Percutaneous Endoscopic (Arthroscopic) Cervical/Lumbar Discectomy

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Table of Contents

Introduction
What is Percutaneous Lumbar/Cervical Discectomy?
Who Should Consider this Procedure?
The Procedure
Postoperative Course
Advantages
Summary

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Introduction

Back and neck pain is the price human beings pay for prolonged sitting, obesity, repeated bending, and whip lash injury from high-speed traveling accidents. It is providing the United States with an economic headache. Approximately 75-85 percent of inhabitants of the Western world are afflicted with some degree of neck pain at some point in their lives. About 15-30 percent of our population has been incapacitated for two weeks or more, and approximately one million people have permanent disability. In most cases, simple treatments, such as cervical collars, heat, physiotherapy, rest, exercise, and painkillers bring relief. But many sufferers are not so fortunate. If one or more of their vertebral disks rupture and press on the nerve roots, the pain radiating from the neck and down the arms can be incapacitating and severe.

Side view of herniated lumbar disk.

For many, the only treatment is surgical removal of part of the herniated disk; a major traumatic operation that requires anesthesia, the dissection of muscle and removal of bone and bone fusion. Now there is a new and less traumatic procedure for some disk patients known as percutaneous micro-decompression cervical/lumbar discectomy with laser thermodiskoplasty, an outpatient procedure.

Side view of herniated cervical disk.

 

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What is Percutaneous Cervical/Lumbar Endoscopic Discectomy with Laser Thermodiskoplasty?

Percutaneous Cervical Microdecompression Endoscopic Cervical/Lumbar Discectomy with Laser Thermodiscoplasty, is a new procedure to shrink and remove a herniated disc. Using brief general (cervical) or local (lumbar) anesthesia and the help of x-rays for guidance, specially designed micro-instruments, the discectome and a laser probe are inserted into the herniated disk space, and a portion of the offending disk is removed with suction and then vaporization with a laser to shrink the disc further, instead of open surgery.

Top view of herniaged lumbar disc.

Percutaneous cervical/lumbar discectomy is different from standard disk surgery because there is no muscle dissection, bone removal, bone fusion, or incision, except for a puncture wound to accommodate the micro-instruments that are inserted into the herniated disk. Most complications that occur with conventional surgery, therefore, are eliminated with this procedure.

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Who Should Consider This Procedure?

Percutaneous cervical/lumbar discectomy is specifically designed for patients with uncomplicated, herniated disks accompanied by the following:

1. Pain radiating from the neck or back downward to the limbs
2. Symptoms including sensory loss, tingling, numbness, and muscle weakness
3. A positive CT or MRI scan for disk herniation
4. No improvement of symptoms after six to eight weeks of conservative therapy
5. Positive electromyogram study is helpful

The procedure is not designed for:

1. Evidence of acute or progressive degenerative spinal cord diseases
2. Evidence of neurologic or vascular pathologies mimicking a herniated disk
3. Evidence of advanced spondylosis (significant bony spurs) with disk space narrowing, diffuse annular bulging and other spine irregularities
4. Evidence of significant bony spurs blocking entry to disk space
5. Evidence of cervical spinal canal or lateral recess narrowing
6. Evidence of a large extruded disk or a free fragment or leakage of disk material
7. Existence of other pathologies or conditions such as fractures, tumors, pregnancy or active infections

Other surgical procedures, including micro-surgery, micro-discectomy, and fusion, are used for those patients who cannot have the percutaneous procedure. Only patients with clinical abnormalities confirmed by physical examination, tests, and x-ray are considered for the new procedure. Tests can be done prior to the procedure.

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The Procedure

The procedure is performed under brief general (cervical) or local (lumbar) anesthesia with the patient awake and in a supine (cervical) or lateral (lumbar) position. A small needle is inserted into the disc.

Over this probe, a slightly larger sleeve is inserted to permit a 2mm incision to be made in the disk itself. Using x-ray fluoroscopy control, the micro-instruments (forceps, currets, cutters), the discectome (which is a hollow probe with a cutting knife inside), and the laser probe are inserted into the disk space through a sleeve. Very small pieces of the disk material are removed and suctioned. The laser shrinks the disk bulge further. The procedure takes about 20 minutes, on average. X-ray exposure is minimal.

 

Band Aid covers tiny incision without stitches

The amount of disk removed varies. The supporting structure of the disk is not affected. Upon completion, the needle is removed and a small Band-Aid is applied over the probe incision.

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Postoperative Course

The patient may feel relief from pain immediately following the procedure. This is an outpatient procedure. Walking and exercising are usually encouraged on the same day. Some patients experience muscle spasms that can generally be relieved with mild analgesics. Pain in the area of the operation is usually minimal and requires little or no medication. From the day of discharge, a daily exercise program is recommended and there is a re-evaluation several days later. Little, if any, postoperative medication is required for most patients. Normal activities can usually be resumed at the doctor's discretion within a few days up to three weeks.

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Advantages

The primary advantage of this procedure is that there is no interference with the muscles, bones, joints or manipulation of the nerves in the neck or back areas. Since insertion of the probe through the muscle is the only wound, there is no scarring in or around the nerves postoperatively. Additionally, it is an outpatient procedure. Unfortunately, patients who have large free fragments of disk in the spinal canal, as determined by the x-ray, cannot benefit from this procedure. However, the laser can shrink the bulging disc further for disc decompression.

It is essential to understand that all patients are not relieved of their pain with this procedure. Approximately 90 percent of patients will experience pain relief. Patients who do not obtain relief within three to six weeks may be considered for micro-cervical disc removal and fusion, depending on the circumstances. There does not appear to be any detrimental effect from performing percutaneous cervical discectomy before micro-cervical procedure to remove bony discs and bony fusion.

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Summary

Results with percutaneous cervical/lumbar discectomy with laser thermodiscoplasty indicate no hospitalization requirement, earlier return to work and earlier return to previous daily activities. Rare patient complications include: mild cervical or lumbar muscle spasms and transient pain. Patients who initially have obtained good results usually remain pain free.

Contents courtesy California Center for Minimally Invasive Spine Surgery
Used by permission