Duration of Swelling After Microdiscectomy
Swelling around the surgical incision after microdiscectomy typically resolves within 3-7 days postoperatively, though this can extend up to 2 weeks in cases involving more extensive tissue manipulation, such as revision surgery. 1
Expected Timeline for Normal Postoperative Swelling
Immediate postoperative period (0-48 hours): Swelling peaks during this time as part of the normal inflammatory response to surgical trauma. 1
Days 3-7: Most patients experience progressive reduction in swelling with appropriate postoperative care, including rest and anti-inflammatory medication. 1
Days 7-14: Residual swelling should continue to diminish, with complete resolution expected by 2 weeks in uncomplicated cases. 1
Revision surgery considerations: Your second microdiscectomy, described as "quite difficult," likely involved more extensive tissue dissection and manipulation, which can prolong the inflammatory response and extend swelling duration toward the upper end of this range (10-14 days). 1
Distinguishing Normal from Pathological Swelling
Critical warning signs that swelling represents a surgical site infection (SSI) rather than normal postoperative inflammation include: 1
- Purulent drainage from the incision
- Progressive worsening of swelling after day 3-5 (normal swelling should plateau then improve)
- Increasing pain, warmth, and erythema that extends beyond the immediate incision margins
- Fever developing after the first 48 hours postoperatively
- Wound dehiscence (separation of incision edges)
Important distinction: Flat, erythematous changes around a surgical incision during the first week without progressive swelling or drainage typically resolve without treatment, including antibiotics. 1
Management to Optimize Swelling Resolution
For normal postoperative swelling: 1
- NSAIDs (ibuprofen 600 mg three times daily) for 3-7 days to control inflammation and discomfort 1
- Avoid acetaminophen/paracetamol alone as it lacks anti-inflammatory properties 1
- Consider corticosteroids if swelling is particularly pronounced: dexamethasone in decreasing doses (8 mg day of surgery, 6 mg day 1,4 mg day 2 mg day 3) can reduce postoperative edema 1
- Keep the surgical dressing undisturbed for minimum 48 hours unless leakage occurs 1
Activity restrictions to prevent increased swelling: 1
- Avoid strenuous physical activity (swimming, aerobics, running) for 7-10 days
- Avoid sudden pressure changes that could increase venous congestion
- Maintain adequate hydration
When Swelling Requires Urgent Evaluation
Seek immediate surgical evaluation if: 1
- Swelling increases after day 5 rather than improving
- Purulent drainage develops
- Fever occurs beyond 48 hours postoperatively
- Severe pain that worsens despite medication
- Neurological changes (new weakness, numbness, or bowel/bladder dysfunction)
If SSI is confirmed: The primary treatment is opening the incision, evacuating infected material, and continuing dressing changes until wound healing by secondary intention. Antibiotics have limited evidence for benefit in superficial SSI when adequate drainage is achieved. 1
Prognosis for Revision Microdiscectomy
- Microdiscectomy generally results in favorable long-term outcomes, with 88% of patients reporting excellent or good results at average 34-month follow-up. 2, 3
- Revision surgery has a higher reoperation rate (25% at 11-year follow-up) compared to primary procedures, though most patients still achieve satisfactory outcomes. 2
- The more difficult nature of your second surgery may result in slightly prolonged recovery but should not fundamentally alter the expected swelling timeline beyond 2 weeks. 2