Endoscopic disc surgery is a minimally invasive surgery on the spine to remove herniation of the nucleus pulposus, compressing the spinal cord's nerve roots in a less dangerous manner than other methods.
The endoscopic herniated discectomy is a reasonably modern surgery that relies on inserting a tube with a camera and two guiding tools to remove the herniated disc inside the spinal canal and release the nerve roots compressed by the disc herniation.
Recently, laparoscopic spine surgery has begun to replace the traditional operation because it is less traumatic and less complicated than conventional surgeries, and because in this way, the patient can enter and leave the hospital on the same day.
What is endoscopic discectomy surgery?
Endoscopic disc surgery is a type of Minimally invasive spine surgery In this procedure, the herniated disc is removed using an arthroscope. This disc, or a herniated nucleus pulposus, causes pain due to pressure on the nerve roots of the spinal cord.
This operation is considered one of the most modern methods available and has the most minor pain and recovery after surgery. Its success rate is high, exceeding 90%, and it is the best method currently available to relieve the patient from the pain caused by the disc herniation.
Before talking about the operation, we must know what it is the disk herniation.
Herniated disc (slipped disc)
The spinal cord is inside the spine, and 31 pairs of nerves emerge through holes between the vertebrae. These vertebrae are connected by a cartilage disc to relieve pressure and allow greater movement.
Before talking about the operation, we should know what is disc herniation.
After learning a little about disc herniation disease, let's talk about the endoscopic herniated discectomy operation, which removes the herniated part of the herniated disc to rest the nerve roots.
This operation is performed through a small incision in the body and entering the spine with an endoscope to enter between the vertebral holes. The disc herniation is removed laparoscopically using two tools controlled by the surgeon from outside the body, with which he can treat the pain arising from the disc herniation.
Indications for laparoscopic discectomy
We mention at the beginning that surgery should not be performed solely because of the presence of a disc herniation. It is possible to avoid the pain only through rest and pain-relieving medications when needed.
A herniated disc operation should be performed on patients who suffer from symptoms of the disease that prevent them from performing some of their tasks. Among these symptoms we mention:
- The presence of pain in the neck, back, or extremities after 4-6 weeks of correct treatment, which causes discomfort to the patient.
- When there is resistance to pain relief with morphine (which are powerful and addictive pain relievers).
- The presence of a state of muscular weakness in the muscles affected by the herniated disc.
- Having some advanced disc symptoms, such as urinary or fecal incontinence.
Features of laparoscopic herniated discectomy surgery
This surgical procedure has advantages that differ from the traditional operation to treat a disc, and these advantages include:
- Short hospital stay, and no need to stay in it for many weeks.
- Low blood loss during surgery.
- Low incidence of postoperative infections.
- The speed of recovery time for the movement of the spine and the start of a return to normal life.
- In endoscopic discectomy, local anesthesia is used, which allows the patient to interact with the doctor while performing the procedure, which helps the doctor to ensure that he does not harm the nerve root.
- It is considered the least risky of all disc herniation surgeries.
How to perform arthroscopic disc surgery
Before starting the surgery, the patient is given antibiotics to reduce the incidence of postoperative infection, and then the surgical procedure is carried out with the following steps:
The position of the patient during the operation
The patient is placed in the facial pronation position before starting the surgery. If he cannot bear this position due to respiratory problems or severe back pain in this position, the lateral position must be taken into account. After taking the appropriate position, the incision point is determined from the connection of two lines, the first being the tangent line. The iliac crest to the base of the supraspinatus of the vertebra in posterior anterior photography, and the second is at the junction of the bottom of the supraspinatus with the peduncle of the same vertebra in lateral fluoroscopic imaging.
Anesthesia and skin incision
Endoscopic disc surgery is usually performed under local anesthesia. A local anesthetic (Lidocaine 1%) is first injected to numb the skin, muscles, and the nearby vertebral joint, then the skin is incised.
Then lidocaine is injected into the foramen between the vertebrae, but at a dose of 0.25%. The dose was reduced so as not to get complete inhibition of the nerves. Some sensory functions remain that make the patient feel pain if the surgeon approaches the nerve roots.
Inserting the endoscope into the body
The operation is carried out under the guidance of anterior-posterior imaging with fluorescence, where a guide wire is inserted at the beginning, and the wire is inserted according to the pre-established lines. After inserting the guide wire approximately halfway, the imaging direction changes to become lateral, where the depth of insertion of the guide wire is confirmed. After that, the guide wire is inserted until it touches the articular facet of the vertebrae, where the surgeon feels some resistance, then we pull the wire slightly and deviate it vertically until we enter the space between the vertebrae.
After the guide wire arrives, the dilator is inserted, followed by the cover of the endoscope, and then under fluorography, the last location of the endoscope sheath is confirmed, as it is near the base of the vertebral peduncle in lateral imaging, and in the middle of the vertebral peduncle in anteroposterior imaging.
At this point, the endoscope is inserted, and it has a camera at the end and three entrances, The larger entrance is called the working canal, the two smaller ones are for electrocoagulation aid and one for forceps.
A drill is used to drill the base of the superior articular process or the base of the pedicle, and then the bleeding vessels are electrocoagulated, which reduces bleeding.
Then, some vessels and ligaments in this area are cut, which helps to move freely. The nerve root in this area must be identified and protected. as if the surgeon touches the nerve root, then the patient feels pain and responds to the surgeon, who immediately moves away from the root, If a herniated disc is found in this area, it is removed.
But if the disc is more inward, the doctor excavates the bone until reaching the spinal canal, and through it, the spinal cord cyst is identified and moved away from it, and the disc herniation is identified and removed.
Last check before taking out the endoscope
The doctor makes sure that there is bleeding before exiting, as he performs electrical or thermal coagulation of any bleeding vessel, and then withdraws the scope and closes the wound.
Complications of laparoscopic discectomy surgery
Endoscopic discectomy surgery has a few complications, most of which come from the surgical work itself, and the doctors of the Bimaristan Center in Turkey are among the best doctors in existence who can operate accurately, among these complications:
- Postoperative sepsis
- Injury to the nerve roots, which may lead to paralysis
- Cerebrospinal fluid leakage due to insufficient closure of the bone
- Postoperative recurrence
The percentage of disc herniation recurrence after its eradication
The percentage of disc herniation recurrence after its excision differs for many reasons, but it remains lower than its percentage in traditional surgery, and among these reasons, we mention:
- The type of disc present
- The degree of herniated disc
- And the height of the disc area increases the risk of relapse
The recurrence rate after arthroscopic disc surgery is estimated at approximately 8.83% This is after undergoing the operation for the first time, and the rate of disc recurrence after undergoing another operation is estimated at approximately 17.65%.
Advice after laparoscopic disc surgery
Performing an arthroscopic herniated disc does not necessarily lead to a complete recovery and return to the normal state before the disc herniation occurred, so it is preferable to:
- Not lifting heavy weights
- Proper sitting in front of the TV and computer
- Exercising daily
- Sleep on your sides, not on your stomach, with your knees bent
- Follow a diet to lose weight if it is excessive
How much does arthroscopic disc surgery cost?
Laparoscopic disc surgery costs from about 2,500 to approximately 4 thousand dollars, depending on the difficulty of performing the operation for the person and the number of endoscopic hernias that must be removed.
In the end, endoscoic discectomy surgery is a relatively recent procedure that offers a better way to remove the disc from the back with the least possible trauma, with the possibility of leaving the hospital on the same day.