Endoscopic discectomy is a minimally invasive surgical method that removes the cause of pain in selected pathologies of the spine, e.g. sciatica or shoulder pain. The aim of the procedure is to decompress the pressed nerve root, thus eliminating the pain radiating to the lower or upper limb. The operation consists in removing the nucleus pulposus (discectomy), which has escaped from the degenerated intervertebral disc and pressed against the nerve root.
Endoscopic discectomy involves making a small hole in the body's integuments (the diameter of a pen) through which an endoscope (camera) and surgical instruments are inserted into the spine area. Thanks to the low invasiveness of the procedure, the return to daily functioning is much faster compared to the open surgery, where the incision at the spine is more extensive.
Endoscopic procedures are performed mainly in the lumbar and cervical spine, much less frequently it is necessary in the course of the pathology of the thoracic intervertebral disc.
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Indications for endoscopic discectomy
The indications for surgical decompression of the nerve root are:
occurrence of paresis of the limb (limbs),
the occurrence of urinary incontinence,
ineffective analgesic, anti-inflammatory and rehabilitation treatment - if pain and / or sensory disturbances persist and lead to a significant deterioration of the patient's quality of life.
In the process of qualifying for surgery, the result of magnetic resonance imaging of the spine and its correlation with clinical symptoms are also taken into account.
What is endoscopic discectomy?
The procedure is usually performed under local anesthesia - in most cases it is not necessary to use general anesthesia. During the procedure, the patient lies on his side (operated lumbar spine) or on his back (operated cervical spine).
The surgeon makes two small incisions (about 5 mm in diameter) on one or both sides of the spine, through which he inserts a camera (endoscope) and neurosurgical instruments into the area of the compressed nerve root. The most commonly used accesses to compressed nerve structures are:
through the intervertebral openings of the lumbar spine TELD (Transforaminal endoscopic lumbar discectomy),
interlaminar (between the lamellae of the lumbar vertebrae).
An anterior or posterior approach is used to decompress the nerve root at the level of the cervical spine.
The surgeon uses the tools under the control of an intraoperative X-ray machine (fluoroscopy) and a visual track. The endoscope image is observed on the monitor screen, which enables direct visualization of the compressed nerve root. There is no need to cut the muscles or bones of the spine during endoscopy.
The surgeon removes the pulmonary nucleus material from the spinal canal, which forms a hernia that presses on the nerve root. Then it carefully checks whether the surrounding of the nerve root guarantees its conflict-free positioning. The operating field is rinsed with physiological saline all the time, which prevents the formation of tissue adhesions. After performing the required procedures, the neurosurgical instruments and the endoscope are removed, and the holes at the spine are covered with 1-2 sutures and secured with a dressing.
Endoscopic discectomy takes approximately 30-40 minutes. After the procedure, the patient stays in the observation room for 2-3 hours. The day of discharge is determined individually after the analysis of the general and neurological condition of the patient. For a few days, physical activity that causes pain in the operated area should be avoided. It is advisable for the patient to participate in specialized rehabilitation aimed at restoring limb movements and rebuilding muscle strength.
Benefits of endoscopic discectomy surgery
In most cases, the pain resulting from compression of the nerve root disappears immediately after the operation.
Less traumatization of the perianal tissues prevents the formation of undesirable scars and intra-canal adhesions that could lead to irritation of the nervous structures.
Less interference in the peri-spine structures - the procedure does not significantly disturb the stability of the spine,
Lower risk of complications compared to open surgery (e.g. lower risk of infection).
Low invasiveness significantly shortens the recovery period after the procedure, enabling faster return to normal activity or work
It should be noted that the final choice of the operating method is always selected individually, depending on the anatomical conditions and the neurological condition of the patient. Sometimes the endoscopic method is chosen, but in many cases the arguments in favor of an open procedure may prevail.
Source:
Choi, Gun et al. “Endoscopic Spine Surgery.” Journal of Korean Neurosurgical Society 60.5 (2017): 485–497. PMC. Web. 20 Apr. 2018.
Important information
| Duration of the procedure (depending on the method) | |
| Tests required for surgery | morphology, coagulation, electrolytes, blood group |
| Anesthesia | |
| Hospital stay | |
| A period of significant dysfunction | |
| A period of limited dysfunction | |
| Removal of stitches - first visit | |
| Change of dressings | |
| Contraindications to the procedure |
Frequently asked questions about the endoscopic discectomy procedure:
Discectomy is the removal of the nucleus pulposus that slipped out of the degenerated intervertebral disc and led to irreversible pressure on the nerve root. Nerve root decompression enables the restoration of muscle functions supplied by the compressed nervous structure (lifting of paresis). The endoscopic procedure is characterized by low invasiveness - it requires making one or two small holes (approx. 5 mm) on the back through which surgical instruments and a camera are inserted. There is no need to cut the muscles or bone elements of the spine. As a result, the patient's convalescence period is shorter compared to an open surgery.
The indications for surgical treatment are irreversible pressure of the nucleus pulposus on the nerve root. An urgent indication is the occurrence of complications in the form of limb paresis or dysfunction of the sphincters (urinary incontinence). Surgical treatment is also undertaken in the case of no effects of rehabilitation, anti-inflammatory and analgesic treatment, when pain and / or sensory disturbances persist and negatively affect the patient's quality of life.
The discectomy procedure is most often performed under local anesthesia, i.e. local deprivation of sensory stimuli. In most cases, general anesthesia is not necessary.
