Endoscopic - Percutaneous Discectomy / Microdiscectomy
What it is
Endoscopic – percutaneous discectomy or microdiscectomy is the most common operation performed in cases of intervertebral disc herniation (herniated disc). The ultimate goal is to decompress the nerve root that has been pressed by the hernia, resulting in pain relief. The procedure is most effective for treating pain that radiates into the arms or legs.
The spine surgeon chooses this surgery in case that there is continuous pain and discomfort for more than 2 months with low back pain radiating down the leg.
Conditions treated by Endoscopic Discectomy (Microdiscectomy)
Herniated disc is the main condition treated with endoscopic discectomy or microdiscectomy. The surgeon may choose endoscopic surgery for many spinal disorders that cause pain which radiates into the arms or legs. The patient’s anatomy determines the choice of the surgical technique.
Endoscopic Discectomy (Microdiscectomy)
Surgical Procedure
A lumbar discectomy is a surgical procedure that is performed to remove herniated disc material from the lower back (lumbar) that is pressing on a nerve or the spinal cord. When this procedure is performed with the use of an endoscope, it is called a lumbar endoscopic discectomy. It is considered a minimally invasive procedure because only a small incision is necessary. In addition, the endoscope (a small metal tube with a camera and light on the end) provides direct visualization through magnified video images, as well as a passage way for the surgical tools, so the patient’s muscles do not have to be torn or cut. As a result of the minimal damage to bone and muscle tissue, most people who have a lumbar endoscopic discectomy experience less surgical trauma, and a quicker recovery period, than those who undergo more-invasive traditional back surgery.
Endoscopic discectomy is usually performed under local anesthesia to make the patient feel more comfortable.
One of the most common causes of leg pain has nothing to do with a problem in your leg. Instead, it may be coming from a herniated disc in your spine.
A herniated disc can cause pain felt in the leg or lower back. If medication and other treatments don’t provide relief, a minimally invasive surgical procedure called microdiscectomy may be an excellent option. This surgery involves taking out a small part of the disc to ease pressure on the spinal nerve.
The surgeon makes a small incision in the lower back (Fig. A) to access the herniated disc and uses small tools and a microscope to remove the part of the disc causing nerve pressure (Fig. B). Finally, the surgeon removes the part of the disk that causes the problem (Fig. C & D).
The success rate for microdiscectomy is very high. These procedures are minimally invasive than other back surgeries, causing less pain, reducing infection risk and allowing for a faster recovery. Microdiscectomy is usually done as an outpatient procedure, meaning you can go home the same day. The surgery is done with general anesthesia and takes about 30 to 60 minutes. Afterward, you will spend a few hours in the recovery room. This method is bloodless, extremely safe with minimal complications and has excellent results.
A newer method is endoscopic discectomy in which an even smaller incision is made and the surgeon employs a miniaturized camera and instruments; this approach also involves less disruption to surrounding tissues. Endoscopic (or ‘key hole’) discectomy is the most minimally invasive way of removing a disc herniation from the lumbar spine. By combining tiny incisions (usually less than 1 cm) with high-definition endoscopic visualization, endoscopic discectomy can be performed with minimal disruption to normal tissues and often without the need for general anesthesia. Patients can often go home the same day, and return to normal function sooner than any other method. Endoscopic discectomy has more advantages such as less surgical trauma and even faster postoperative recovery.
Lumbar Microdiscectomy
Indications
The treatment of a herniated disc depends on the stage of the condition and its symptoms. If the symptoms allow it, then it is preferable for the patient to start with a conservative treatment. This includes medications, physical therapy and injections (epidural as well as intradiscal/DiscoGel injections).
Unfortunately, in about 10% of cases non-surgical treatment fails to improve symptoms even after weeks. In these cases, the surgical repair is the only option. Also, surgery should be the initial treatment when neurological damage is present, such as worsening paresis, paralysis as well as urinary and fecal incontinence.
- Neurological damage
- Cauda equine syndrome (a medical emergency that happens when an injury or herniated disk compresses nerve roots at the bottom of your spinal cord).
- Bladder or bowel incontinence
- Severe pain and numbness in the leg without improvement for a long time.
The operation takes less than 1 hour. It is bloodless and completely safe. The patient’s hospitalization lasts only a few hours and he/she is encouraged to walk immediately after anesthesia. The patient can return to work a few days after the surgery. Heavy manual work is allowed in 6 weeks after surgery.
The complications are minimal, especially if the surgery is performed by a specialized spine surgeon. If any postoperative complications occur, they will be managed immediately and effectively.
Endoscopic Discectomy (Microdiscectomy)
Surgical Outcomes
The pain in the leg is expected to disappear almost immediately after the operation. A little discomfort in the lower back is to be expected, as it takes some time until full recovery. The numbness in the leg will go away in a few weeks. Once the patient returns home, he/she will intake mild pain medications.
The patient should avoid weight lifting and twisting/bending of the back or heavy manual work in general for 6 weeks after surgery, until the wound on the disc’s annulus heals. Please, contact your doctor to discuss about the cost.
