you home as you will not be able to drive yourself after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for METRx Discectomy/Decompression
The minimally invasive METRx discectomy/decompression surgery will involve the following steps:
- You will lie face down on the operating table under the influence of general anesthesia.
- Under fluoroscopic (live X-ray) guidance, your surgeon passes a thin needle called a guide wire through the skin and muscles in your back to locate the diseased area.
- The needle is withdrawn and a small incision of about 1 inch is made over the area to be treated and dilators are inserted sequentially.
- The dilators create a tunnel leading to the affected disc by splitting the back muscles instead of cutting them.
- Retractors are used to hold the tunnel open, and a microscope and special surgical instruments are inserted.
- Viewing through the microscope, your surgeon trims and removes the diseased disc (herniated disc) using special cutting instruments to decompress the spinal nerve root. Only the damaged portion of the disc is removed instead of the entire disc. Synovial cyst or bone spurs that may compress the nerve root are also removed.
- After completion, the dilators are removed, and the muscle fibers joined back together.
- A small strip of adhesive bandage is applied over the incision site at the completion of the procedure.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after METRx discectomy or decompression will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- Most patients can go home the same day. However, some may need to stay in the hospital for a day or two before discharge to home.
- You may experience pain, inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
- Application of cold and heat therapy on the low back area is also recommended to reduce inflammation and pain.
- Walking and moving around in bed is strongly encouraged to prevent the risk of blood clots.
- Antibiotics are prescribed as needed to address the risk of surgery-related infection.
- Your diet is slowly advanced post surgery. You will start with clear liquids, then progress to having normal solid foods, as tolerated.
- Instructions on surgical site care and bathing will be provided.
- Eating a high-calcium and low-fat diet is strongly recommended to promote healing and a faster recovery.
- A high-fiber diet and drinking 8 to 10 glasses of water daily are recommended to keep stools soft. Laxatives or stool softeners may also be recommended as needed.
- Activity restrictions for the first 2 weeks after surgery include:
- Avoid lifting, bending, or twisting your back
- Do not lift anything heavier than 5 pounds
- Refrain from any strenuous activities such as housework, yard work, or sex
- Refrain from smoking as it inhibits bone growth and delays healing.
- A physical therapy protocol is recommended to help strengthen low back, pelvic, and leg muscles and optimize their function. Walking is a good exercise and is strongly recommended to improve your endurance.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- You will be able to resume your normal activities in 2 to 3 weeks but may have certain activity restrictions.
- Complete recovery and return to work vary from patient to patient as it is related to a patient’s overall health status and the type of work one does.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
METRx discectomy/decompression is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:
- Blood loss
- Blood clots or deep vein thrombosis
- Anesthetic/allergic reactions
- Neurovascular injury
- Persistent pain
- Bowel or bladder problems