Endoscopic Discectomy


Endoscopic Discectomy is a minimally invasive procedure for the treatment of herniated disc, lower back and leg pain. The aim of surgery is to remove the herniated disc which is exerting excessive pressure on the spinal nerves to relieve the patient’s lower back and leg pain.

The surgery is performed through a small tube or trocar, inserted through the skin, down to the disc.  With the help of an endoscope inserted through the trocarthe surgeon is able to visualize a magnified image of the entire working area on a monitor..The endoscope has a camera and a light source at its end which allows a better visualization of the work area and helps in precise removal of the damaged tissue. Moreover the whole procedure is performed under fluoroscopic guidance.  As opposed to the open approach the muscles are retracted and not cut, therefor the procedure has a shorter recovery time.


Endoscopic discectomy is a term to define a minimally invasive technique for removing a herniated disc compressing a nerve resulting in radiating extremity pain, numbness, or weakness.  The term “endoscopic” refers to the use of a long cylindrical tube that is placed relatively atraumatically between muscle fibers overlying the portion of the back to be operated upon.  Rather than making an incision and dissecting muscle off of the vertebra to access the area where the disc is herniated, a series of cylindrical tubes are placed over dilators that are placed between muscle fibers, thereby avoiding the need to cut muscle.  In theory, the use of these dilators and cylindrical tubes may limit the amount of muscle damage created during the surgical approach.  The disadvantage of this technique is that it may limit the surgeon’s field of view when looking for fragments of disc material that may have migrated out of the field of view.  There are clear pros and cons when using this minimally invasive technique to perform lumbar discectomy.  The advantages include a potentially smaller incision, less muscle dissection, and a theoretically more rapid recovery.  Disadvantages, as suggested above, include the potential limitation of visualization of the disc herniation and the adjacent nerve to be decompressed, the need for additional x-ray imaging at the time of surgery to ensure proper placement of the cylindrical endoscope, and the reports in the literature that suggest that there may not, in the end, be any shorter recovery when compared against traditional discectomy.  Your decision to opt for endoscopic discectomy versus traditional discectomy could be enhanced by obtaining a second opinion from spine surgeons experienced in both techniques.


Procedure

The patient lies face down on the operating table. a mild sedative is then administered to keep them relaxed throughout the procedure. A small incision is made on the skin over the back of the patient, just above the disc space. A thin wire is inserted through the incision till it touches the damaged area of the spine under fluoroscopic guidance. A tube is then inserted through the same incision, over the guide wire. The endoscope and other special micro-surgical instruments are introduced through this tube and the segment of the herniated disc compressing the nerves is removed. The endoscope and intra-operative fluoroscopy guide the surgeon throughout the procedure. After the completion of the procedure, the tube and the endoscope are then withdrawn and the incision is closed.

Most patients experience a significant reduction in their back and leg pain after the procedure. The numbness and tingling sensations may take some time to resolve. The patient is usually discharged home on the same day of the surgery.


Risk and Complications

Some of the risks and complications associated with this surgery may include infection, bleeding, nerve damage and leakage of spinal fluid.


What is Endoscopic Discectomy?

Endoscopic Discectomy is a procedure used to remove damaged disc material in the spine. It is a minimally invasive technique that unlike the conventional procedure does not involve major tissue injury. Instead, a small metal tube, the size of a pencil, is inserted into the herniated disc space under x-ray guidance. The tube serves as a passage for the surgical tools and a tiny camera (endoscope). Under the guidance of real-time x-ray image (fluoroscopy) and a magnified live video feed, the fragment of the disc pinching the nerve is removed.


Who should get Endoscopic Discectomy?

You might benefit from discectomy if your presentation includes:

  • Pain, numbness or weakness in arms or legs 
  • MRI, CT Scan, or discogram reveal disc problems such as disc annular tear, disc bulge, or disc herniation.
  • Electromyogram (EMG), a nerve diagnostic test demonstrates nerve root compression or irriation

What are advantages of endoscopic discectomy over a conventional open procedure?

Endoscopic discectomy is a minimally invasive procedure with very little blood loss, tissue damage or scar formation. It has a short recovery period with patients usually going home the same day.


What are the risks or potential complications?

Discectomy is generally a safe procedure. But as with any interventional procedure, it carries a small risk of potential complications such as bleeding, infection, leaking spinal fluid and injury to blood vessels or nerves around the spine.