Endoscopic Lumbar Discectomy
Updated: Nov 27, 2020
Discectomy is one of the most common minimally invasive spinal procedures
Written by Bansal Gaurav MBBS, MS, MCh (AIIMS), IFAANS (USA)
A lumbar (low back) herniated disc is one of the most common spinal problems. Your spinal discs are the cushion-like shock absorbers of your spine. When your discs are healthy, they enable optimal spinal movement. If one (or more) herniates or bulges out of position, that disc(s) can push (compress) on the nerves and cause low back and leg pain. In many cases, nonsurgical treatments can help manage herniated disc symptoms; however, your doctor may recommend lumbar discectomy—also called a microdiscectomy—if surgery is necessary. And, thanks to technological advances in the spine field, you may have this surgery using minimally invasive techniques in an outpatient setting.
Lumbar microdiscectomy is arguably the most common minimally invasive spine surgery, and the patient outcomes are impressive (the success rate is approximately 95%). This procedure achieves the same results as the traditional open low back discectomy, with the additional benefits of smaller incisions and a faster recovery.
Minimally Invasive Lumbar Discectomy
A minimally invasive lumbar discectomy involves removing a small portion of the bone over the nerve root and/or a portion of the intervertebral disc from under the nerve root to relieve nerve compression and provide space for the nerve to heal.
A minimally invasive lumbar discectomy utilizes surgical instruments especially designed for minimally invasive spine surgery (MISS). These small instruments allow the surgeon to separate muscles and other soft tissues instead of cutting them. This means less postoperative pain after surgery. MISS procedures are typically safer, quicker, and get you back on your feet faster than traditional “open” spine surgery
Benefits of MISS include:
Smaller incision(s)
Less blood loss
Lower risk of muscle and soft tissue damage
Lower risk of infection
Reduced postoperative pain
Reduced pain medication use
Faster recovery
When you talk to surgeons about MISS, the focus is often on the size or length of the incision, but lumbar discectomy/ microdiscectomy has a greater aim of being minimally traumatic to the body. The ultimate goal is to improve your quality of life quickly and with less pain as soon as possible. The technological advances in MISS have not only given spine surgeons a new way to perform one of the most common types of spine surgery, but allowed many patients to have surgery performed on an outpatient basis.
Patients who undergo MISS report a more comfortable experience that allows them to go home next day of surgery and begin recovery sooner at home—in contrast to a two to three-day hospital stay for a traditional open discectomy in a hospital.
Conditions Treated Using Minimally Invasive Lumbar Discectomy
When a disc herniates in your lumbar spine, you will likely experience not just low back pain but also leg pain. Sciatica is a term used to describe low back pain that radiates (travels) downward into one or both legs.
In addition to sciatica, your surgeon may recommend a minimally invasive lumbar discectomy if you have been diagnosed with spinal conditions that cause both low back and leg pain. These diagnoses may include:
Lumbar synovial cyst
What Happens During Minimally Invasive Lumbar Discectomy?
The goal of lumbar discectomy is to decompress (clear space around) the spinal nerve(s) at one or more levels of the low back. Your surgeon achieves this by removing bone and disc material that impinges on the spinal nerves.
Prior to surgery, general or local anaesthetic specific to your needs and surgery is administered. You are positioned on the operating table stomach down.
Throughout surgery, the surgeon utilizes real-time x-ray images known as fluoroscopy. These images enable the surgeon to navigate your anatomy and precisely guide his or her surgical instruments.
The surgeon makes a small skin incision (almost pin hole-like), about 1-inch long directly over the spinal level to target the herniated disc. Next, the surgeon slides sequentially-sized tubular retractors through the incision and separates soft tissues. The tubular retractor holds the tissues apart. While operating, the surgeon may wear special eyeglasses (loupes) or use a surgical microscope to provide precise views of the operative field. The loupes’ or microscope’s ability to magnify and illuminate enables the surgeon to see the disc and other small tissues that may be compressing spinal nerves. In addition, bone drills and other instruments specially designed for MISS are utilized to remove bone spurs (ie, osteophytes) or ligament tissue causing nerve compression.
The surgeon may remove a portion of the lamina (thin piece of bone located at the back of each vertebral body; it covers and protects the spinal canal). The nerve structures are gently moved aside while the surgeon removes the herniated disc material using instruments designed for microdiscectomy.
When the procedure is finished, the surgeon removes the tubular retractors allowing the soft tissues to move back into their natural places. The surgeon closes the tiny incision using sutures that dissolve within 2-4 weeks.
From start to finish, a minimally invasive lumbar discectomy in an outpatient spine center takes about 90 minutes.
Minimally Invasive Lumbar Discectomy Considerations
Minimally invasive lumbar discectomy has many benefits over traditional discectomy—less blood loss, small incision(s), and quicker recovery time to name a few. However, not every patient is a candidate for this type of procedure, particularly in an outpatient setting.
If you have a pre-existing condition, such as cardiovascular disease, your doctor may recommend you undergo surgery in a hospital to ensure your safety should any unforeseen medical issues arise.
While few risks are associated with a lumbar discectomy or microdiscectomy—up to 5% of patients experience recurrent disc herniation.
Your surgeon will explain all potential risks and benefits of undergoing minimally invasive lumbar discectomy well in advance of your procedure.
Conclusion
Low back pain, particularly when it radiates down your leg, can have a huge impact on your activity level. When nonsurgical treatments aren’t sufficient to manage your pain and symptoms, your doctor may refer you to a spine surgeon who performs lumbar discectomy. Minimally invasive technology and advances in outpatient surgery have helped to make lumbar discectomy or microdiscectomy more accessible. If you have low back and leg pain, talk to your doctor or ask for a referral to a spine surgeon, who can provide an accurate diagnosis. Potentially, you may be a candidate for a MISS procedure performed on an outpatient basis.